03 Nov 2014

Covered California: Health Net Network Changes

03 Nov 2014

For those of you enrolled with Health Net through Covered CA, you have received notices from both entities, letting you know that Health Net will no longer be offering a full PPO plan in 2015 through Covered California. Health Net was one of the only carriers to keep their full PPO network in 2014, which is why it made sense for many people to choose one of their plans. It meant access to both the UC hospital system and Sutter Health doctors and facilities, including Palo Alto Medical Foundation, CPMC, etc.

Health Net will still be an option through Covered CA in 2015, but with new networks of providers: an EPO (exclusive provider organization – basically a PPO without out of network coverage) in Northern CA and an HMO-like network in SoCal. These networks have not yet been approved by the State, nor published for searching, but we expect both of them to be significantly smaller than the large, 2014 PPO network.

I know that this can be a stressful situation and many of you are looking for guidance. With the information available right now, here are my best recommendations for you:

1. Be patient. Specifically, I recommend waiting until several weeks in to the open enrollment period that begins November 15, before making any decisions. It is likely that we will have much more complete information about the new networks after Thanksgiving. Please consider contacting my office manager and client advocate, Madhu Macrae, to schedule a call with me for the first week in December.
You will be able to make plan changes up to December 15 for a January 1 effective date.
macrae@allpointe-is.com or (888) 992-2244 x5

2. Take a close look at your projected income for 2015. Will you still qualify for a tax credit? A single tax filer with more than $47,000 in adjusted gross income will not qualify for a tax credit. For 2-person tax households, the threshold is about $63,000. For 3- and 4-person households, the thresholds are about $79,000 and $97,000 respectively.

No tax credit, no Covered CA. There are many more choices available outside of Covered CA, including:

  • Health Net PPO plans
  • Assurant Health plans which use Aetna’s wide PPO network. Assurant will offer the largest network available to California individuals and families in 2015.

Small tax credit, your choice — are you willing to give up a credit of say, under $100/month in order to have access to plans with a better network?

3. If you will still qualify for a significant tax credit. This is where we will really need to get down to the nitty gritty details of the available options. What will work best for you inside of Covered CA?

  • Health Net EPO/new network – still TBD
  • Anthem Blue Cross – no Sutter Health, Stanford hospital, or PAMF
  • Blue Shield of CA – no UC hospitals
  • Kaiser – completely closed system (but worth considering for some)

I hope this helps to lay out a path forward for your upcoming health insurance decisions. Please consider scheduling a call for late November / early December by contacting Allpointe’s office manager and client advocate, Madhu Macrae by email or call (888) 992-2244 x5.

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