Category Archives: PPO Plan

Blue Shield PPO replaces Anthem Blue Cross

Blue Shield PPO replaces Anthem Blue Cross on January 1, 2018, as the only major medical PPO plan in Santa Cruz, San Benito and Monterey counties, according to statements released by Anthem and Covered California.

Which Counties will Anthem keep?

(Anthem will not offer individual policies in Santa Cruz County. Refer to related story…)

Even Kaiser Permanente is jumping on the chance to add new subscribers in selected zip codes of Santa Cruz county [see related Kaiser Story].

Blue Shield replaces Anthem Blue Cross- Kaiser is an option

Blue Shield PPO replaces Anthem Blue Cross?

“Our readers would ask why is the Blue Shield PPO the best option to replace Anthem?”

According to Covered California’s August 2017 published report, “Covered California’s Health Insurance Companies and Plan Rates for 2018,” Anthem held 39% of its 29,050 individual health policies in Region 9 (Santa Cruz, San Benito and Monterey counties):

Blue Shield PPO replaces Anthem Blue Cross

  • 39% Anthem
  • 34% Blue Shield PPO
  • 8% Blue Shield HMO
  • 2% HealthNet EPO
  • 17% Kaiser Permanente HMO

Effective January 1, 2018, Blue Shield appears to be the only individual PPO plan available through Covered California.  In fairness to HealthNet, they offer an EPO plan.  Request a FREE Free Rate quote between Blue Shield and HealthNet.


Is Blue Shield PPO Really Your Best Option

The 2018 rates are not released yet, but Blue Shield has filed two sets of rates for the upcoming open enrollment, depending on whether or not CSR funding is approved in Washington.

Sample 30 year-old 2018 Premium for Blue Shield’s Silver 70 PPO:
Without CSR Subsidy Funding                    Including CSR Subsidy Funding

$609.49 monthly (2018)                            $562.63 monthly (2018)

To compare the current (2017) year premiums in your county, use this free quote engine.




3 Actions To Keep Affordable Health Coverage- Private Insurance

The previous articles covered Part I and Part II, and this final segment describes the 3rd of 3 Actions To Keep Affordable Health Coverage- Private Insurance. [Small Employers should read about huge penalties beginning August 2015]

  • Going directly to the insurance carrier (Kaiser Permanente, Anthem Blue Cross, Blue Shield of California, Cigna, HealthNet and others) is easier than going through Covered California and the prices are virtually identical under California law.
  • In our opinion, the only reason one would choose the Covered California exchange (Part II of story) over your 3rd option (private insurance) is the likelihood of receiving a subsidy or Advance Premium Tax Credt. Otherwise, CoveredCA is not worth the hassle, due to the burden of providing tax forms, proof of California residency, employment information etc.
  • Deadlines: Regardless of your choice among the 3 Actions To Keep Affordable Health Coverage, the 60 day limit applies.

    Time is of the essence to find or keep affordable health coverage while looking for a new job, and you must take action fast. Read more about Special Events here or request assistance.  

    Need Temporary Health Insurance?   CLICK TO QUOTE

In conclusion of this 3-part article, the easiest part of this process is choosing a plan, and the hardest is getting the triggering loss of coverage form to the carrier (the specific document and method vary by health plan). Don’t risk losing your effective date, use a competent broker who is licensed and certified to help you compare your options under all 3 alternatives above, and will help you submit a properly completed application to the health plan of your choice!

Certified Insurance Agents are a free service to consumers under the ACA and California law. However, the best certified agents will also help you compare your private insurance (PPO, HMO) options vs. your CoveredCA options.  Find a local office of one of these broker-agents, in order to keep affordable health coverage while looking for a job.

Click to return to Part I or Part II of this article.

Everybody’s Happy With Obamacare In California

Need Temporary Health Insurance?   CLICK TO QUOTE

On May 13, 2015, Jamie emailed me late at night to ask what it would cost to change from a Covered California PPO plan and re-enroll directly with the same insurance company, off the exchange. [Check out our latest article for students leaving school]

I asked, “Jamie, it’s the same total premium, either way, but don’t you want to keep your $199 per month subsidy?  “…because you can’t have a subsidy unless you go through Covered California.”

Jamie responded, “My CPA told me we have to re-file my tax return and pay back hundreds of dollars because Covered California sent me a revised 1095-A form on May 1st.”  I offered to help and Jamie completed the Insurance Help Form for 1095-A Questions.

