November 13, 2016
Area(s) of Interest: Advocacy Health Care Reform
In 2017, Covered California, California's health benefit exchange, enrolled approximately 1.48 million individuals in qualified health plans. With a number of changes set to occur for 2018, it is critical that physician practices understand their participation status, which products are being offered and what changes to expect.
Some of the most significant changes for Covered California in 2018 include:
Anthem Blue Cross, which offered either an EPO or PPO product in all geographic regions in 2017, will exit California’s exchange marketplace in all but three regions for 2018. Citing market instability and changes to federal rules and guidance, Anthem will now only offer an EPO plan in the following regions.
- Region 1: Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Nevada, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne and Yuba counties
- Region 7: Santa Clara County
- Region 10: Mariposa, Merced, San Joaquin, Stanislaus and Tulare counties
Physicians are reminded that the Anthem EPO product does not provide benefits for services provided by an out-of-network provider except in urgent/emergent situations.
Health Net will offer its PPO product in the following five regions for 2018:
- Region 3: Greater Sacramento (certain zip codes)
- Region 15: Los Angeles County, partial
- Region 16: Los Angeles County, partial
- Region 17: Inland Empire (certain zip codes)
- Region 18: Orange County
- Region 19: San Diego County
A Health Net Health Savings Plan will also be added in the regions specified above, excluding Greater Sacramento (Region 3).
Additionally, Health Net will no longer offer its HMO product in the Northern counties (Region 1); Greater Sacramento (Region 3); Santa Clara County (Region 7); and Fresno, Kings, and Madera counties (Region 11).
Two plans will be expanding their footprint this year:
- Blue Shield of California will expand its HMO product in Solano, Contra Costa, Alameda and Ventura counties.
- Oscar is expanding into Northeast Los Angeles.
To help physicians understand how these changes will affect their practice, the California Medical Association has published a new tip sheet, “Surviving Covered California: Preparing for changes in 2018.”