Open Enrollment for Covered California Ended on January 31, 2016
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 2016 for more information or visit Covered California’s website at
www.coveredca.com. Open enrollment for 2016 health insurance plans through Covered California
ended on January 31, 2016.
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
- Anthem Blue Cross PPO**
** Hoag is a tier 2 participating provider for Anthem Blue Cross PPO; however,
patients may have higher out-of-pocket expenses for certain elective services
under this plan. Hoag Medical Group physicians are NOT participating providers
for Anthem PPO. Hoag Affiliated Physicians may be participating providers,
so please contact your physician to verify.
The Orange County community can access Hoag through
individual health plans outside the exchange as well, including Health Net Silver, Platinum and
Gold PPO, and Cigna Local Plus.
At Hoag, 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 participating in?
Access to Hoag is available through the Blue Shield PPO Bronze, Silver,
Gold or Platinum Plans, Oscar 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?
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 -- bronve, 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.
How does the Health Exchange affect me if I currently use Medicare or Medi-Cal?
If you have insurance through Medicare, 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).
With all of the changes that took place in 2014 through Covered CA, it
was likely that your Medicare coverage was unaffected. Medicare plans
do 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
Hoag offers community education classes to assist with Medicare enrollment
and finding the plan that best fits your needs.
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
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 2015?
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 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 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 8 a.m.
- 8 p.m. & on Saturdays 8 a.m.- 6 p.m.