This is one of a series of posts designed to update clients and prospective clients with what is happening on the individual and family health insurance markets.
Anthem Blue Cross offers individual and family coverage directly, and through Covered CA for those who qualify for a federal tax credit or subsidy.
Can I keep my current plan? Generally, no. Only if you enrolled in your current plan prior to March, 2010 and did not make changes since then; in that case your plan is likely considered grandfathered, and you will have the option to keep that plan. Note that if your 2014 household income is below the threshold for a tax credit, it still may be worth looking at new options through Covered California.
Are my rates going up? Almost certainly, and significantly – unless you were previously placed into a Level 2 or higher risk category due to health history, or were on a HIPAA guarantee-issue plan.
Do I need to do anything to change to a new, compliant plan? Anthem will move you to a new ACA-compliant plan that they think maps most closely to your current plan. You are not required to accept this plan. You may consider alternate options from Anthem, or consider changing to a carrier that better meets your needs. As a cost-mitigation strategy, we think all Anthem clients should consider changing to a Cigna PPO plan before the end of 2013.
Is the network of providers changing? Yes, Anthem is creating a series of tiered networks, which means plan benefits will vary depending on which network you use. The primary PPO network will be called the Pathway PPO, which you can search here. This network is likely to represent a smaller number than the current Anthem network of PPO providers. This may change in the future, but at this time, we believe Anthem’s network will include the UC hospitals, such as UCSF and UCLA, but not any of the Sutter hospitals (e.g., California Pacific Medical Centers). When traveling outside of CA, members will continue to have access to the national and international BlueCard network.
What is the difference between a PPO and an EPO? Depending on the county you live in, Anthem will offer either a PPO or an EPO plan. An EPO, or “Exclusive Provider Organization” is a PPO but without out of network benefits.
Can I view all of the new 2014 plan options and rates? Yes, please visit this page which will let you access direct 2014 quotes from all of the major carriers, as well as submit a quick-apply application when you are ready. For those who think they may qualify for tax credits, please contact us to discuss options through Covered California.
Are these the same plans that are available through Covered CA? Blue Shield will offer the same exact plans directly, as they do through Covered California, at the same rates (as required by law). There are no additional plans offered by Blue Shield outside of the marketplace.
Are there HSA-compatible options? Yes, Anthem offers a Bronze level HSA-compatible plan.
I know I won’t qualify for a tax credit or subsidy. How do I apply? Please use the Quick-Apply links and select the carrier logo. Remember, there are no more health questions on individual applications. We expect many people to be pleasantly surprised at how quick and easy applying for coverage will be for 2014 and beyond. Please contact us if you need assistance with your online application, or would prefer a paper application.