Marin's Cheapest Health Insurance 

Follow Marin Events

• HomeMarin HousingPlan Bay Area TruthsSMART & MARIN TRANSITCA Transportation PlanTraffic Congestion Relief is not a goalSite MapMarin's PENSIONS are a time bombNewsInsurance Companies in marinMTC Cost EffectivenessBooks & LinksMarin's Cheapest Health InsuranceSR Airport •
• Benefits of Water FlouridationEye Glasses MonopolyCalifornia Healthcare BillVaccinationMosquitos & West Nile VirusThe 90+ Study on AGINGFake Olive OilCarcinogenicity of EMFBottled Water Con GameMarijuana  vs AlcoholWhat is a Root CanalEat to Live & Live for something Else •

(as of Nov 2011) The three cheapest in Marin County were:   

Summary of Cost & Coverage  

KEY FEATURES Kaiser Plan's Coverage Anthem Plan's Coverage Aetna Plan's Coverage

Estimated Monthly Base Rate

 $285

 $302

 $307

How accurate is this estimate?

You may be charged more. 
1% received surcharged quotes.

79% received surcharged quotes.

You may be charged more.
 23% received surcharged quotes.

How many applications are denied?

21% who applied were turned down.

10% who applied were turned down 13% who applied were turned down

Deductible

Individual:$5,000
Out-of-Network: Shared with in-network
Prescriptions: None

Individual:$5,000
Out-of-Network: 5000/10000
Prescriptions: $7500 Individual applies to Brand, Non-Formulary

Individual:$8,000
Out-of-Network: 10000/20000
Prescriptions: None

In-Network
Out-of-Pocket Limit

Individual:$7,500 Includes deductible

Individual:$4,500 Includes deductible

Individual:$12,500 Includes deductible

Does in-network out-of-pocket limit include deductible?

Yes

Yes Yes

Coverage Limits

Check the plan. Sometimes there is a limit on the number or cost of benefits that will be covered within a year.

Check the plan. Sometimes there is a limit on the number or cost of benefits that will be covered within a year. Check the plan. Sometimes there is a limit on the number or cost of benefits that will be covered within a year.

Is this plan Health Savings Account (HSA) eligible?

No

No No

How can I find a doctor in this plan's network?

Find your Doctor 

Find your Doctor  Find your Doctor 

Doctor Choice

EPO PPO PPO

Do I need a permission from my primary care doctor to see a specialist?

Yes

No No

Do I need authorization before seeing an out-of-network doctor?

Yes

No No

Excluded Services

Chiropractic
Prescription Drug Coverage
Maternity Coverage

Chiropractic
Mental Health Coverage
Substance Abuse Coverage
Maternity Coverage

Maternity Coverage

   

What we can learn from UK Healthcare

Which countries have the best healthcare?

March 2017, SB 562 Healthy California Act, healthcare for all

Confused by Obamacare? Here are answers to key questions.

Weekly US Flu Map When California's neighboring States go from "Regional" to "Widespread is when to get inoculated.

Colorado Single Payer Healthcare: A Closer Look

90+ study on Aging

Minnesota SINGLE PAYER  Health Plan

Idaho Healthcare for all

Beyond Obamacare: How a Single-Payer System Can Save US Health Care

see this Government Website and sort by the cheapest first.

California's SINGLE PAYER Healthcare

Vermont Could Be First In Line for Single Payer

Single Payer News

Oregon's Single Payer Status

Water Flouridation ?

 
                           Coverage Scenarios
,
Illustrating Cost Sharing and Limitations. For each covered service, this chart lists your cost sharing amounts.

COMMON MEDICAL EVENT SERVICES YOU MAY NEED

Your Cost Sharing

 Kaiser  Anthem  Aetna

If you are sick and go to the doctor's office or need other services?

Primary care physician office visit

$50 Copay after deductible

$40 Copay

Visits 1-3 $50 copay; deductible waived.
Visits 4+ member pays 100% Aetna discount applies Aetna pays 100% once OOP is met

Specialty physician office visit

$50 Copay after deductible

$40 Copay

Visits 1-3 $50 copay; deductible waived.
4+ member pays 100% Aetna discount applies. Aetna pays 100% once OOP is met

Outpatient X-rays /lab testing/imaging

$10 Copay after deductible

no charge (after out of pocket maximum)

30% Coinsurance after deductible (Non-Preventive)

If you go for a checkup visit?

