Open enrollment for the Affordable Care Act’s marketplace is currently live. If you’re in need of health insurance, be sure to enroll by December 15 to be covered by January 1, 2016.
Covered California offers twelve different health insurance carriers to choose plans from. That might seem like a lot, but many of these carriers only offer coverage in select areas. In order to help you choose the right plan before the December 15th deadline, here’s an overview of health insurance carriers offered by Covered California.
If you’re looking for what pricing region you belong to or if you’d like to know what the average plan costs are for your pricing regions, please refer to this Covered California PDF.
Anthem BlueCross of California
Anthem is one of the largest health care providers in California. It serves 28% of Covered Calfornia’s enrollees and is located in Thousand Oaks, CA. It’s a subsidiary of Anthem Inc.
Anthem has provider groups that have more than 11,000 physicians. Anthem covers a great deal of California’s rural areas like Monterey Country.
Your medical needs will be covered with Anthem’s team of nurses that have a multitude of specialized healthcare needs. This includes (but not limited to) diabetes, coronary artery disease, asthma, and multiple sclerosis.
Anthem also has a Future Moms program that helps families have the healthiest pregnancy possible. This includes 24-hour access to obstetric nurses for any questions a mother-to-be may have.
It’s just not mothers that have access to telemedicine. All members have access to doctors via phone, tablet, and computer for a face-to-face consult, 24 hours a day.
Anthem has integrated care that works with doctors and hospitals to share responsibility for providing more coordinated treatment plans for patients. There are currently more than 20 medical groups that serve 600,000 members at this time.
Blue Shield of California
Blue Shield is one of two providers that offers PPOs in every county and zip code in California. They’re replacing its “exclusive provider organization” (EPO) with PPOs in the Northern, North Bay, and Central Coast regions.
To help patients with chronic conditions, Blue Shield is collaborating with Dignity Health on a accountable care organization (ACO). This will help healthcare professional coordinate care to help members manage their health.
Blue Shield has online tools to help its members estimate their costs. Members can get an estimate for more than 400 treatments, 1,600 procedures, and 160 episodes of care.
To help service members that live in rural areas, Blue Shield offers telemedicine services. If members don’t have access to the proper technology, they can travel to one of Blue Shield’s local Telehealth offices for a consult, which can cut down your commute.
Chinese Community Health Plan
The Chinese Community Health Plan (CCHP) is a San Francisco-based non-profit health plan founded to serve the Chinese-American community. It’s only available in San Francisco County and San Mateo County.
More than 40% of CCHP members identify Cantonese, Mandarin, or traditional Chinese as their first language. CCHP helps its members with language translation and holds informational seminars in these languages.
Preventive Care Passport is a tool that recommends preventative health services. This health risk assessment, which is available to CCHP members, helps identify members for care coordination. More than 30% of CCHP members completed the risk assessment in 2014.
Health Net was founded in 1985 and serves 18% of Covered California enrollees. In 2016 Health Net is expanding its covered to reach the greater Sacramento area, Fresno, Kings, and Madera counties.
Health Net has been nationally recognized for its cultural and linguistic services to better serve its non-English speaking members. Health Net offers members workshops and easy-to-read materials that inform members the basics of health care. The program is available in English, Spanish, and Chinese.
Health Net offers a social networking site called T2X that’s aimed at teens. The site gives teens access to the health information they need in a form they’re willing to interact with.
Headquartered in Oakland, CA, Kaiser Permanente (KP) is a non-profit, group-practice health plan. Kaiser Permanente serves 24% of Covered California enrollees and is comprised of the Kaiser Foundation Health Plans, Kaiser Foundation Hospitals, and Permanente Medical Groups.
Like other big insurance companies, KP has made a concerted effort to service the multi-cultural needs of many Californians. Nearly one in four KP physicians is bilingual, including Spanish, Armenian, Cantonese, and Russian.
Kaiser Permanente has been dedicated to helping improve disease management. Their program for cardiovascular disease (heart disease/stroke) is an example of how their programs are working. By implementing its risk factor modification (control of hypertension and diabetes) KP reported that in 2008 the death rate for cardiovascular disease dropped below cancer.
KP makes contacting healthcare professionals easy with its online tools. Member can email physicians, make appointments, view lab results, and order prescription refills all online.
L.A. Care Health Plan
L.A. Care was founded in 1997 and is dedicated to serving LA Country residents that are low-income. To accomodate these members, many of whom don’t use traditional banking, L.A. Care allows members to pay monthly premiums with cash at 7-Eleven, ACE Cash Express, or Family Dollar Stores.
Nearly three quarters of L.A. Care’s members belong to an ethnic group outside of Caucasian/White. More than a third of its members also prefer to speak a language other than English. Therefore, L.A. Care has services in place to help facilitate the needs of its members who many not speak English.
To eliminate unnecessary referrals and reduce wait times for specialists, L.A. Care partnered with LA Department of Public Health to implement the eConsult system, which allows primary care and speciality physicians to consult on behalf of patients.
L.A. Care continues to grow its network, in the past three years its more then doubled its medical groups and tripled the number of primary care and specialists in its network. The L.A. Care network includes access to 42 hospitals, 19 medical groups, 2801 primary care physicians, and 2559 specials around the greater Los Angeles area.
