Anthem Blue Cross of California
Anthem Blue Cross is one of the largest managed health care companies in California. It is an independent licensee of the Blue Cross Blue Shield Association based in Thousand Oaks, California. Anthem and its affiliates serve over 8 million Californians and have offered Covered California plans since 2014.
Anthem is pleased to announce that we are expanding our participation in an additional six regions for 2020. In addition to currently offering plans in regions 1 (Northern California counties), 7 (Santa Clara County), and 10 (San Joaquin, Stanislaus, Merced, Mariposa and Tulare counties), Anthem will also offer plans in regions 9 (Santa Cruz, San Benito and Monterey counties), 11 (Fresno, King and Madera counties,) 12 (San Luis Obispo, Santa Barbara, and Ventura counties), 15 (Los Angeles County East), 16 (Los Angeles County West), and 17 (Inland Empire).
Anthem is working with doctors and hospitals that share responsibility for increasing access to appointments, improving the member experience, and providing a more coordinated treatment plan to patients.
We also want to help our members spend more time focused on their health and less time managing the ins and outs of health care. That’s why Anthem is driving meaningful change through technology to deliver an easier to use, more complete web and mobile health care experience.
Anthem’s new pharmacy benefits manager, IngenioRx, not only manages Anthem drug plans, it also offers better support to our members. This means members will have around-the-clock access to teams of specialists, online tools that can be used at home or on the go, and the ease of managing health and drug plans in one place.
Mobile and Online options Meet Sydney, Anthem’s new mobile app designed to provide members a more personal, simplified experience. Along with quick access to their Digital ID card, Find a Doctor, and a Personal Goal Setting tool, members can also use the new ChatBot to help guide them on the app, and try the new Care Team set up feature, too. And at anthem.com/ca, members can find all the same features built with easy access and personalization in mind as the mobile app and much more.
24/7 Access with Telehealth Anthem’s LiveHealth Online telehealth program gives members access to real-time, face-to-face visits with a choice of doctors across a range of specialties via computer, tablet or mobile phone 24 hours a day. Available in both English and Spanish, doctors can answer questions, diagnose common problems, and even prescribe some medications.
A deductible is the amount that you have to pay for your health care each year before your insurance starts paying for your care. Similar to car insurance, many health plans require you pay a certain amount out-of-pocket before the coverage kicks in. For example, if you have a deductible of $1500 you have to pay the first $1500 of your medical costs before your insurance starts paying. In some plans the deductible applies only to services that you get outside of the provider network. Also, some plans have a separate deductible for prescription medications. Usual deductible does not apply for preventive services.
The money that you pay out-of-pocket for the services that you receive. This could include anything from an office visit to the doctor, prescription medicine, an x-ray, or even a hospital stay.
Now if the money you pay is a set amount that would be called a co-payment or a copay. If the money that you pay is a percentage of the cost then that would be called coinsurance. Now depending on the plan that you have it dictates whether you have a co-payment/copay or coinsurance.
Health insurance is divided into four main categories. Each category has the name of a metal, the more expensive the metal the more expensive the premium but the richer the benefits. Bronze for example covers 60% of your medical expenses it is also the least expensive premium. Silver covers 70%, Gold covers 80% and Platinum, the most expensive tier, covers 90%.
A health insurance premium is the amount of money you pay per month to the health insurance carrier. Now, you either pay by the month of you pay it per pay period depending if you get it through your employer or not.
If you get it through your employer, your employer most likely covers a portion of your premium.
If you get your insurance through either Covered California or through the exchange in another state then you most likely get an Advance Premium Tax Credit, that's where the Federal Government pays a part of your health insurance premium for you.
If you are not on the exchange and you buy directly through the carrier then you're paying 100% of the premium yourself.
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HMO - Health Maintenance Organization
An HMO is a type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. You will usually need a referral from your Primary Care Physician to see a Specialist, resulting in multiple co-pays. All healthcare services are managed in-network through your Primary Care Physician.
In California, the popular HMOs are Kaiser Permanente, Sutter Health Plus, Western Health Advantage, Health Net of California, Sharp Health Plan, LA Care, Molina Healthcare, and Valley Health Plan.
PPO - Preferred Provider Organization
A PPO is a type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost. PPOs do not require you to select a Primary Care Physician. One of the benefits of a PPO is you usually can self-refer to a Specialist.
In California, the popular PPOs are Blue Shield of California, Health Net Life Insurance Company, and Oscar.
EPO - Exclusive Provider Organization
A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency). Under an EPO plan you do not choose a Primary Care Physician. You can receive care from any of the in-network doctors and self-refer to in-network specialists.
In California, the popular EPOs are Anthem Blue Cross, Health Net Life Insurance Company, and Oscar.
If you want to discuss options about your health insurance, we recommend speaking with an independent insurance agent like George Beach Insurance Services. We work for you the client, and not a particular big company.