Covered California and Sutter Health
In 2010, the federal government passed the Patient Protection and Affordable Care Act (ACA) to increase the number of Americans with health insurance and decrease the cost of health care.
The law provides access to insurance for many people who have not had it, including people with pre-existing health conditions and those who cannot afford insurance.
Legal residents of California who do not have health insurance from their job or from another government program can buy insurance through the state’s health care exchange called Covered California. The federal government required U.S. residents over the age of 18 to have health insurance by March 31, 2014 to avoid paying a fee.
Sutter Health’s 2014 Participation in Covered California*
Patients can access our affiliated hospitals and medical group doctors by choosing the following products available through Covered California:
- NEW! - Anthem Blue Cross: Effective Oct. 1, 2014, Sutter North Medical Group doctors and Sutter Surgical Hospital – North Valley are new participating providers in the Anthem Blue Cross Pathway PPO individual and family plan. The following hospitals continue to participate in this plan: Alta Bates Summit Medical Center, California Pacific Medical Center (including St. Luke's campus), Memorial Hospital Los Banos, Novato Community Hospital, Sutter Lakeside Hospital, Sutter Amador Hospital and Sutter Coast Hospital.
- 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 and family PPO plan and Health Net's PPO plan in the SHOP.
- Chinese Community Health Plan: Effective June 1, 2014, the following providers participate in Chinese Community Health Plan's individual and family HMO plan and Chinese Community Health Plan's HMO plan in the SHOP: Physician Foundation Medical Associates, California Pacific Medical Center (including St. Luke's campus) and Mills-Peninsula Health Services.
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.
*Attention Health Net Covered California members: Sutter Health physicians and Sutter hospitals will not be participating in the Health Net Covered California PureCare individual and family plan network in 2015.
What You Need to Know About Covered California
- All health plans purchased through Covered California must cover certain services called essential health benefits. These include doctor visits, hospital stays, emergency care, maternity care, children’s care, prescriptions, medical tests and mental health care. They also must cover preventive care services, such as mammograms and colonoscopies.
- If you buy coverage through Covered California, you may qualify for federal tax credits or subsidies. Tax credits are available to people who make up to 400 percent of the federal poverty level ($46,000 a year for an individual and $94,200 for a family of four).
- Expanded Medi-Cal eligibility makes it easier for low-income people to qualify for coverage.
- The online Covered California calculator can help you estimate your cost to purchase health insurance in 2014 based on the information you provide. You can also learn the amount of financial assistance that may be available.
- The plan options vary by location and are available at four different levels: bronze, silver, gold and platinum. A bronze plan will have the lowest monthly premium with the insurance company paying 60 percent of the cost of services and you paying 40 percent. Whereas, in a platinum plan, the insurance company pays 90 percent of the cost of services but you will pay a much higher premium.
- Young people can stay on their parents’ plans until age 26, and those under age 30 may qualify for less-comprehensive and less costly “catastrophic coverage.”
- Insurance companies must offer everyone insurance and can’t charge more for pre-existing conditions; men and women will pay the same price.
- New policies can no longer impose lifetime limits on benefits or rescind people’s coverage when they are sick.
- Health plans can’t turn people down for coverage or charge more based on health status, claims history or expected use of health services.