Individual & Family Health Insurance – Carrier Direct (Off-Exchange)

The most important consideration when purchasing health insurance—whether through Covered California or directly from an insurance carrier—is making sure the plan qualifies as Minimum Essential Coverage (MEC).

MEC-compliant health plans include the Affordable Care Act's required Essential Health Benefits, do not exclude pre-existing conditions, and do not impose annual or lifetime maximum benefit limits. Unfortunately, some plans advertised online, by phone, or on the radio are not true major medical insurance. While they may appear less expensive, they often contain significant limitations that can leave you responsible for substantial medical bills if you experience a serious illness, injury, or hospitalization.

California residents who do not maintain MEC coverage and do not qualify for an exemption may also be subject to a state tax penalty. The penalty is generally the greater of a flat dollar amount per household member or 2.5% of household income above the tax filing threshold.

Doctor high-fiving a baby

Is Carrier-Direct Coverage Right for You?

Not everyone should enroll through Covered California. If you do not qualify for premium assistance, purchasing coverage directly from a health insurance carrier may be a better option.

At Benefit Packages, we help individuals and families compare both Covered California and carrier-direct plans so they can make informed decisions based on their healthcare needs, provider preferences, and budget.

Many individuals and families who do not qualify for Advanced Premium Tax Credits (APTCs) choose to enroll directly with a carrier. In some situations, carrier-direct enrollment can also help families avoid a "split household."

A split household may occur when parents qualify for private health insurance while their children are determined eligible for Medi-Cal. Some families welcome the cost savings associated with Medi-Cal, while others prefer to keep their children enrolled in a private health plan for reasons such as broader provider access, continuity of care, or shorter wait times for appointments.

If your children are eligible for Medi-Cal but you prefer to keep them enrolled in private coverage, we can help. We can enroll your dependent children (age 18 and under) directly in an individual and family health plan while enrolling the parents through Covered California so you can take advantage of available premium tax credits.

Learn More About Covered California 

We'll explain your options, compare the costs and benefits of each approach, and help you choose the solution that best fits your family's needs.

Learn More About Covered California 

We'll explain your options, compare the costs and benefits of each approach,
and help you choose the solution that best fits your family's needs.

Covered California

Important Questions to Consider

Before selecting a health plan, it's important to understand:

  • Are your doctors, specialists, and hospitals contracted with the plan?
  • Are your prescriptions covered on the carrier's formulary?
  • Would an HMO or PPO better fit your needs?
  • Would an HSA-compatible High-Deductible Health Plan (HDHP) provide valuable tax advantages?

We take the time to explain health insurance terms such as deductibles, copayments, coinsurance, and out-of-pocket maximums in plain English so you can feel confident in your coverage decisions.

Ongoing Service After Enrollment

Our service doesn't end after enrollment.

Clients often contact us when they receive an Explanation of Benefits (EOB) and need help understanding what the provider billed, what the insurance company allowed, and what they may owe. We can also help identify potential issues such as duplicate claims, billing errors, or missing information that could delay or affect claim payments.

Health insurance can be complicated, but we're here to make it easier.

Call Benefit Packages at (818) 999-3595 for personalized guidance and assistance with Individual & Family Health Insurance.

Essential Health Benefits

All ACA-compliant health insurance plans we offer include a comprehensive package of benefits known as Essential Health Benefits:

  1. Ambulatory patient services (outpatient care)
  2. Emergency services
  3. Hospitalization
  4. Pregnancy, maternity, and newborn care
  5. Mental health and substance use disorder services
  6. Prescription drug coverage
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services, including chronic disease management

Pediatric services, including dental and vision care

Carriers We Represent

  • Anthem Blue Cross (Elevance)

  • Aetna

  • Alignment Health Plan

  • Beam

  • Blue Shield of CA

  • Cigna

  • Delta Dental

  • Health Net

  • HealthSpring

  • Humana

  • Kaiser

  • Imperial Health Plan of California

  • LA Care

  • Medico/Wellabe

  • Molina

  • SCAN

  • Sutter Health

  • UCLA Health Medicare Advantage

  • United Concordia

  • UnitedHealthcare / AARP

  • VSP

  • WellCare / Centene

Navigate Health Insurance Options with Expert Guidance

We'll help you figure out what you're eligible for, and what will best meet your family's needs.