Health Plans in California
Understanding health insurance requirements and terms can be confusing for many people, especially young millennials in their 20s trying to figure out how to best insure themselves for the first time. By conducting careful research and seeking help from resources, you can work toward choosing a health insurance plan in your 20s.
Under President Obama’s Affordable Care Act (ACA), you can stay on your parent’s health insurance plan until you reach 26. Regardless of your marital status, parental status, education level or tax bracket, you are eligible to use your parent’s health insurance until your 26th birthday — you can even live away from home or study at a university during that time. It is important to have a policy lined up to continue receiving healthcare coverage after turning 26.
When choosing a health insurance plan, you need to know what you are paying for. Many studies have determined that Americans generally have little understanding of their health insurance plan...
by John Hansen
What’s an EPO? That was the big question for many consumers during the 2017 Open Enrollment Period in California. It made consumers uneasy, and it caused many to switch from Anthem Blue Cross Covered California to Blue Shield Covered California.
Yes, there is a difference. Anthem stopped offering out-of-network coverage. And, for many Californian’s who want choice, they felt they would be limited by this.
Whether you go with Anthem or Blue Shield, it most often makes the most sense to stay in network. Your out-of-pocket costs remain so much lower when you stay in-network.
Anthem was losing money on their out-of-network coverage offered by their PPO’s so they made a gutsy move to switch all their individual and family plans over to EPO’s and stop offering out-of-network coverage. But they may have made a mistake.
Blue Shield of California was facing the same challenges with their PPO products, but they chose to keep offering out-of-network coverage. This was a huge ri...
by John Hansen
TRIO is Blue Shield of California’s aim at providing an affordable, high quality managed care product. It is an HMO, so the primary care physician (PCP) serves as the gateway to specialists in an effort to lower costs.
Blue Shield Covered California aims to get every patient to do an initial visit with their PCP to get their checkups. Or, as Renee Casserly, Director of Sales Operations and Business Development at Blue Shield of California, says “to get their tires checked.”
With the TRIO product, Blue Shield expects to compete with Kaiser Permanente. Top officials at Blue Shield fully admit that Kaiser is doing a lot right. They understand that Covered California Kaiser plans have a strong brand, and they are looking to similarly build a strong, trustworthy brand.
Kaiser Permanente’s integrative model with their one-stop shop with doctors, specialists, etc. all under one roof has been very appealing to many Californians. Many consumers in the state have gotten to the...
by John Hansen
When the Affordable Care Act was passed, Blue Shield Covered California hit the pause button on brand building. They focused their attention on Health Care Reform and being ready for the radical changes in the market. In so doing, they road on their reputation as it was previously established and stopped working on building their brand.
After Obama Care California was passed into law in 2010, Blue Shield turned their focus almost completely to getting ready for the implementation of Health Care Reform. According to Renee Casserly, Director of Sales Operations and Business Development at Blue Shield of California, this leading California carrier planned for three years, worked on their systems for 18 months, and spent tens of millions of dollars getting ready for 2014. They wanted to do well in the new world of Health Care Reform and they wanted to succeed in the Covered California exchange market.
With the busyness of transformation and adaptation, brand identity was almo...
by John Hansen
Things are getting shaken up at Molina Health Care. In the last month, the company terminated two top executives from the Molina Family, chief executive J. Mario Molina and his brother, finance chief John Molina. The company blamed this on “disappointing financial performance”. When you put that together with the bold moves Molina Insurance made in California in 2016 (very aggressive pricing, high broker commissions, and rapid gaining of low risk clients leading to RAF penalties), it seems that Molina may have taken a misstep that they are trying to recover from.
From 2016 to 2017 Molina Healthcare increased their Individual and Family Business from 53,000 to 180,000 members. They nearly quadrupled their book of business. Top leaders at Blue Shield of California question whether this was a mistake that could lead to rate increases of around 25% for 2018.
Any way you look at it, Molina made a gutsy move. They offered some of the highest broker commissions in the market...
by John Hansen
Health Net has issued off cycle second quarter rate changes that will impact Covered California Small Business renewals and new business with effective dates of May 1, 2017 and June 1, 2017.
