21 Nov 2013

2014 Health Insurance: Beware the “Narrow Network”

21 Nov 2013

We have been posting and talking with clients consistently over the past few weeks about the best choices for 2014 health insurance, and one constant theme comes up: Is my doctor/hospital/provider going to be in the network?

Now that the mainstream media is beginning to pick up on the issue (AP, and Washington Post from today), we may see some added pressure on carriers to expand their 2014 networks. But for now, it is buyer beware.

In Marin and Sonoma counties, and other areas north of San Francisco, Health Net is looking like the best PPO option, despite higher rates. That’s because Anthem Blue Cross does not include any Sutter facilities or docs in their 2014 network (no Marin General, no CPMC). Cigna will only be offering 2014 plans in a limited number of counties. And Blue Shield’s plan will be an Exclusive Provider (EPO) network in these areas – a microscopic network compared to their full PPO, and with no out of network coverage.

In San Francisco, the issue is similar: Anthem is the carrier offering the EPO. And while Blue Shield’s PPO for San Francisco residents will include the Sutter hospitals such as CPMC, it will not include UCSF.  Kaiser, anyone?

As usual, Chris Rauber of the SF Business Times is a day ahead of the national media, and does a good job of outlining the problem in California. He also makes clear a crucial point – it doesn’t matter whether you purchase your individual coverage through Covered California or directly from the carrier. The narrow networks are identical regardless of which avenue you use to get your coverage.

How does this affect me? More and more clients are embracing our strategy of switching to Cigna before the end of 2013. Cigna’s full PPO network is grandfathered in through 2014, and you can live anywhere in California and still qualify for Cigna coverage.  The catch?  You do have to be healthy enough to qualify – medical underwriting still applies for the remainder of the year.

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