Shopping the marketplace: The #1 benefit to researching health coverage

main benefit to researching health coverage options

Overview: This main benefit to researching health coverage options will help you choose the ideal plan.

Choosing the right health coverage plan requires conducting personal and professional research if you want to experience the full benefits. We don’t recommend that you choose the first health coverage plan that comes your way — as rushing and picking the wrong health insurance plan could be costly in more than one way.

It’s important that you prioritize your needs — whether that involves others (families) or not. As such, the main reason you should do research on health coverage plans is because you’ll be able to compare plans across the marketplace and essentially curate what you need based on the different options in the marketplace that you’ve come across. Granted, there aren’t too many options, but there are enough variations for you to pick-and-choose certain factors.

Do research to specialize your health coverage plan to your needs

Let’s say your employer offers health coverage plans but you’d rather shop the marketplace, this is when research and time come in. Conducting your own health coverage research is beneficial even if your employer does offer plans because you get to compare the different types of health insurance plans.

You might come across one plan that offers one thing that you like and another plan that offers another thing that you like. You’ll ultimately be able to curate an “ideal” list of factors you would like to have in a health coverage plan and start to tailor your research to that.

This isn’t to say that you’ll get exactly what you want, but the more specific you could get when doing research, the easier it’ll be to sift out what you don’t want. The reality is that there might be some aspects of certain plans that you don’t need and aspects of other plans that you consider to be a must-have. Factors such as cost, in-network options, referrals, and provider choice all play a role in what health coverage plan you ultimately decide on.

main benefit to researching health coverage options

The main benefit of going through your employer for health insurance plans

If your employer offers health insurance, this already cuts the research aspect in half. While you can always search for alternative plans available in the marketplace, receiving health coverage through your employer means that you’re likely to have lower premiums since your employer pays a portion.

For the best decision, be aware of past treatment trends

Regardless of whether you choose to go through your employer or not, doing the right research should also take into consideration (1) the amount of treatment you’ve received in the past and (2) the type of treatment you’ve received in the past.

To help you narrow down choices, think about the following factors:

  • You see a primary physician or a specialist frequently.

  • You frequently need emergency care.

  • You take expensive or brand-name medications on a regular basis.

  • You are expecting a baby, plan to have a baby or have small children.

  • You have a planned surgery coming up.

  • You’ve been diagnosed with a chronic condition such as diabetes or cancer. Or, on the contrary:

  • You can’t afford the higher monthly premiums for a plan with lower out-of-pocket costs.

  • You are in good health and rarely see a doctor.

Comparing common plans to start

Though it’s impossible to predict every medical expense, being aware of trends can help you make an informed decision. Let’s compare two common health coverage plans and see how they may or may not benefit you based on your needs.


If cost is your biggest determining factor, HMOs might be your best option. Choosing this plan means that you typically must see a primary care physician before scheduling a procedure or visiting a specialist. Due to this restriction, HMOs tend to be the cheapest type of health plan, overall.

  • You have to stay in network to get coverage except for an emergency

  • Procedures and specialists typically require a referral

  • There are lower out-of-pocket costs

  • You get a primary doctor who coordinates your care for you

  • Less freedom to choose providers

At the same time, another benefit with choosing HMO is that there is technically less work on your end, since your doctor’s staff coordinates visits and handles medical records.


If being able to choose your specialist is your main interest when doing health coverage research, a PPO might prove ideal.

  • You do not have to stay in network to get coverage

  • In-network care is less expensive

  • Procedures and specialists do not require a referral

  • You have more provider options and no required referrals

  • There are higher out-of-pocket costs

This might be better for individuals who live in a remote or rural area and have limited access to doctors and care since you may be forced to go out of the network.

Related article(s): Your Step-by-Step Guide to Choosing a Health Insurance Plan

I Forgot To Enroll For Health Insurance – Now What?

Understanding Penalties Under Obamacare

Since fees were not implemented during the first trial of enrolling in the new health insurance marketplace, the first Obamacare open enrollment period proved to fall short of successful. However, now that enforced penalties mean that you will be faced with a fee if you do not have health coverage, it seems that many enrolled before February 15th passed.

If you failed to obtain health coverage before the open enrollment deadline passed, you will be faced with a penalty until the third Obamacare open enrollment period arrives. Therefore, it is important that you understand why you are being penalized and how much. Gathered are some helpful guiding points for determining how much your penalty for not enrolling for health insurance will be:

Failing To Have Coverage In 2015:

Two calculations are made to determine your penalty amount. Of the two below, you will need to pay the higher amount.

  • $325 per person in your household, $162.50 per child under 18 years old – The maximum penalty an entire family can be charged is $975.
  • 2 percent of your household annual income – In this calculation, the amount above your tax filing threshold is considered, approximating about $10,000 per individual. The most a family can be charged is the national average premium for a bronze plan.