Periodic health exam

No charge (deductible waived)

No Charge

No Charge

If you need minor surgery?

30% after deductible

40% Coinsurance after deductible

40% after deductible

If you stay overnight in the hospital?

Hospitalization

30% after deductible

40% Coinsurance after deductible

40% Coinsurance after deductible

If you have an emergency?

Emergency room fees

$150 Copay after deductible (waived if admitted)

$100 Copay (waived if admitted), plus 40% Coinsurance after deductible

$100 Copay (waived if admitted), plus 30% Coinsurance after deductible

If you need drugs?

PURCHASE FROM PHARMACY:

Generic Drugs

Not Covered

$20 Copay

Brand Drugs

Not Covered

Not Covered

Non-formulary Drugs

Not Covered

Not Covered

Prescription Drugs (other coverage)

Not Available

25% Coinsurance for Specialty/Self-administered injectable drugs after deductible

Not Available

PURCHASE FROM MAIL ORDER:

Generic Drugs

Not Available

$45 Copay

$40 Copay

Brand Drugs

Not Available

$120 Copay after deductible

Not Covered

Non-formulary Drugs

Not Available

Not Covered

Not Covered

Prescription Drugs (other coverage)

Not Available

Not Covered

Not Available

Mail order days supply

Not Available

90 days

60 days

Is there a drug deductible?

None

$7500 Individual applies to Brand, Non-Formulary

None

What drugs are covered in the formulary?

 

Check the Formulary 

No Link Provided

Check the Formulary 

If you have mental health or substance abuse needs?

Mental health coverage

$50 Copay Individual Visit / $25 Copay Group Visit, 20 Visits per year (after deductible)

Not Covered

Inpatient and Outpatient: coverage is only provided for severe, biologically based mental or nervous disorders. Deductible and co-insurance/copay apply.

Substance Abuse Coverage

$50 per visit after deductible/$5 group visit after deductible Inpatient Detoxification: 30% coinsurance after deductible

Not Covered

Inpatient and Outpatient: coverage is only provided for treatment of drug and alcohol dependencies associated with severe, biologically based mental or nervous disorders. Deductible and co-insurance/copay apply.

If you become pregnant?

Prenatal and postnatal care

Not Covered

Not Covered

Not Covered (except for pregnancy complications)

Labor & Delivery hospital stay

Not Covered

Not Covered

Not Covered (except for pregnancy complications)

Well Baby Care

No charge (deductible waived)

No Charge

No Charge

Free Preventive Services:  The Affordable Care Act will help make wellness and prevention services affordable and accessible to you by requiring health plans to cover preventive services and by eliminating cost-sharing. Learn More

 Terms used in this chart:

Co-payments: A flat dollar amount you must pay for a particular covered service. For example, you may have to pay a $15 copayment for each covered visit to a primary care doctor. Some or all copayments may count toward a plan's annual in-network out-of-pocket limit. For example, copayments for prescription drugs might not be limited by this annual maximum. In other cases, you may have to pay a "balance bill" amount for covered services, or covered services out-of-network, if the total charge is more than the allowed charge. You will need to read the plan to learn more.

Co-insurance: The percentage of allowed charges for covered services that you're required to pay. For example, the health insurance may cover 80% of charges for a covered hospital stay, leaving you responsible for the other 20%. This 20% is known as co-insurance. Not all co-insurance may count toward a plan's annual in-network out-of-pocket limit. For example, co-insurance for out-of-network care, or for specified benefits, might not be limited by this annual maximum. In other cases, you may have to pay a "balance bill" for out-of-network covered services, if the total charge is more than the allowed charge under your plan. You will need to read the plan to learn more.

Out-of-network: A health care provider or facility, such as a hospital, that has not contracted with your health insurance to provide services to you. Using an out-of-network provider or facility will usually incur a higher or additional cost to you. Sometimes, use of these services is not reimbursable whatsoever.

Questions? info@MarinInfo.org