Covered California Provider Networks

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The California exchange (Covered California) is offering 12 health plans to Californians and small businesses to purchase affordable health insurance. The ACA (Affordable Care Act) requires all people/residents/citizens to have health insurance or pay a penalty of 1% of income or $95 dollars whichever is lower.  Covered California is a web-based marketplace for health coverage.

A recent article by the Los Angeles Times explores the hidden costs of Covered California’s affordable coverage.

Health plans bidding for participating in Covered California had many requirements about provider networks (credentialing, access to care, quality, etc.) but were allowed flexibility on the provider network model.  Covered California plans will offer a variety of provider networks –

  ✓ comprehensive HMO networks

  ✓ narrow HMO networks (30-50% of full HMO network primary care physicians),

  ✓ comprehensive PPO networks,

  ✓ narrow PPO networks (up to 50% of full PPO network physicians)

  ✓ EPO networks

  ✓ Regional networks

It will be important for Californians accessing Covered California for health coverage to take a careful look at the provider network associated with the health plan they are considering.

Click here to view the article