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COST SAVING EXAMPLES

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The California Individual Mandate Requirement

The Affordable Care Act penalty has been reversed federally; however, effective January 1, 2020, California lawmakers have reinstated a state individual mandate requiring California residents to purchase a qualifying health insurance (Covered California, private insurance or members of a healthcare sharing ministry) or they will incur a penalty from FranchiseTax Board on their taxes.

To help lower-income individuals and families afford insurance, the government will pay a portion (subsidy) of the monthly insurance premium. The amount of the subsidy varies based on income and family size. Below are some examples. Keep in mind that once incomes reaches four times the poverty level, the subsidy disappears, as follows:

INDIVIDUALS
$45,960

COUPLES
$62,042

FAMILY OF 3
$78,120

FAMILY OF 4
$94,200

FAMILY OF 5
$110,280

...etc

For individuals who qualify for a subsidy, the federal government created healthcare exchanges where individuals can shop for and purchase insurance. There are four categories of insurance coverage: Bronze, Silver, Gold, and Platinum. Each category differs in terms of monthly premium, deductibles, and copays. A Bronze Plan has the lowest monthly premium, but the highest deductible and copays. Platinum has the highest premiums, but lowest deductibles and copays. California’s healthcare exchange is www.coveredca.com. You can log on, enter your annual gross income, family size and ages, and view the plans available for you. Each plan shows your monthly premium costs and corresponding benefits, copays and deductibles. Higher incomes result in lower subsidies and higher premium costs.

BRONZE PLAN MAY BE BEST CHOICE

In nearly all cases, the difference in monthly premium costs between the Bronze and Silver plans is substantial. In these cases, an individual could purchase the Bronze Plan, buy a Prestige membership, and still save money compared to purchasing a Silver Plan. In addition, Silver Plans still have high deductibles and copays (except where family income is below 2.5 times the poverty level). This represents additional out-of-pocket expenses for healthcare.

POTENTIAL COST SAVINGS

The following examples illustrate the potential cost savings of purchasing a high-deductible Bronze plan plus a Prestige membership, compared to buying a more expensive Silver Plan:

Cost Savings Examples
MAKING THE RIGHT CHOICE FOR YOUR FAMILY

The above information is for comparison purposes only. Any actual cost savings will depend upon the number and type of healthcare visits incurred by each person. Healthy individuals and families frequently find that buying a high-deductible insurance plan and combining it with a Prestige membership represents their most cost-effective healthcare option.

Please note that though a high-deductible insurance plan may reduce your annual premium, it could result in greater overall healthcare costs if you experience a major medical event, such as a serious accident or major surgery, due to the higher deductible. Therefore, every person and family should carefully weigh the benefits and risks associated with different options to determine the right choice for themselves. Prestige highly recommends you make these decisions in concert with your insurance agent.

Prestige Urgent Care has connections with multiple insurance agents and can assist you in finding an agent if you do not have one already.

We're here to help!

From membership plans for local patients to telemedicine available nationwide, we are here to help you stay healthy.