Failing To Have Coverage In 2016:

Each year, the penalty for not obtaining health insurance will increase. You can expect the following increases in 2016 if you still do not have health coverage:

  • $695 per person in your household
  • 5 percent of your household annual income

Rather than leaving yourself unprotected, seek the care you deserve today! Contact Bernardini & Donovan Insurance Services in Redlands for all of your California health insurance needs. As Covered California experts, you can rest assured that we will be your guiding hand in the realm of health insurance and health care.

Open Enrollment 2015: Where To Start?

With open enrollment 2015 right around the corner, you may be stressed out, especially if this is your first time applying for health coverage. However, there is no need to fret! We are here to break down the process and help you understand the often-confusing subject of health care. Here are a few useful tidbits of information to help ease your mind:

  • The only way to apply for health care before November 15th is to qualify for a Special Enrollment Period.
  • Your current health coverage will end on December 31st of 2014 if it was purchased prior to November 15th, 2014.
  • To apply online for health coverage, you will first need to make an account. Be prepared with a username and password that are secure, and memorable.
  • You can begin filling out your application on the 15th of November.
  • Be prepared to answer questions regarding your income, current health plan, how many individuals are in your household, and more.
  • After your application has been filed, you will be presented with the coverage options that you are eligible to take advantage of.
  • Once you have evaluated your options, you should select the plan that best suits your lifestyle.
  • Your next and last step is to enroll in the plan of your choice, and to pay your first premium before the payment is overdue.
  • Get in touch with one of one of our certified Covered California agents here at Bernardini & Donovan Insurance Services to help you through the process!

We hope that these tips have proven useful to you! For any additional answers to your health insurance questions, contact the insurance professionals at Bernardini & Donovan Insurance Services, located in Redlands! We cannot wait to assist you, today!


Does Your Business Qualify For SHOP Tax Credits?

Did you know that as a small business owner with fewer than 25 employees you may be eligible to receive a tax credit? This is only of course if you qualify to offer your employees health coverage through the Small Business Health Options Program, also known as SHOP.

The Small Business Health Care Tax Credit is typically awarded to small businesses whose full time employees make an average of $50,000 or less annually. In order to qualify, you must be willing to pay at least 50% of the premium costs of your full time employee’s health care. You will not be required to offer health coverage to your part time employees or to the dependents of your full time employees. If you have fewer than 10 employees, expect to receive the ultimate benefits. The smaller your business, the larger tax credit you can expect to receive.

Employers abiding by the SHOP qualifications can receive up to 50% of their contribution towards employees’ premium costs. As a tax-exempt employer, you can receive up to 35 percent of your contribution towards employees’ premium costs in tax credits. Remember, this tax credit is only available for those employers who have provided their employees’ health coverage through the SHOP Marketplace.

How to Qualify for the Benefits of the Small Business Health Tax Credit:

  • You must have 50 or fewer full time employees in order to offer health coverage through the SHOP Marketplace.
  • As a SHOP member, you must offer health coverage to each full time employee.
  • In order to qualify, about 70% of your employees must enroll in your SHOP plan.
  • You will need to be relatively close to a SHOP service area in order to take advantage of this program.

Bernardini & Donovan Insurance Services strives to provide Redlands, California residents with excellent insurance services custom tailored to meet your unique needs. Contact us today and allow us customize a unique health insurance package for your family based on your needs.


SHOP: How It Can Benefit Your Small Business

With all the confusion surrounding the implications of the Affordable Care Act, it is imperative that you utilize all the available options as a business owner. The Small Business Health Options Program has been put in place to guide small businesses through the process of offering health coverage to their employees.

As a small business owner with 50 or fewer full-time employees, you are given the opportunity to take advantage of the Small Business Health Options Program Marketplace, also known as SHOP. If you are a small business owner with less than 25 employees, you may be eligible to receive tax credits when purchasing health coverage for your employees through the Small Business Health Options Program.

Benefits of The Small Business Health Options Program, Include:

  • You are in control of what coverage you offer your employees and how much you pay toward employee premiums.
  • Your business’ needs and your employees’ needs can be met by choosing between 4 different levels of coverage.
  • You can choose to begin coverage at any time. As long as you enroll by the 15th of the month, coverage will begin on the 1st of the following month.
  • As previously mentioned, as a small business with fewer than 25 employees, you may be eligible to receive a tax credit.

Qualifying Terms for The Small Business Health Options Program, Include:

  • Any business with 50 or less full time employees may be qualified to offer employees coverage through SHOP.
  • If you are interested in using SHOP, you must offer coverage to every single one of your full time employees.
  • If you are looking to use SHOP, you may be required to have a large majority your employees enroll in your SHOP plan. This percentage is typically around 70 percent.
  • You must be within the boundaries of a SHOP service area to utilize the service.

Bernardini & Donovan Insurance Services strives to provide Redlands, California residents with excellent insurance services custom tailored to meet your unique needs. Contact us today and allow us customize a unique health insurance package for your family based on your needs.

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