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 almost...

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 John Hansen

United Health Care (UHC), through their Select Plus Network, offers one of the largest PPO networks in California. They have an HMO network as well, which is stronger in Southern California.

In support of affordable health insurance for California, United Health Care took a rate reduction the beginning of 2016 for small business health plans.

United Health Care is a national carrier that offers California group health insurance. This is very helpful for multi-site groups who have some employees in California. It allows these businesses to keep some continuity in their coverage across multiple business locations.

For small businesses of 1 to 100 employees, they only need 5 California employees to enroll on a slice along with Kaiser Permanente. Many other carriers require 50% enrollment, so for some business owners this helps a lot.

United Health Care backed out of Covered California, the California Exchange, in 2014. In 2015, they entered back into the Health Insurance Marke...

by John Hansen

In 2013, United Health Care (UHC), America’s largest insurer, played it safe and withdrew from the California Exchange. So Covered California offered no California health plans from UHC in 2014. Later, the United Health Care Insurance Plan came back to Covered California asking to enter the Health Insurance Marketplace for the 2015 Open Enrollment.

Dave Jones, Commissioner of the California Department of Insurance said, “They should embrace them coming back in.” However, it seemed that top level officials at Covered California wanted to punish the United Health Care Insurance Plan for dropping out the first year. So they only let UHC enter the market in the least populated counties in the most remote areas.

“They were willing to do all of California,” says Dave Jones. “It was a mistake not to let them. I hope they’re still interested, but they might not be.”

Jones who said “I’m not shy” spoke very strongly against Covered California’s treatment of t...