Most Doctors (primary care physicians and specialist) in California accept one of the health insurance plans offered by Covered California. Covered California was specifically designed for people who are either permanently or temporarily loosing their health insurance from somewhere like: work coverage, spousal coverage, or Medicaid / Medi-Cal. This is because, the coverage can be started anytime somebody loses their health insurance coverage and can be stopped, anytime they go back to work or get other coverage. The biggest concerns that anybody has when looking at healthcare options is first how much does it cost, second what does it cover and last,  and often the most important, especially for people who have ongoing care is does my doctor or doctors take the plan that I am trying to enroll into . This last question seems like an easy Question to find the answer but in practice it can be exceedingly difficult to figure out. Especially, if  somebody has multiple doctors like a primary care doctor (PCP) and multiple  specialist, This is because on the individual side , that is health insurance for people not getting coverage through work, there are a huge amount of different plan types, different plan levels and different doctors networks that are available, even within the same insurance company. Through Covered California, most doctors in California accept at least one of the private health insurance plans offered though the exchange. But not all of them. Today we are discussing the different types of health plants doctors accept though Covered California and how to tell if your doctors accept the Covered California plan you enrolling into. Please do not forget to like and subscribe 

 What is Covered California 

• Covered California is a state-based health exchange that provides access to health coverage through private insurance
• It includes companies like – Kaiser, Blue Shield, Healthnet, Molina, LA Care and many more. 
• For people who fall within the income guidelines, Covered California will provide subsidy or premium assistance to help ensure that their private health insurance plan cost is affordable
• The general income range for Covered California starts at 138% of the Federal Poverty Level and goes up to 600% of the Federal poverty level
• For example, for a household of 4 in 2020 this would mean people with incomes between $36,157 up to $157,200 annually could apply to get some assistance paying for their monthly insurance premium. 
• If your income is lower, you will get more assistance and pay less,  and if your income is higher than you will get less assistance and pay more

Covered California networks

• One of the most frustrating things about trying to find a health insurance plan that your doctor accepts on the private market is, that there are so many different types of plans
• There are Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and even things like Exclusive Provider Organizations (EPOS) 
• Each plan type will have their own doctors’ network even if they are within the same insurance company 
• For example, if Blue Shield offers and HMO and PPO, somebody enrolling into either of these plans may not have access to the same doctors. This is because in many cases doctors who are apart of doctors’ groups or operating independently will find that a HMO’s , PPO’s or EPO’s work better with their medical practice and also  pay doctors very differently
• Additionally doctors come in and out of networks throughout the year meaning that your doctor could take one plan in the beginning of the year and no longer takes that plan by the end of the year Or takes a different plan all together 
• Doctors usually will limit how many patients they are able to effectively see. This is to ensure they are giving the correct level of attention to each of their patients
• Even though a doctor takes a plan, they may not be accepting new patients

 Some Networks are harder to figure out than others

•  In general, the HMO networks that also provide healthcare services are easier to figure out if your doctor will accept or not
• This means Insurance providers like SHARP or Kaiser who also are affiliated with the hospital networks under the same names tend to have a stable doctors’ networks
• This is because the doctors in these cases are employees rather than independent doctors who contract to accept the insurance for health services
•  If your doctor is at Kaiser, then you must get a Kaiser plan to see that doctor
• You could not get a Blue shield plan if its less expensive and still be able to see that Kaiser doctor
• The drawback to this is you are only able to see doctors within those hospital networks
• If you wanted to go to another doctor, who is not in Kaiser, then you would not be able to do so, with your Kaiser insurance
• The flip side to this is if you go to Kaiser and have a Kaiser plan, then you do not have to worry about if your doctors takes that in durance or not, If they are at Kaiser they will only take a Kaiser insurance 

• On the other hand, if you choose a PPO plan you will have a plethora of doctors to choose from 

• Most doctors in California will accept a PPO plan, but not all of them are in the same network
• This is especially the case if the doctor you are seeing is their own private practice
• The benefit to a PPO is you will be able to see a larger variety of doctors
• PPO’s have doctors who are either in network or out of network 
• If your doctor is network, you will pay less than if your doctor is out of network
• This can be a cause of a lot of frustration because the cost for visits to different doctors can vary wildly depending if they are in network or out
• This is an important thing to keep an eye on when looking at your health insurance options 

 3 step process to be sure your doctor takes your plan

• How do you know if your doctor takes the insurance you are applying for or if they are in network or out of network
• With our clients we usually have three step process to check if a doctor accepts a specific plan, and if they are in or out of network 
• The First step is to check the Covered California doctor finder

• • On the CCA website coveredca.gov there is an option to put your doctors in and see which of all the plans that Covered California offers they take
  • It is a great tool that will show if you if all your doctors take one plan or another
  • Maybe just some of your doctors take some of the plans or maybe even just one of your doctors takes just one of the plans
  • Either way it is a good way to get the initial check out of the way
• Second step is to check the insurance companies’ website
  • Each carrier will have a website with a “provider search” or doctor search
  • Which you can use to put in the plan you are looking at and search the doctor list to see 

• • • What plan they take
    • What network they are in
    • And if they are accepting patients
• And finally, as a last step, we will try to reach out to the doctor office to ask them which plan they take. 
  • This can be tricky because often you will have to talk with the specific insurance department or billing department
  • Often the person at the front desk usually doesn’t know all the ins and outs of which of the 100’s of insurance they probably take

 Conclusion 

• Overall ensuring your doctor is on the plan that fits your healthcare needs best
• Can be a tricky proposition, especially because contracts, networks and doctors can move in and out accepting insurance through out the year
• But if you use the CCA doctor’s finder utilities and the Provider search tools on your preferred insurance carriers website you can get a pretty good idea of whether or not you will be able to see your doctors 

Covered California Doctors Search – www.CoveredCa.com