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    • One Hoag Drive,
      P.O. Box 6100
      Newport Beach, CA
      92658-6100
    • 949-764-HOAG (4624)
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Covered-California-Hoag-Hospital.jpg

Covered California

Many Californians without health insurance coverage through their employers are able to purchase it online through Covered California, our state's health insurance exchange.

At Hoag Medical Group, we understand that you may have questions about how the program works. The following guide helps answer frequently asked questions:

What exchange-based health plans is Hoag Medical Group participating in?
​Access to Hoag Medical Group is available through Blue Shield PPO Bronze, Silver, Gold and Platinum and Health Net Bronze PPO. All other exchange plans are subject to "out of network" benefit and physician referral. Visit the Covered California website at www.coveredca.com​ to apply and ensure your access to Hoag. 

Who qualifies for a subsidy to help pay for premiums?
Those who earn between 138 percent and 400 percent of the federal poverty level qualify. This year, that would be up to $44,680 for an individual and $92,200 for a family of four. Subsidies vary based on income and family size, and are in the form of tax credits that will be advanced, meaning that each month you will only have to pay that part of the premium that is not subsidized. 

What type of plans are offered?
Four main types are offered -- bronze, silver, gold and platinum -- with bronze providing the least amount of coverage and platinum the most. As you move from bronze to platinum, premiums rise, but your coverage improves and out-of-pocket costs go down.

Does the exchange take the place of Medi-Cal?
​No, Medi-Cal is a different plan and is generally less expensive than the exchange for an individual or family. However, you must be eligible for Medi-Cal. To see if you are eligible for Medi-Cal, go to www.benefitscal.org

How much do people pay if they don't have health insurance?
Most citizens and legal residents are required to have coverage or pay a penalty. Some people may be exempt, including those who are uninsured for less than three months or who have to pay more than 8 percent of their household income for premiums. 

What are the essential benefits health plans must provide in 2014?
Physicians and other ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse services (including behavioral health treatment), prescription drugs, rehabilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatrics services including oral and vision care.

Are there any options to ensure access to Hoag Medical Group outside the exchange?
Yes. In addition to the plans offered through the Covered CA Exchange which are also available through an individual family plan or broker, members may access Hoag Medical Group through Cigna Local Plus along with the additional Health Net PPO Plans (Silver, Gold and Platinum).

​How can I find out more information?
You can visit the Covered California website at www.coveredca.com​​ or call 800-300-1506.  Representatives are available Monday - Friday 8a.m. - 8p.m. & on Saturdays 8a.m.- 6p.m.