California is known for laid-back lifestyle, environmentalism, technology, entertainment and high cost of living, among many other things. It can also be one of the healthier places to live in the United States, with an abundance of locally grown food and outdoor activity in its temperate climates.
California residents have a variety of quality medical insurance companies to choose from, including Aetna, Anthem Blue Cross, Blue Shield of California, Cigna, HealthNet, HealthNet California Farm Bureau and Kaiser Permanente.
For such a large state, the overall level of health is decent in California. UnitedHealth Foundation ranked the state number 24 in 2011 for health. Though the number of smokers is decreasing, the number of overweight and obese adults has increased over the past decade.
Also, the diabetic population has increased over the past ten years in California. There are also a large number of uninsured individuals in California, 7. 1 million, as recorded last year. With these and other factors taken into consideration, the state is unfortunately predicted to see a decline in overall health in the future.
If accessibility to healthy foods and activities were more widespread, it could help those with illnesses. High quantities of air pollution is still prevalent and detrimental to those living near it, which can only be helped by using transportation alternatives (like walking and biking) and taking precautions as to what gets released into the environment.
Health Insurance Plans
- Open Access Managed Choice plans are available in several types: high deductible, value, and HSA compatible. These plans are used in conjunction with Aetna’s Preferred Provider network, or you may seek care from an out-of-network provider. PPO plans offer flexibility, and discounted rates on services within the network. Preventive care is covered at 100% when using an in-network provider, which includes routine physicals and GYN exams. Most major medical services are covered after you have met your deductible, with coverage varying based on the plan you have chosen. HSA compatible plans allow you to use tax-free funds from a health savings account on medical expenses. Some plans are also eligible for a dental coverage option.
- Preventive & Hospital Care plans have more basic coverage (as the name suggests) limited to preventive care services before your deductible has been met. After your deductible is reached, you can receive medical care for injuries and illnesses for a coinsurance payment. Some of these plans also qualify for use with a health savings account, which can be useful when you need to meet your deductible sooner, pay coinsurance, or save for the future in case of emergency.
Anthem Blue Cross of California
- ClearProtection and CoreGuard are PPO plans with a variety of deductibles, low monthly premiums, prescription coverage, and preventive care covered at 100%. You also have various options of coinsurance coverage levels to choose from. With ClearProtection Plus plans, you have immediate benefits on your first two doctor’s office visits, and two deductibles that work together to help you meet your out-of-pocket maximum. Once your out-of-pocket maximum has been met, the plan will cover most services in full.
- SmartSense is a basic coverage PPO plan, with a variety of deductibles to choose from, and no charge for preventive care with an in-network provider. Doctor’s office visits are available for a copay for the first three visits, and prescription drugs are also covered with a copay specific to the tier under which it falls. Outpatient surgeries, inpatient hospital care, and maternity care are all covered before meeting your deductible for the coinsurance level of your choice.
- Lumenos HSA plans are high deductible PPO plans, compatible with a health savings account, with which you can save or use funds for medical expenses. These plans have a range of coverage options available for a percentage of coinsurance before your deductible has been met. Preventive care is covered in full – including routine physical exams and GYN exams, as well as well baby care. Hospitalizations and emergency room care are some of the services you will receive through one of these plans.
- HMO plans are available in several types, which includes Saver, Select, and Individual HMO. These plans are budget-friendly and act similarly to an HMO provided through group health insurance through an employer. If you are familiar with having a plan that works with flat copays for in-network services, and having a primary care doctor facilitate all of your medical care, an HMO may be a good choice. Anthem Blue Cross has a network of nearly 315 hospitals and over 37,000 doctors in California, and a lower cost option with over 20,000 in-network doctors.
- PPO Share Plan from Anthem Blue Cross offers doctor’s office visits and prescriptions for a copay, as well as many services available before deductible for a percentage of coinsurance. Unlike many plans, the PPO Share Plan has maternity coverage, as well as inpatient and outpatient hospital care. This plan also gives you the flexibility to use in-network doctors and facilities for a much lower rate, though you can choose any provider you like, regardless of network affiliation.
Blue Shield of California
- PPO plans available through Blue Shield include Shield Secure, Shield Saver, Shield Spectrum and Shield Wise. These plans have many choices of deductibles, and once you have met the deductible, you pay a percentage of coinsurance (outlined by which plan you choose) for most medical care. You will receive significant price breaks with in-network providers, though you have the ability to use out-of-network providers depending on your preference. Some of these types of plans qualify for a health savings account.
- HMO plans are convenient, easy to use plans for individuals who would rather have copays and one network of providers to select from, as well as a primary care physician to oversee their care. There is a copay for doctor’s office visits, X-rays and lab work, emergency room services, home health care, and mental health services before deductible. After the deductible has been met, more services are available for a copay. Preventive care is covered immediately at 100%.
