California Marketplace Health Insurance Plans
Qualified Plans on Covered California
Beginning October 1, 2013, each state was required by law to have a new online marketplace where residents can buy health insurance. In these marketplaces, most states will offer five tiers of Obamacare Health Exchange Plans: platinum, gold, silver, bronze and catastrophic. Platinum plans will offer the highest level of coverage but tend to cost more in monthly premiums. Bronze plans will cover only a bare minimum of health care expenses but tend to have low premiums. If you are relatively healthy and want to pay less up front, consider a lower-tier plan such as bronze or silver.
You should also look at a Covered California plan if you are lower-income, because the government will give financial help on a sliding scale to pay for premiums, and better benefits if you select a silver-tier plan. If you have not already done so, we can tell you if a Covered California plan makes sense given your income on the State Overview tab, under the heading, "Do I Qualify For a Tax Break?"
Read ACA and Health Insurance: Which "Metal" Tier is Right for You? for more advice on choosing between metal tiers.
Certain insurers, including some of those selling the least expensive plans, will offer consumers access to only a limited number of doctors and hospitals. Health Net Inc., for example, will have only 920 doctors on its network in Orange County, where Blue Shield members will have more than 2,500 to choose from, the Los Angeles Times reported in September 2013. In San Diego, similarly, Health Net will have fewer than 800 doctors in its network, compared to Anthem Blue Cross's nearly 3,000 and Sharp Health’s 2,600. But in exchange for tolerating Health Net's narrower network of doctors, that insurer's members will reap savings. Across Southern California, its plans will be up to $100 cheaper per month than its competitors', according to the L.A. Times analysis.
In addition, some desirable hospitals may be available through one insurer but not another. Anthem Blue Cross, for example, claims to be the only insurer whose network includes University of California-affiliated hospitals such as UCLA Medical Center, according to the L.A. Times. And doctors who accept a particular insurer's employer-based plans may or may not accept its qualified health plans. Reportedly only about half of Blue Shield's overall network of physicians will be available to members of Blue Shield's qualified plans.
Whether you live in the northern or southern part of the state, you will want to check the details of any Marketplace plan to see if your doctor or hospital is in the network.
Alameda Alliance for Health. This public, nonprofit health insurance company has been providing health care services to Alameda County residents for more than 16 years. The insurer offers multilingual services, free health education programs, case management and disease management programs for members. The network includes 8 hospitals and 2,000 physicians.
Anthem Blue Cross of California. Anthem Blue Cross has more policyholders in California than any other insurer and serves all regions of the state. Its network includes approximately 300 hospitals and 30,000 physicians.
Blue Shield of California. This California-based nonprofit health insurance company serves all regions of the state. Its network includes 223 hospitals and 22,048 physicians, not counting hospital-based physicians.
Chinese Community Health Plan. This insurer formed in 1986 as an alternative health maintenance organization (HMO) for patients served by the Chinese Hospital Health System, which was created more than a century ago to serve Chinese-Americans who were often excluded from mainstream health care. Chinese Community Health Plan focuses on offering culturally competent care and is available to those who are employed or reside in San Francisco and northern San Mateo counties. Its network includes 9 hospitals and 315 physicians.
Contra Costa Health Plan. CCHP is the first county-sponsored health insurance company in the nation to receive federal qualification and to offer Medicare. Contra Costa Health began enrollment of Medi-Cal patients in 1973. Today, the plan delivers services to Contra Costa county employees, small and large business groups, seniors, people with disabilities, children and low-income patients. CCHP currently cares for the county residents in the Low Income Health Program (LIHP), many of whom will be eligible for Covered California and may be able to keep their current physician and medical home. CCHP offers 24/7 advice nurse assistance, as well as case management and transition care nurses to assist patients being discharged from hospitals to receive timely appointments with their doctors. Its network includes 10 hospitals and approximately 5,000 physicians.
Health Net. A publicly traded managed care organization, Health Net Inc. delivers managed health care services through health plans and government-sponsored managed care plans. The insurer serves many but not all regions of the state, including Los Angeles, San Francisco, San Diego and the Inland Empire. Its network includes 204 hospitals and approximately 44,000 physicians.
Kaiser Permanente. Since 1945, Kaiser Permanente has grown to be of the nation’s largest nonprofit health insurance companies. It claims to be a pioneer in online tools to let members e-mail their doctor, make appointments and get lab results and prescription refills all online. Kaiser Permanente, which serves more than 7 million Californians, offers coverage in most but not all parts of California; the region including Santa Cruz and Monterey is an exception.Its network includes 35 hospitals and 14,219 physicians.
L.A. Care Health Plan. Founded 15 years ago, L.A. Care Health Plan is the nation’s largest publicly operated health insurance company. It is an independent local public agency created by the state of California and Los Angeles County to serve especially vulnerable and low-income populations. To address the diverse population of Los Angeles, L.A. Care produces member materials in 10 languages, provides face-to-face interpretation services in 50 languages annually and renders telephonic interpretation servies in 180 languages each year. Itshe network includes 35 hospitals and 1,005 physicians.
Molina Healthcare Inc. From its beginning 33 years ago as a single clinic providing care for low-income individuals, Molina has grown into a national managed care organization. It serves Los Angeles, San Diego and the Inland Empire (San Bernardino and Riverside counties). Its network includes 29 hospitals and 4,568 physicians.
Sharp Health Plan. Formed in 1979, this nonprofit is San Diego’s only locally based commercial health insurance company. It serves only the San Diego region with a network that includes 10 hospitals and 2,600 physicians.
Valley Health Plan. Licensed in 1985, VHP offers health insurance through Covered California for individuals living or working within, and small businesses located within, Santa Clara County. It also insurers some employees of employer groups such as the County of Santa Clara. Its network includes Santa Clara Valley Medical Center and three additional area hospitals, 993 physicians, 11 community-based federally qualified health centers, eight clinics operated by the County of Santa Clara, and a range of specialty services such as behavioral health.
Western Health Advantage. This non-profit health insurance company was founded by UC Davis Health System, Dignity Health and NorthBay Healthcare System. Western Health Advantage offers services to northern California individuals, families and employees in the counties of Napa, Sonoma, Solano, Marin, Sacramento, Placer, El Dorado and Yolo. Its network includes 15 hospitals and 3,000 physicians.
*Insurance company information was obtained from Covered California's website.
Last updated by Heilbrunn, Evi | October 11, 2013