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 CaliforniaOpens new window. The federal government requires U.S. residents over the age of 18 to have health insurance to avoid paying a fee.
Sutter Health’s 2015 Participation in Covered California
Patients can access our affiliated hospitals and medical group doctors by choosing the following products available through Covered California:
- Anthem Blue Cross: Sutter North Medical Group doctors and Sutter Surgical Hospital – North Valley are participating providers in the Anthem Blue Cross Pathway PPO individual and family plan. The following hospitals also 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).
- Chinese Community Health Plan: 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.
* The Sutter Health and Blue Shield agreement expired on December 31, 2014. We have now entered into a six-month transition period of our agreement. Please check with Blue Shield directly by calling the customer service number on your health plan identification card or 1-800-200-3242 to ask how the transition agreement applies to you and your family.
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. Expanded Medi-Cal eligibility makes it easier for low-income people to qualify for coverage.
- The online Covered California cost calculatorOpens new window can help you estimate your cost to purchase health insurance in 2015 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 has the lowest monthly premium whereas, in a platinum plan, the insurance company pays a much higher percentage 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.