Molina Healthcare was founded by Dr. C. David Molina in 1980 to serve low-income familines in Southern California. Based in Long Beach, CA, Molina Healthcare serves members in five pricing regions (13,15,16,17,19).
In 2016, Molina Healthcare is expanding its coverage to reach Riverside and Imperial Counties. Molina’s network of doctors has doubled and its mental health providers have increased by 60%. In all, members have access to more than 20,000 health providers.
The MyMolina portal offers members health appraisal in English and Spanish. Members have access to personalized health education information, which includes things like medical library, exercise library, and cookbooks. It also has a Procedure Cost Estimator which calculates a rough estimate of how much a specific treatment will cost.
Molina Healthcare has a strong multi-cultural approach to its business. They conduct seminars for young adults, through trade schools, in languages other than English. They also have English as a Second Language (ESL) parent groups at local schools. Molina Healthcare is dedicated to reaching its members and educating them on healthcare issues.
Oscar Health Insurance
We previously wrote about this New York based startup, looking to disrupt the health insurance industry. Oscar is new to Covered California in 2016 and will only service pricing regions 16 and 18 this year.
Oscar stands out among its peers for two primary reasons. One its cutting edge technology tools. Second, it’s easy and valuable healthcare plans (many include free doctor visits and prescription drugs).
Among its online tools, Oscar offers search tools with natural language processing that assists members when they try to spell difficult medical terms and prescriptions. Providers can be filtered based on tags like distance, experience, and commonly treated conditions.
More than two-thirds of Oscar enrollees take advantage of its preventative, health risk assessment. Members then receive customized preventative care checklists.
Oscar makes doctors on-demand a basic feature of its plans. Every member has access to doctors for 24/7 telemedicine services.
Oscar has partnered with Providence Health and Services of Southern California to offer quality-focused physicians and access to hospitals for its members.
Sharp Health Plan
This non-profit organization has been around since 1992 and is focused on San Diego and southern Riverside counties. Sharp is currently expanding its locations through MinuteClinics. MinuteClinics are located in several San Diego locations right now. They operate within CVS/pharmacy stores and offer routine services. These services include things like strep throat checks, vaccinations, sports physicals, and ear/nose/throat infections. MinuteClinics are open 24/7 and healthcare is provided by nurse practitioners and physician assistants. No appointment is necessary.
Sharp is not only focused on treatment programs, but also a wellness program known as Best Health. The program offers online workshops. fitness tracking tools, one-on-one health coaching, and a health library. It’s the only health plan in the state and one of 12 to be accredited by the National Committee for Quality Assurance’s “Wellness & Health Promotion.”
Like other health insurance companies, Sharp offers online consumer tools. Members have access to FollowMyHealth mobile app and a web portal that helps individuals manage their health more closely online. Included in this tool is the ability to view test results, communicate with the doctor’s office, and getting information from doctor or hospital visits.
Sharp also offers telemedicine services through Telehealth Sharp. Select physicians in the Sharp Ree-Stealy Medical group are available by phone for certain medical conditions and follow-ups.
United Healthcare is another new option to Cover California. UHC will cover pricing regions 1,9,11,12, and 13 in 2016.
UnitedHealthcare offers a mobile app called Health4Me to help members manage their health on the go. Members can search for providers, get estimates on healthcare procedures, and access real-time updates on the account balance (i.e. deductibles and out-of-pocket spending).
UnitedHealthcare has a UnitedHealth Premium designation this assists members make better informed decisions. UnitedHealthcare takes clinical information from healthcare claims, across 42 states and 350,000 physicians, dating back to 2005. With this information, UnitedHealthcare can help members make informed decisions about the appropriate care they need.
UnitedHealthcare offers a health management program called eSync. This platform identifies personalized health management programs for individuals. Specialized nurses assess members and take appropriate action based on the member needs. UnitedHealthcare also offers virtual visits for members, which can be video-based, 24 hours a day.
Valley Health Plan
Valley Health Plan is a health maintenance organization owned and operated by the County of Santa Clara and is the only locally based commercial health plan in Santa Clara County.
Valley Health Plan offers health education to its members, free of charge. These services include fitness classes like yoga and pilates. They also have chronic disease prevention programs and management programs for diseases like diabetes. If a member would like one-on-one support and advice from a nurse, they can enroll in the Complex Case Management Program or Disease Management Program.
To further assist its members, Valley Health Plan offers different consumer and pharmacy tools. These tools include resources that help members prepare for their doctor visits, pharmacy search, copay information, medication history, and more.
Western Health Advantage
Based in Sacramento and founded in 1996, Western Health Advantage services pricing regions 2 and 3.
Western Health Advantage offers its members personalized resources and access to their plan at any time through their MyWHA accounts. These resources help members understand and get the most out of their deductible health plan. WHA also offer a cost estimator to help members gauge the cost of different procedures and a tool called the Accumulator which tracks all medical expenses so the member can see how much has been spent on the deductible and out-of-pocket expenses.
Since Western Health Advantage is a provider-owned organization, they are able to easily integrate different services for member care. WHA members are able to get healthcare services from different groups like:
- Hill Physicians
- Mercy Medical Group
- Meritage Medical Network
- Northbay Healthcare
- UC Davis Medical Group
- Woodland Healthcare/Dignity Health
There’s a great deal of information you must sort through while you choose your Covered California health insurance provider. Use these snapshots of each insurance carrier to give you a better idea of what options are available to you in your area.