However, as a result of this delay, April rates will not be affected.
Covered California is calling on their agents to make sure clients are aware of these new rates when selecting plan offerings for their business, either during their renewal process or when quoting new business for these effective dates. If you have any questions, please call 1-877-752-4737 and select the option 5 for our small business department.
By Wendy Barnett
Early in January, Blue Shield of California announced that they signed a new 3-year agreement with Sutter Health effective January 1, 2017. This is great news as it allows Sutter Health Hospitals and doctors to remain a part of Blue Shield’s network across the state.
Blue Shield of California members can now rest assured that their Sutter Health doctors and hospitals will still be considered “in-network” providers through 2019. Using in-network providers helps consumers save money. Even with a PPO plan where you can go out-of-network when desired, if you choose to stay in-network, you will have lower costs (think less co-insurance, lower deductibles, and lower out of pocket maximums).
Blue Shield Covered California plans will also continue to have Sutter Health as a part of their network. In certain areas, Blue Shield is sometimes the only insurance company that offers a PPO plan through Covered CA. Many Covered CA members desire the flexibility of having a PPO pl...
By John Hansen
As a reminder, effective January 1, 2017, some consumers who have Anthem Blue Cross Covered California will have a plan change from a Preferred Provider Organization (PPO) to an Exclusive Provider Organization (EPO). Covered California consumers who were enrolled in certain Anthem Blue Cross PPO plans in regions 1 through 9 and 15 through 19 in 2016 are impacted by this change.
If you take no action to renew or change plans through Covered California, your coverage will automatically be renewed 30 days after the date on the Covered California renewal notice, into the Anthem Blue Cross EPO plan available in your area. If you want to make a change to your plan for coverage beginning January 1, 2017, a new plan must be selected by December 15, 2016.
PPO plans are the most desirable because they offer out-of-network coverage. However, they tend to be more expensive and sometimes people don’t use the out-of-network coverage enough to make it worthwhile. On a PPO, your out-o...
by Stephen Saucier
One strength of Blue Shield’s PPO plans has been the fact that they have only one deductible rate regardless of in or out of network charges. For example, in 2015 the deductible for the Blue Shield Silver 73 PPO was $1,600 for individuals and $3,200 for families. These rates held true regardless of whether you receive coverage from in-network providers or out-of-network providers.
Starting on January 1st of 2016, Blue Shield will be implementing a change that effectively adds a new out-of-network deductible. Next year the in-network deductible for the Blue Shield 73 PPO will be $1,900 for individuals and $3,800 for families. This by itself would be bad news considering the $300 and $600 price increase respectively. But that’s not all; there will also be an out-of-network deductible of $3,800 for individuals and $7,600 for families. These 2 deductibles exist separate from one another. That is, meeting the in-network deductible doesn’t have any effect on you out-of...
by Stephen Saucier
In the past, Bronze 60 HSA plans through Blue Shield provided an aggregate deductible on family plans. What that means is that before benefit coverage could kick in for anyone, the whole family would have to pay 100% of the plan deductible. That is, a family would have to cover a total of $9,000 in costs before they would receive benefits. This will not be the case moving forward.
As of January 1st, 2016, Blue Shield is shifting its HSA deductible from aggregate to embedded. That means that if one person in the family meets the plans individual deductible ($4,500), then plan benefits kick in for that person! So if one of your family members gets sick or injured, requiring expensive medical assistance, plan benefits will kick in twice as soon with the new embedded deductible than they would have with the aggregate deductible.
This is great news for any family that is interested in purchasing a Blue Shield Bronze 60 HSA plan for the upcoming coverage year.
Not sure how Obamacare affects your health care plans in California? Learn how the ACA works in California, including benefits, costs and enrollment.
Covered California is the Golden State’s official health exchange marketplace where individuals, families and small businesses can find high-quality, low-cost California government health insurance.
Learn about Obamacare income guidelines in California using our income limits chart, and see if you’re eligible for government assistance.
Learn about the Covered California website. Find easy online enrollment. Set up your account, log in, buy insurance and more on the California health marketplace website.