Questions? We have some helpful answers.

With Covered California now part of our healthcare delivery system, there are plenty of open ended questions about how it will affect private practice medicine. We’ve curated a list of Covered California frequently asked questions below for you to review and learn more about this important shift in healthcare.

Looking for more answers?

Please download and view a helpful Covered California Update by Ted Steuer.

What is Covered California?

Covered California is the State’s healthcare exchange, created to provide healthcare coverage to those citizens who currently do not have healthcare coverage through their employer or purchased privately. It was created in response to the Affordable Care Act, and is frequently considered California’s version of “Obama Care”

Who Qualifies for Covered CA?

All residents of the State of California are eligible, including children.

Has Physician Partners involved me in any Covered California contracts?

No. None of the Physician Partners contracted payers are participating in Covered California.

What are the plans being offered in San Diego?

The health plans being offered in San Diego County are:

  • Anthem Blue Cross EPO & HMO
  • Blue Shield PPO
  • Health Net PPO & HMO
  • Kaiser Permanente HMO
  • Molina Healthcare HMO
  • Sharp Health Plan HMO (co-pay, or coinsurance)
What will patients say?

Patient payment will vary depending on the plan they choose. There are 4 plans: Bronze, Silver, Gold & Platinum. Patients are responsible for 40% of the reimbursement amount in the Bronze plans, 30% under the Silver plans, 20% under the Gold Plans, and 10% under the Platinum plans.

Aside from 1 free preventive care visit, patients have co-pays, in addition to their % of responsibility until they reach their maximum out of pocket for the year. The maximum out of pocket also varies according to the plan the patient chooses. And patients will pay premiums every month to maintain their coverage. Premiums also vary depending on the plan, with higher premiums affording lower out of pocket maximums, or lower deductibles.

Where do patients go to sign up?

Patients can sign up by going to the Covered California website, and clicking on the Shop & Compare tool at coveredca.com

What is the enrollment date?

Patients had until December 27th to enroll for coverage effective Jan 1, with payment due by Jan. 6. For those who missed the January 1 deadline, sign-ups are ongoing through the end of March, 2014. Signing up on or before the 15th of each month will make the plan effective the first of the following month.

What if people don't enroll?

If people don’t enroll, or have healthcare coverage, penalties will be assessed on their 2014 income tax and collected by the IRS. Penalties vary depending on annual income and tax filing status.

What is the impact of these changes?

At this point, it’s hard to determine how this change will affect physician practices. We’ll continue to monitor and update our website regularly, so check back frequently for the latest information.

Where can I get more information?

Please visit the Covered California website at - www.coveredca.com