Published in the December 27 – January 9, 2018 issue of Gilroy Life

Open enrollment is a full month in now, for the individual market. You have until Jan. 31 to make your final plan change, even if you’ve already made a plan change. After this date, you are stuck in your plan for the remainder of the year. Very few counties have added new carriers and most have lost carriers.

 HMO vs. PPO vs. EPO?

Confused? You’re not alone, so are a lot of people. This is where we are seeing the most confusion. Here’s brief description of the difference between the types of plans: EPO plans combine the flexibility of PPO plans with the cost-savings of HMO plans. You won’t need to choose a primary care physician with an EPO, like you do with an HMO, and you don’t need referrals to see a specialist. But you’ll have a limited network of doctors and hospitals to choose from.

While it seems that an EPO is sort of a hybrid between an HMO and PPO, we have heard from many clients that the networks are pretty small and can’t find providers or other services such as diagnostic tests in network, which causes them to have to get an in-network referral for an out-of-network provider. Beware that with an EPO, if you don’t get a referral for out of network providers, you will not be covered.  For this reason, some folks are choosing PPO’s and paying a higher price tag.

On Exchange:

Covered California (California’s Exchange) is where we apply in order to get financial assistance with health insurance in California. The lower your income, the higher the financial assistance you get. (If you have no income or your income is below a certain threshold, you will qualify for MediCal.) Not only can the financial assistance lower your premium, but can also lower your deductible and copays. These are called the Silver Enhanced plans. You can’t select these plans by your choice, you fall into a specific bracket based on your household income.

Off Exchange:

If you do not qualify for any financial assistance, there is no need to purchase your plan through Covered CA, you can go directly to the insurance company or through an insurance agent to purchase a plan.

The application is much shorter as you won’t have to supply a list of personal information on your household and income. There are also more plans available off exchange; some insurance companies don’t want to participate on the exchange and they are not required to.  Some companies’ plans are cheaper off exchange for the exact same plan.  If you are confused about this, check with an agent. In some cases we’ve saved folks more than a hundred dollars per month writing it direct.

 Medicare Advantage

Disenrollment Period:

Medicare annual open enrollment period closed Dec. 7, however, if you’re not happy with the Medicare Advantage plan you chose, Medicare offers a “Medicare Advantage Disenrollment Period” where you can disenroll from an Advantage plan (typically the HMO plans). You have to do this between Jan. 1 and Feb. 14 and then your insurance converts back to original Medicare, Parts A & B, and this allows you to add a drug plan and if you qualify, pick up a Medicare Supplement plan, to supplement your Medicare A&B. During this disenrollment period, you cannot switch to another Medicare Advantage plan, you can only go back to original Medicare.

 New to Medicare?

Are you just turning 65 or just now retiring? You might be feeling a little overwhelmed if this is your first time looking at Medicare and how it works.  While there is a ton of information out there, it is still very confusing when you’re first learning about it.

First you need to enroll in Medicare, a few months prior to turning 65, or if you’re collecting Social Security, you will be automatically enrolled and your card will be sent to you.

Once you get enrolled in the Medicare system, then you can purchase either a Medicare Advantage plan or a Medicare Supplement and a Part D prescription drug plan.

If you’re not sure which way to get coverage, you can ask an insurance agent for help to guide you through this process.

Michele Campbell is the owner of Michele Campbell Insurance Services. Feel free to give their office a call to help with any health and life insurance needs. They can be reached at (408) 848-2271 or email There is no cost for her services.


Michele Campbell

Michele Campbell

Michele Campbell owns and operates Michele Campbell Insurance in Gilroy. If you have questions or need help, reach her at (408) 848-2271 or at
Michele Campbell