Health Insurance Explained: Is My Doctor on Covered California?

hi I'm Michael and this is California and right now with the reemerging pandemic and the potential second lockdown there are a lot of people who are reaching there last week of health coverage through their work and looking at what are their health care options through the California health exchange or as we call it covered California now covered California is specifically designed for people who are either permanently or temporarily losing their health insurance from somewhere else so like from their work coverage or their spousal coverage or maybe Medicaid or Medicare or even from their parents

coverage this is because the coverage can be started at any time you lose your health insurance coverage it can be stopped at any time you go back to work so it's not something you have to have for a set period of time now one of the biggest concerns that people have when they're looking at their health care options is one how much does it cost - what does it cover and three and lastly most important especially for those folks who have ongoing care is does my doctor all my doctors take the plan that I'm trying to enroll into through covered California now this last one seems like an easy question to find the

cancer but in practice it can be very difficult to figure out especially if you have multiple doctors like a primary care doctor a PCP and multiple specialists this is because on the individual side health insurance for people not getting health insurance to do work there are a huge amount of different plan types plan levels and different doctors networks even within the same insurance company luckily it's through covered California most doctors in California accept at least one of the private health insurance plans offered to the exchange but not all of them so today we are discussing the different

types of health plans doctors accept through covered California and how to tell if your doctor accepts your covered California plan that you're trying to enroll into now before we do that if you like this information if you find interesting if you find it helpful please don't forget to Like and subscribe now you can get updates when our newest and most informative videos become available so let's talk a little bit about covered California so covered California is a state-based health exchange that provides access to health coverage through private health insurance to anyone who lives in

California regardless of their income so it includes plans like Kaiser and Blue Shield and Health Net and Molina and LA care and a whole lot more now for folks who fall in the income guidelines cover California will provide subsidy or premium assistance to help ensure that the private health insurance plan costs are affordable now the general income range for covered California starts at 138 percent of the federal poverty level goes all the way up to 600 percent from the federal poverty level so for example for a household of four in 2020 doesn't mean

people's incomes between $36,000 a year and 157 thousand dollars a year could apply to get some help paying for their health insurance plan now of course if your income is low you'll get more assistance and you'll pay less if your income is high then you'll get less assistance and you'll pay more and if your income is below the minimum income amount you can still submit an application through covered California but your info be sent as a referral to your local county to enroll you in the medical and less you specifically request that it does not now medi-cal is a government-run health

insurance plan and is completely different from covered California and will save the medical discussion for another video because there's a lot there so in this beer we're only discussing private non government run plans that are offered through covered California one of the most frustrating things about trying to find health insurance plan that your doctor accepts on the private market is that there are so many different types of plans there are HMOs which are health maintenance organizations there's PPOs which are preferred provider organizations there's even something called an EPO which is an exclusive provider organization in each

plan type will have their own doctors networks even if they are within the same insurance company so for example if Blue Shield has a health insurance plan they have HMO and they have a PPO and someone who rolls into either of these plans they will not necessarily have access to the same doctors this is because in many cases doctors who are part of doctors groups or operating independently will find that HMOs or PPOs or even apos work better with their medical practice and also pay doctors very differently additionally doctors can come in and out of networks

throughout the year meaning that your doctor could take one plan at the beginning of the year and then at the end of the year not take that same plan or takes a whole different plan all together now finally doctors usually will limit how many patients they're able to effectively see this is to ensure that they're giving the correct level of attention to each of their patients so even though a dog takes a plan they may not be accepting new patients because they already have too many patients to take care of so these are just a few quirks of the individual health insurance market and

you may experience this when you're trying to find out if your doctor takes the plan that you're looking to switch into through covered California some networks are harder to figure out than others and in general HMO networks that also provide healthcare are easier to figure out if your doctor will accept your plan or not this needs insurance providers like sharp and San Diego or Kaiser who are also affiliated with the hospital networks under the same names and they tend to have a more stable of doctors list this is because the doctors in these cases are actually employees rather than independent doctors who

contract to accept the insurance for health care services so for example if your doctors at Kaiser then you must get at Kaiser plan in order to see that doctor you could not get a Blue Shield plan even if it's less and still be able to go see that Kaiser doctor so the drawback is that you're only able to see a doctor within those hospital networks but if you want to another doctor who is outside of Kaiser it then you would not be able to do so with your Kaiser insurance now on the flipside to this it could also be that if you have Kaiser and you have a Kaiser plan you don't really have to worry about if your

doctors in network around a network if you go to a Kaiser facility they're gonna take that Kaiser plan so that makes things a lot easier on the other hand if you choose a PPO plan you'll have a plethora of doctors to choose from in most doctors in California will accept a PPO plan but the issue is that not all of them are on the same network especially that doctor you're saying is in a private practice or has our own office so the benefit to a PPO is you'll be able to see a larger variety of doctors from doctors at large hospitals all the way down to your neighborhood independent practice doctors but PPOs

have doctors networks that are in networks can out of networks and your doctors in network you will pay much less than if your doctor is out of network this can be the cause of a lot of frustration because the cost of visits from different doctors can vary wildly depending if they're in network or if they're out of network this is an important thing to keep in mind when you're looking at purchasing a health insurance plan through covered California so the big question is how do you know if your doctor takes the insurance you're applying for or if they are in network or out of network with our clients we usually have a

three step process to check the doctor to see if they accept the plant and if they're in or out of network the first step that we do is to check with the covered California doctors findings so all the CCA website coverage ca.gov well I'll put it down below there is an option to put it in your doctor's and see which of all the plans are offered through covered California that they take it's a great tool that will show you if all your doctors take one of the plans maybe some of your doctors take some of the plans or maybe just one of your doctors only takes one of the plan either way it's a good way to get that initial check out of the way the second

step is to check the insurance company's website now each carrier will have a website with a provider search or a doctor's search and you can use this function to put in the plan that you're looking at and putting the doctors less that you have and you can see what plan they take what network they are in or out of as well as if they are accepting new patients or not and finally as the last step we'll try to reach out to the doctor's office to check with them to see which plans they actually take now this can be a little bit tricky because oftentimes you'll talk to the person at the front desk and they're not usually versed on the hundreds of plans they

usually take so you have to talk either to the billing department or the insurance department specifically overall insuring that your doctors on the plan that best fits your healthcare needs can be a tricky proposition especially because contracts networks and doctors move in and out of accepting insurance throughout the year but if you use the CCA doctor finder utility and the provider search quality of preferred insurance carriers website you can get a pretty good idea of whether or not you'll be able to see that doctor if you choose that health insurance plan thank you so much for watching our videos I hope that you found them interesting or

helpful or at least useful if it did please don't forget to Like and subscribe now way you can get updates when our newest and most informative videos become available also if you have any comments or questions leave them down below we'd love to see your comments and questions and we'll be happy to make a new video or a new post as soon as we can and also we here at California we know health insurance so whether it's private health insurance or covered California or Medicare or Medicaid or Medicare or even health insurance for a small group we know health insurance so if you have a question about your health care you can

leave those down below we can help you with that as well other than that I'm Michael in this is California wishing you a happy healthy day