“No problem, I thought.”  I phoned Covered California at the special agent line and was placed in line as number 34.  15 minutes later, Dale answered the phone:  “Dale, your customer received no 1095-A form and was unable to file taxes in early January.  We followed your instructions and filed a 1095-A-Dispute-Form.  As promised, after 60 days (March 31st to be exact), we received the 1095-A form and all the numbers looked correct.”  So Jamie filed her taxes.

“Dale, guess what, on May 1st, CoveredCA issued a “corrected 1095-A form” that is unfortunately incorrect.  In fact, there are zeros in all the boxes.”  The customer is upset, naturally, and is faced with additional tax preparation fees for the amended return.  Dale’s solution:  We need to file a new 1095-A-Dispute-Form and wait two more months.

Being a diligent agent, I pushed back and asked him to look in the system log to see what may have generated a new 1095-A form.  Dale responded with “Medi-Cal has this case under review.”  I asked, “what does that mean? Today is May 14th and the application was enrolled and paid for last December…is there insurance or not?”

Dale suggested he transfer me to another unit in Customer Service who may help further.  So he did…I went back to the end of the line and waited 15 minutes before Valerie picked up.  In the meantime, I phoned the insurance company directly and asked if coverage was in-force.  They said “yes, but Covered California has not yet sent the eligibility information to us…but sometimes they don’t send it if the case renews with no changes.”

I confronted Valerie with this information and she very nicely responded, “our records show the customer has not yet paid the first month (January) premium and that is why we have not sent over the enrollment information.”  (I quickly checked the insurance company’s website and it shows all premiums paid to May 1st).

Valerie was not sure how this could be happening, but also noted Medi-Cal has the case under review since March.  I laughed, “if Medi-Cal has been reviewing this for 1.5 months, then it is going to take them 15 years to get through this season’s new enrollments.”  Valerie responded, “the insured is suppose to contact the local county to help the case worker finish their review.”  “Really, and when did you tell the customer this?”

Valerie said there was an “eligibility determination” in late April and a letter was sent out.  I looked it up on their website and she was right.  It reads,

“Congratulations! You qualify for health insurance through Covered California. You also qualify for up to $199 per month in premium assistance to help pay for your health insurance coverage”

I said (nicely) to Valerie, “let me summarize this.”

  • Covered California never provided a 1095-A form until the customer filed a dispute (which is the only way to get a 1095-A form when it is lost or missing)
  • You issued the correct form in March and the customer filed their taxes
  • In May, you sent a revised 1095-A form for no reason and the client has to pay back the tax credit according to the CPA and pay to re-file the tax return
  • You say there is no person at CovCA who can tell us why this happened, and our only remedy is to file another Dispute form and hope for the best
  • You also say the first premium payment (January) was never paid and therefore you have not sent enrollment data to the insurance company
  • Meanwhile, the insurance company says they are indeed receiving premium payments, but you have never sent them the enrollment data
  • The icing on the cake is you say the case is under review with Medi-Cal for the last six weeks, but nobody has informed the customer to call Medi-Cal to speed it along.  Moreover, the letter you supposedly sent to inform them actually says everything is fine and “congratulations.”

Congratulations!  Everybody is happy with Obamacare in California.

Obamacare Press Releases




Questions About Special Events?  Get Local Assistance Now

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Health Net PPO Plans California

Health Net PPO Plans

Open Enrollment 2015 begins November 15th

Open Enrollment 2015

Health Net has shipped 90-day plan closure notices to Health Net PPO members (see related story about Anthem Blue Cross) in Covered California who are currently enrolled in PPO plans (Individual or Family PPO plans).  These notices shipped October 2nd, as Health Net moves its PPO portfolio off-exchange.  For the time-being, Health Net will not offer an individual or family Health Net PPO plan through Covered California.

What can you do to keep Health Net PPO plan coverage?  Fortunately, you have options… If you wish to keep the same doctor and stay on a similar plan directly (i.e. off-exchange) with Health Net, CLICK HERE to request free assistance.

If you wish to talk with someone to get information about the remaining PPO plans at Covered California, CLICK HERE.

Caution should be observed if you purchased a plan during the last open enrollment:  Effective after this Open Enrollment, Insurers are shifting doctor and hospital networks.  Do not take chances with your policy.  Before you renew, talk with one of our representatives for FREE.

See our related story about Covered California Open Enrollment Notices.

Remember, Open Enrollment begins November 15th:  Changes are coming to certain PPO networks.  If you did not use a Certified Agent last year, now is a good time to find one…they are a free service of Covered California and are here to help.