Anthem Blue Cross will expand their individual and family EPO health insurance plans in California for 2022. EPO expansion will also include Sutter hospitals and medical groups. The Blue Cross EPO rates can be substantially less than the Blue Shield PPO plans.
Blue Cross and Sutter Doctors for 2022
Prior to this Blue Cross EPO expansion, the only way to access Sutter Health doctors and most hospitals in an individual and family health plan was with the Blue Shield PPO plans. Off-exchange, without health insurance subsidies, Sutter Health Plus offers an HMO plan in some counties that includes the Sutter doctors and hospitals. The Health Net Full PPO network also includes some Sutter hospitals and medical groups, but is only available off-exchange without any subsidy.
Now, in the subsidized health insurance market place of Covered California, individuals and families will have a choice of either Blue Cross EPO or Blue Shield PPO plans that include Sutter.
The Sutter providers will mostly benefit counties where Blue Cross is expanding their coverage in the North Bay, East Bay, and Central Valley. A few counties in the Central Valley and most of Southern California will only be offered the Blue Cross HMO plans that do not include the Blue Card Program. Of course, Blue Cross offers additional EPO plans off-exchange, direct from Anthem, with a few extra plan designs that are not offered through Covered California.
Blue Cross EPO Plans To Include Sutter Hospitals
Two of the big drivers of health plan rates are the type of the plan (EPO, HMO, PPO) and the provider network. The EPO (Exclusive Provider Organization) allows the member to self-refer to most providers in the network. Unlike an HMO, the EPO member does not need a referral from their Primary Care Physician to see some specialists. Similar to an HMO, the EPO has no out-of-network coverage.
PPO plans offer some coverage for out-of-network health care services. But with out-of-network deductibles beginning at $5,000, you really don’t want to go out-of-network for routine health care services.
Blue Cross EPO Rates very Competitive with Blue Shield PPO plans
Rates are influenced by including popular, in-demand, high-cost, providers. Sutter doctors and hospitals have been on the high side of the service cost reimbursement scale. In other words, the health plan – on average – pays more for the same service provided by a Sutter doctor or hospital than a competing hospital or medical group. Consequently, many health plans avoid having Sutter in-network to contain costs. Of course, the health plans negotiate the reimbursement rates with the providers. Anthem Blue Cross must have negotiated rates they can live with and provide health plans with Sutter in-network.
To confirm that Sutter providers will be in the Blue Cross EPO network I went straight to the Sutter website for confirmation.
Always visit the Anthem Blue Cross website for California to confirm your preferred Sutter providers are in-network. There are some medical groups associated with Sutter that may not be contracted with the Blue Cross EPO.
The Anthem Blue Cross EPO plans will not be the least expensive in the regions they are expanding into. However, they will be less than the Blue Shield PPO plans in most instances. In Marin County, the Blue Cross EPO trends to be the second lowest cost Silver plan, significantly less than Blue Shield PPO. Rates shown before any Covered California subsidy is applied.
In Sacramento County, the Blue Cross EPO continues to be considerably less than the Blue Shield PPO. For a 40 year old, the rate differential is $200 between Blue Cross and Blue Shield. The cost difference is for the full rate. The subsidy is based on the second lowest cost Silver plan. Even if you get a very large subsidy, the Blue Cross EPO will still be less than the Blue Shield PPO. Rates shown before any Covered California subsidy is applied
If you are partial to Sutter doctors and hospitals, then you should review the rates for the Anthem Cross EPO plans if they are offered in your county. Whether you get your health insurance through Covered California or enroll direct with a carrier like Blue Shield, the Blue Shield EPO plans, on average, will be less than the PPO plans, and now include Sutter in many Northern California counties.