August 04, 2016
Area(s) of Interest: Payor Contracting Payor Issues and Reimbursement Practice Management
Covered California, the state marketplace for health insurance under the Affordable Care Act, recently announced the qualified health plans that were approved to offer coverage in the exchange market for 2017. All of the plans that offered coverage in 2016 will continue to do so in 2017. Three of the plans will also be expanding into new regions this year.
- Molina is expanding its HMO coverage into Orange County (region 18) through delegated relationships with Monarch and Heritage Network.
- Oscar is expanding its EPO coverage into San Francisco (region 4), Santa Clara (region 7), and San Benito, Santa Cruz and Monterey (region 8).
- Kaiser is expanding into Santa Cruz and Monterey through collaboration with Watsonville Community Hospital and Dominican Hospital for inpatient and ambulatory specialty care. Kaiser plans a phased expansion to include the opening of three medical offices in January 2017 and a specialty hub for enrollees to be added by 2020.
For a complete listing of plans and product types offered by region, see the Covered California 2017 Plans Booklet (see page 31) at www.coveredca.com.