Sutter Health Plus Estimated Cost Schedule and Plans for 2020

Sutter Health Plus has added a schedule of estimated costs for many routine health care services similar to the Kaiser Permanente fee schedule. They have also released their individual and family health plans that are available in parts of the Bay Area and Sacramento region.

For individuals and families with High Deductible Health Plans, it is always helpful to have an estimated cost for health care services. Kaiser Permanente has published a fee schedule for many routine health care services for several years for both Northern California and Southern California. To my knowledge, this is the first cost estimate schedule for Sutter Health Plus who operates HMO plans with full county coverage in the counties of Yolo, Sacramento, Solano, Contra Costa, San Joaquin, Alameda, Stanislaus, Santa Cruz, San Mateo, San Francisco. They also offer partial coverage for El Dorado, Placer, Santa Clara, Sonoma, and Sutter counties.

The costs for health care services listed on the estimate schedule are for the specific services where no copayment or coinsurance would cover the fee. In other words, plan members who have a High Deductible Health Plan or Bronze 60 plan where there is no plan cost-sharing (copayment, coinsurance) until the deductible has been met. Some of the services, such as for imaging, may be subject to a deductible in traditional health plans that have many services that include many services at a set copayment.

Overall, the estimated costs for the listed services from Sutter Health Plus are comparable to Kaiser Permanente Northern California fee schedule for 2019. But because Kaiser Permanente has not released their 2020 fee schedule, we can’t make direct comparisons. However, for 2019, Kaiser charges $111 to X-ray a finger at a Northern California Kaiser facility. Sutter Health Plus will charge $105 for a finger X-ray in 2020 for Sutter Health Plus plan members, if the service is subject to a deductible amount.

The new Sutter Health Plus cost estimates only apply if the services are performed by doctor in the

• Palo Alto Medical Foundation
• Sutter Gould Medical Foundation
• Sutter Pacific Medical Foundation
• Sutter East Bay Medical Foundation
• Sutter Medical Foundation

Sutter notes that Costs for similar services provided at a hospital or by a physician from a different medical group or IPA may vary. *Costs listed for colonoscopy services are for physician services only. The separate costs for the facility are not included and may vary by location.

Sutter Health Plus will offer standard benefit design HMO plans in their service region. These plans mirror the Covered California Bronze, Silver, Gold, and Platinum benefit design. Sutter Health Plus plans are not offered through Covered California and are therefore not eligible for any federal or state health insurance premium subsidy.

Below are the various documents for Sutter Health Plus HMO health plans for 2020. Call me if you have questions or need assistance with enrollment.