You can’t assume that all hospitals part of a larger network are all in-network with the same carrier if one is in-network. In Butte County, Blue Shield contracts with all the Enloe associated hospitals. But Anthem Blue Cross only contacts with Enloe Medical Center – Esplanade. The converse is also true. Blue Cross doesn’t typically contract with Sutter hospitals for their individual and family plans. However, in Amador County, Sutter Amador is an in-network hospital for Blue Cross.
Kaiser Permanente has seen their market share increase with the Affordable Care Act. Their percentage of Covered California enrollments has steadily increased from 24% in 2015 to 33% in 2018.They have also been very stable in their plan offerings on and off exchange. Kaiser rates increased 3% – 7% in Northern California and 6% – 10% in Southern California in 2018. In 2019, the average rate increase will be 9% throughout California.
The Medi-Cal representatives also confirm that erroneous information can pop into Covered California applications after an individual or family has been terminated from Medi-Cal. Once a person is deemed no longer eligible for Medi-Cal, the SAWS Soft Pause is released and the individual and family can then enroll in a Covered California plan with the tax credit subsidy. Unfortunately, the data on the Covered California can be missing or in accurate from what was originally entered.
Blue Shield individual and family plans also come with Teladoc for phone call consultations, NursesHelp 24/7 online chat, and the BlueCard program that allows member’s access to providers when they are travelling out-of-network. The plans also include a physician home visit. The home visit, Heal on-demand house calls, is subject to the member’s location. There is also Telebehavioral health benefit that helps members with mental or substance abuse challenges access therapy online with mental health professionals.
Covered California takes a dig at the federal government correctly pointing out that rate increases, because of the removal of the individual mandate, means the subsidy amounts for consumers in Covered California will increase, “…the federal government will end up paying an estimated $250 million more in higher tax credits.” The loss of consumers will also impact Covered California. They estimate that enrollment in Covered California could decrease by as much as 162,000 individuals. Covered California is funded by a health plan fee for every member who enrolls through Covered California.
One of the first filters in selecting an EPO or PPO individual and family plan, either through Covered California or off-exchange, is determining if your current doctor is in-network. For all the enhancements to online doctor directory search tools, they still suck. They are not consumer friendly. Consumers are given either too many conditions to select or the provider search tool offers too little information.
The Department of Managed Health Care (DMHC), who regulates most of the individual and family plans offered through Covered California, has developed a website to allow consumers to compare health insurance companies. The Health Plan Dashboard website does not assign any performance review ratings. But it does give consumers a high level view of some of the data collect on the health plans such as enrollment, complaints, and enforcement actions for medical, dental, and vision plans.
A little known provision of health plans that also are designated as being a Health Savings Account (HSA) require a single member of a family to meet double the deductible amount of an individual before coinsurance is applied to health care services. Unlike traditional family plans where any one member of the household can transition […]
Covered California doesn’t have a monopoly on individual and family health plans in California. In addition to the carriers participating in the California exchange, Cigna is also offering health insurance outside of Covered California. Cigna is offering eleven different individual and family plan (IFP) options in California: seven Baseline Portfolio plans and four plans that mirror the Covered California standard metal tier levels for 2014. None of their plans are available through Covered California for the Advanced Premium Tax Credit.
Consumers are growing frustrated as they find their current doctors aren’t included in new Covered California individual and family plan (IFP) health insurance networks. There is also widespread uncertainty about the rules of in-network providers with the new Exclusive Provider Organizations (EPOs) and California’s new 19 pricing regions. When California consumers are craving information the doctors have been silent and the insurance companies along with Covered California are providing scant information.