Transitions in Coverage for Some HealthNet and Anthem Blue Cross of California Members
In 2018, some Covered California members will have fewer health plan options available to them, and some members will need to choose a new plan. If you need to choose a new plan, we will send you information about your new options and how to switch. You can choose a new plan within 30 days of the date on your Covered California renewal notice. To avoid a gap in coverage, Covered California will choose a new plan for you after 30 days. The plan Covered California chooses may be from a different insurance company, but it will have the same benefits and similar copays as your current plan does. If you do not like your new plan, you can switch to a different plan.
Questions About Your Care
Will my doctor be in my new health plan? What if I want to keep my doctor or hospital?
Many doctors, hospitals and other providers are in more than one Covered California health plan’s network. Use the Covered California provider directory search tool to see if the provider is in another plan’s network. Beginning in early October, you can use the Shop and Compare Tool to check if your doctor is in other plan networks. Make sure to choose 2018 as the coverage year. After entering some important information, like your ZIP code, income and household size, enter your doctor’s name and your new plan options will show if he or she is in network.
The Covered California provider directory is updated monthly and may not be a current or complete list of the health plan’s providers. Contact the health plan you are considering for the most current provider directory.
What if I am in the middle of treatment for a complex medical condition?
If your doctor is not in your new health plan, call your new health insurance company to let them know about the treatment.
Depending on the condition for which you are receiving treatment, your new health insurance company may be able to work with your current doctor while you finish your existing treatment. Be sure to tell your current doctor that you have new health insurance.
What if I need prescriptions filled?
Contact your new health insurance company to see if it has received your premium payment and can issue you a membership ID card or a plan identification number, so you can use it at the pharmacy. If you have not yet paid your premium bill, you will not be able to get a membership ID card. While talking with your new health insurance company, ask which pharmacies are included with your new plan. Read more about prescription drug coverage.
When Covered California chooses a new plan for me, will my new health plan cover the same benefits?
Yes, your new health plan will cover the same benefits as your 2017 plan did. These benefits include doctor visits, prescription drugs, emergency services, pediatric care including dental and vision, laboratory services, maternity and newborn care, hospitalization, preventive and wellness care, rehabilitation and mental health and substance abuse services.
Will I pay the same amount when I see a doctor?
In most cases, yes. The new plan that Covered California chooses for you will have very similar copays, deductibles and coinsurance costs for services, since it will be the same metal tier as your 2017 plan.
Although there have been some changes in cost-sharing since last year, all plans in the same metal tier have the same cost-sharing in 2018. In order to receive the same cost share for services, make sure the provider (doctor, hospital, etc.) you choose is in your new health plan’s network. You may not have coverage, or may have higher costs, if you visit a provider who is not in your plan’s network.
Will my new health plan match me with a primary care physician?
Yes, your new health plan will match you to a primary care physician within 60 days of your first payment.
Can I change my primary care physician in my new health plan?
Yes, if you want to change your primary care physician, you can do so at any time by contacting your health plan.
Will my new plan be the same network type?
Not always. The provider network you have with your plan — typically a health maintenance organization (HMO), preferred provider organization (PPO) or exclusive provider organization (EPO) — is identified on your current health plan membership ID card. Each of these network types corresponds to a list of providers offered by your health insurance company who are available to you as part of your plan. Covered California and your new health insurance company will send information that lets you know the network type of your new plan.
The rules on accessing specialists or out-of-network care may differ depending on the network type. For the best information about your new plan, please check the plan’s Evidence of Coverage (EOC), and keep in mind that you can choose a different plan until Jan. 31, 2018. See below for information on how to switch plans, and deadlines for coverage start dates.
What if I’m switching doctors, and I want to share my health information with my new doctor?
Ask your new doctor for a medical release of information form. By filling it out, you authorize your previous doctor to send your information to your new doctor. You may need to pay to send health information to a new doctor.
It is important to make your first payment to your new health insurance company so that the new doctor receives your information. This will help keep any treatment from being interrupted.
Questions About Enrollment
How can I choose my own plan?
Starting on Oct. 11, you can choose a different health plan before we choose one for you. To review your options and make a change, log in to your account.
When will Covered California choose my new plan?
If you do not choose a new plan by mid-November, Covered California will choose another health plan for you so that you will not have a gap in coverage. You may receive a notice from your new plan with information on how to complete your enrollment, which will involve making your first month’s payment. It is important to make that first payment; otherwise, you will not have coverage with your new plan.
Which health plan is Covered California going to choose for me?
Covered California will choose another plan from the same health insurance company for you, if available; however, the network type may be different. If your health insurance company does not have another plan available, Covered California will choose the most affordable, most similar plan option with a different health insurance company, and it may also be a different network type.
Keep in mind that you have until open enrollment ends on Jan. 31, 2018, to choose a different plan.
Once Covered California has chosen a new plan for me, can I still switch?
Yes. If you do not like your new plan from Covered California, you can switch your plan by logging in to your account. The date you choose your new plan affects the date your coverage becomes available. Deadline dates for applicable coverage start dates are as follows:
|Switch plans by:||For coverage beginning on:|
|Dec. 15, 2017||Jan. 1, 2018|
|Jan. 19, 2018||Feb. 1, 2018|
|Jan. 31, 2018||March 1, 2018|
Will my premium go up?
The monthly premiums for your new health plan may be different from your 2017 rates. If you do not like your new premium, you can switch by Dec. 15, 2017, for a Jan. 1, 2018, start date. Please remember that premiums increase with age because many people have greater health care needs as their age increases.
For enrollment questions, you can call the Covered California Service Center Monday through Friday, 8 a.m. to 8 p.m., at (800) 300-1506 (TTY:  889-4500). The Service Center will be available on Saturdays from 8 a.m. to 6 p.m. during a portion of the open-enrollment period. See Covered California’s Service Center hours.
For questions about a doctor or medical care, please call your new health plan. All Covered California health plan member service telephone numbers can be found here.
Health Consumer Alliance
Free local assistance is available if you have concerns about your health insurance company or access to medical care. The Health Consumer Alliance can help you work with your health insurance company, the Department of Managed Health Care and the Department of Insurance. Contact the Health Consumer Alliance at (888) 804-3536 or https://healthconsumer.org.
Department of Managed Health Care and California Department of Insurance
If you are not satisfied after speaking to your health insurance company and would like to file a complaint, you can call the California Department of Managed Health Care at (888) 466-2219. If your health insurance is Health Net PPO or Health Net EPO, call the California Department of Insurance at (800) 927-4357.