Covered California

Open Enrollment for Covered California Ends on January 31, 2017

Many Californians without health insurance coverage through their employers are able to purchase it online through Covered California, our state's health insurance exchange. Please use Covered California's Shop and Compare Tool for more information or visit Covered California’s website at www.coveredca.com. Open enrollment for 2017 health insurance plans through Covered California ends on January 31, 2017.

Under the Affordable Care Act, insurance companies are no longer able to deny you coverage based on pre-existing conditions. There also may be subsidies through Covered California to assist you with the cost of healthcare for those who meet the income eligibility requirements.

Access to Hoag is available through the following Covered CA Plans:

  • Blue Shield PPO Bronze, Silver, Gold or Platinum Plans
  • Blue Shield PPO Bronze Plans on Small Business Health Options Program (SHOP) Exchange
  • Blue Shield of California HMO (Trio)
  • Oscar EPO
  • Hoag will remain a Tier 2 provider for Anthem Blue Cross PPO through December 31, 2016.

Please note that Hoag will be out of network for any Covered California plan that is NOT listed above.

You can access Hoag through individual health plans outside the exchange as well.

The following guide helps answer frequently asked questions:

What exchange-based health plans is Hoag participating in?

Access to Hoag is available through the Blue Shield PPO Bronze, Silver, Gold or Platinum Plans, Oscar EPO, and Blue Shield of California HMO (Trio). And for small business through Small Business Health Options Programs (SHOP) Blue Shield PPO Bronze Plans. 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?

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. To learn more about subsidies visit Covered California's website at www.coveredca.com.

How does the Health Exchange affect me if I currently use Medicare or Medi-Cal?

If you have insurance through Medicare then changes to individual insurance (Covered CA) may not apply to you; however we encourage you to contact the Hoag Personal Service Team to ensure your ongoing access to Hoag 800-400-HOAG (4624).

Medicare:

Medicare plans change annually so if you are a current Medicare member or new to Medicare this year, you can direct questions to www.medicare.gov or call 800-MEDICARE (800-633-4227).

If you currently access your Medicare health insurance through your employer please click here.

Hoag offers community education classes to assist with Medicare enrollment and finding the plan that best fits your needs.

Medi-Cal:

Medi-Cal is California’s state program which offers medical services for children and adults with limited resources. Eligibility requirements for Medi-Cal are currently expanding. To check eligibility or for a list of participating physicians please go to www.dhcs.ca.gov or call 800-541-5555. 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 2017?

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.

How can I find out more information?

You can visit the Covered California website at www.coveredca.com​​ or call 800-300-1506.