- Open Access plans are PPOs available in two types: Value, and Individual PPO. These plans are available in a range of deductibles and coinsurance options to fit your budget. Most services will be covered immediately when your plan starts, and you will pay the coinsurance amount agreed upon with the plan you choose. Cigna’s Preferred network offers preventive care covered at 100%, as well as the option of using out-0f-network providers. Prescription drugs are covered for both retail and home delivery pharmacy on generics and brand names.
- Health Savings plans are high deductible plans with no charge after you meet your deductible on most major medical services and routine care. Preventive care such as annual physical exams and well-child care are covered completely (when you use in-network providers) as soon as your plan begins. These plans have an integrated medical/pharmacy deductible, and coverage on many forms of medical care that other companies do not offer, such as mental health care and skilled nursing facilities. Coverage is available at 100% for in-network services, and 50% for out-of-network.
- PPO plans available through Health Net’s preferred provider network also allow you to receive out-of-network care. Members of the California Farm Bureau have access to PPO plans with 100% in-network coverage, with the option of a standard plan or an HSA-qualified plan. Standard CFB plans come with deductibles of either $4,000, $6,000 or $7,500. Plans with a health savings account can help you to meet your deductible sooner or save for future medical needs.
- HMO plans from Health Net are similar to an employer-sponsored health plan, with a convenient copay for many services. Such services include doctor’s office visits, prescription drugs, vision and hearing exams, maternity care and outpatient hospital services. These plans also give you access to a large HMO network, and make it easy to receive care with a primary care doctor to organize all of your treatment.
- Copayment plans that give you access to Kaiser Permanente’s HMO network, with services such as doctor’s office visits, lab work, and prescription medications available for a simple copay. Other services can be paid with a copay from the beginning of your plan as well, such as inpatient hospital and maternity care. Preventive care is covered at 100%, and you will have a primary care physician responsible for referring you to any other network providers.
- Deductible plans are also HMOs, with similar qualities to the copayment plan above, but with a more comprehensive level of coverage. Because these plans have higher deductibles, major medical care such as hospitalization, maternity care, and outpatient surgery are covered in part by your plan, and you pay the remainder in coinsurance. Certain services like ambulance, X-ray and emergency care require you meet your deductible before they are covered.
- HSA Deductible plans are high deductible plans with the option of opening a health savings account (HSA) for tax-advantaged funds to use on health care costs. Preventive care is available immediately after your plan becomes effective for no cost. Once you have met your deductible, you will have access to a wide variety of benefits for a set copayment, such as inpatient hospital care, maternity, and prescription drugs. Doctor’s office visits are covered at 100% after deductible.
Public Health Options
California has a well-funded state health department, with many services to be utilized by any qualifying resident. Whether you have been turned down for a health plan from a private insurer, or have health insurance and need extra assistance for a certain condition, there is a public program that may be able to help. Medi-Cal is the most n0table, which is California’s Medical Assistance program (or Medicaid). There are many programs within Medi-Cal to help families, pregnant women, women with breast and cervical cancer, and individuals with disabilities and low-income. For a full list of public health services in California, please refer to the California Department of Public Health site. Below are a few key public programs in the state of California.
- Medi-Cal: health care coverage funded by the state for low-income families, children, pregnant women, individuals with disabilities, blindness, the elderly and other eligible persons.
- Family PACT: comprehensive family planning services for California residents with low income
- AIDS Drug Assistance Program (ADAP): assistance for individuals with HIV/AIDS who are uninsured and under-insured, making sure they have proper medications to treat their condition
- Women Infants and Children Program (WIC): provides access to nutritious foods and education on health living for women, infants and children with low income
Health Insurance Laws
California has been kind to its residents by passing new legislation stating that regardless of the outcome of the Supreme Court health care reform ruling, they have passed a law permitting individuals with pre-existing conditions to receive health insurance from all insurers without rejection. While other states have to wait until 2014 for pre-existing conditions to become insurable, California is on the cutting edge. These new laws make sure such individuals will qualify for health plans with any California insurer, and cannot be issued an elimination rider or any exclusion periods. This means insurance companies are required to pay for the treatment of pre-existing conditions (if necessary).
Since the law has only been in place for several weeks, high-risk pool programs are still in place and can be utilized by those who qualify. The Pre-Existing Condition Insurance Plan is still available to individuals who have been rejected by private health insurers for having a pre-existing condition. If you have been denied a health plan by a private insurer and are waiting for the new provisions to be enacted, you can look at PCIP pricing in your area by filling out a quote.
Under the HIPAA law, all insured residents of California must be guaranteed renewal of their health plan when their coverage expires. The guaranteed renewability provision also secures an individual’s plan from being terminated in case of getting an illness while their policy is active. As long as the policy-holder is paying their premiums, copayments, and has no outstanding claims, they must be offered the same plan for another term.
HIPAA also protects the transfer of personal medical data from one provider to another, ensuring the patient is informed of the information release occurring. Every insured individual has the legal right to know when their medical history, provider information, and contact information is being sent to another source according to this regulation. If the process does not take place in front of you with a consent form to sign, the provider must contact you to let you know when your information is being used.