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    Covered California Frequently Asked Questions

    Sutter Health’s Participation in Covered California

    Patients can access our affiliated hospitals and medical group doctors by choosing the following products available through Covered California:

    • Blue Shield: Most Sutter Health doctors and hospitals participate in Blue Shield’s Individual and Family Plans. In Alameda County, we participate in Blue Shield’s Access Plus HMO plan available in the Small Business Health Options Program (SHOP).
    • Health Net: Most Sutter Health doctors and hospitals participate in Health Net’s Individual Plan and Health Net’s PPO Plan in the SHOP.
    While some of our hospitals participate in Anthem Blue Cross' individual Pathway EPO product, our affiliated medical group doctors do not. Participating hospitals include: Alta Bates Summit Medical Center, California Pacific Medical Center, Memorial Hospital Los Banos, Novato Community Hospital, St. Luke’s Hospital, Sutter Lakeside Hospital, Sutter Amador Hospital and Sutter Coast Hospital.

    It’s important to note that not every health plan and product is available in every county in California. Please view the Accepted Health Plans list on our website and check with your health plan to verify details of coverage.

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    What is Covered California?

    Beginning Oct. 1, 2013, Covered California is the state's established health exchange—the marketplace to go to for Californians to purchase health insurance. You can shop online, over the phone or in person to find and compare the health care insurance options available to you.

    Individuals can also learn if they qualify for federal financial assistance that can lower the cost of health insurance. In addition, individuals can find out if they qualify for health programs like Medi-Cal.
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    Who can use Covered California to purchase insurance?

    Legal residents of California without access to affordable health insurance through their employer or another government program can purchase health coverage through Covered California.
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    When can I purchase coverage through Covered California?

    Enrollment in health plans through Covered California began Oct. 1 and continues until March 31, 2014. You must purchase health insurance during this open-enrollment period in order to obtain coverage in 2014. If you do not enroll during this period, you will not be assured a health plan will cover you – through Covered California. The next open-enrollment period begins in October 2014 for coverage in 2015.
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    What kind of health insurance will Covered California offer?

    Covered California will offer qualified health plans that are the same high-quality health plans available on the private market today. These plans are guaranteed to provide essential levels of coverage and consumer protections required by the Affordable Care Act. Covered California will offer these plans in metal categories (Bronze, Silver, Gold, Platinum) based on the percentage of an individual’s out-of-pocket costs and covered expenses paid by the health plan.

    In addition to these traditional health plans, Covered California will offer what is called "catastrophic coverage," which helps protect a person from financial disaster in the event of a serious and expensive medical emergency. Covered California will provide catastrophic coverage to those up to age 30, or those individuals who can provide a certification that they are without affordable coverage or are experiencing hardship.

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    How will Covered California make it easier for me to compare different plans?

    Covered California will have four basic levels of coverage: Bronze, Silver, Gold, Platinum. This ranking system will make it easy to compare different health plans. As the metal category increases in value, so does the percent of medical expenses that a health plan will cover. You can choose to pay a higher monthly cost so that when you need medical care, you pay less. Or you can choose to pay a lower monthly cost so that when you need medical care, you pay more.
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    How much will it cost to purchase health insurance through Covered California?

    The cost of health insurance depends on how much coverage you choose to purchase and whether you qualify for financial assistance like tax credits that can be paid to the private health plan you choose through Covered California to lower your monthly payment.

    You can access a cost calculator at coveredca.com that can help you determine about how much you will pay for insurance coverage, including any subsidies you might qualify for.

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    What kind of help is available to help lower the cost of insurance?

    Starting in 2014, the government will help individuals seeking health coverage in three ways:

    1. Tax credits: Tax credits are available to lower the cost of health coverage for individuals and families who meet certain income requirements and do not have health insurance from an employer or a government program.
    2. Cost-sharing subsidies: Premium and cost-sharing subsidies reduce the amount of out-of-pocket health care expenses an individual or family has to pay. These expenses might include the copayments for health care services or other costs.
    3. Medi-Cal assistance: Starting in 2014, the State of California is planning to expand the Medicaid program (called Medi-Cal in California) to cover people under age 65, including people with disabilities, who meet certain income requirements.

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    Why does the law require me to purchase health insurance?

    A key goal of health care reform is to ensure everyone has health coverage and that nobody can be denied coverage or be priced out of coverage due to a health problem. However, if you allow people to wait until they have a problem to purchase insurance, then the market won’t work. There would be few choices available to consumers, and the choices would be expensive for everyone. So the law requires everyone to have minimum coverage, creating a pool of both sick and healthy individuals.
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    Do I have to buy health insurance?

    If you don't have health insurance, you should. Health insurance is an important way to make sure we have access to medical care when we need it. Starting in January 2014, the government will require most people to have health insurance or pay a penalty if they don't. Coverage may include employer-provided insurance, coverage someone buys on their own, Medicare or Medi-Cal.
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    Does the law cut my Medicare benefits?

    No. It does not eliminate or reduce benefits provided under Medicare.
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    Covered California web site for more information

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    www.coveredca.com

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