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Where to get individual health care in California
July 30, 2014 1:54 PM   Subscribe

In a few months, I'll be turning 26 and kicked off my dad's policy.

I'm a contractor, so I don't have benefits. Is my best option, in California, to enroll with Covered California? I am currently with Palo Alto Medical Foundation, and I really like them. Would I be able to stay with them? I know I can call Covered California and ask more questions, but I wanted to get an idea if they are the people I should be calling.

The plan is also to get married mid 2015, so I don't know if this would affect the kind of plan I'm looking for.

Any insight into this would help.

Thank you!
posted by madonna of the unloved to Health & Fitness (7 answers total) 2 users marked this as a favorite
 
I'm a contractor, so I don't have benefits. Is my best option, in California, to enroll with Covered California? I am currently with Palo Alto Medical Foundation, and I really like them. Would I be able to stay with them?

Is Palo Alto the medical group you see or the health insurance company you have? I used to have Sharp (a widespread, multi-faceted health care provider) as my medical provider, but my insurance was under blue shield. You may want to check with Palo Alto to see what insurance they accept, but I'd guess that you'd still be able to see them somehow. They'd probably be the first people to talk to to find out how. Covered California had a range of plans from every insurance system I've ever heard of (Blue Shield, Kaiser, Healthnet, etc.), so it's quite likely that you can still see your provider.

I enrolled with Covered California as a contractor. While I've never done it another way (aside-from insurance provided by my employer), it seems like it's probably the way to go. One thing I noticed is that the paper form seems to be more flexible as far as variable income than the online application. The paper form asked how much I made in the last month, but also asked how much I expected to make in the upcoming year and had a space for average monthly income and other things. While I made very little money in 2013, I made much more in December than in any other month, which really skewed my subsidy away from where it would have been considering my yearly salary. If you're making more than the subsidy level, this wouldn't matter.
posted by LionIndex at 2:11 PM on July 30


The plan is also to get married mid 2015, so I don't know if this would affect the kind of plan I'm looking for.

Don't worry about it until it happens.
posted by LionIndex at 2:15 PM on July 30


Yep, Covered California is the place to start.

Turning 26 and getting kicked off your parents plan would be a qualifying event which means you can enroll in healthcare outside the designated open enrollment period.
posted by brookeb at 2:16 PM on July 30 [1 favorite]


Covered California is the exchange where you sort through your options and choose a plan; your plan is administered by a health insurance company, like Blue Cross. The FAQ is pretty straightforward and covers the basics, so start with reading that. As for whether your current providers will accept a plan you choose - call them and ask them what plans they accept. Only they can say!
posted by rtha at 2:17 PM on July 30 [1 favorite]


For the record, getting married is also a qualifying event, so no matter what you choose now you will be able to reevaluate at that time and make any changes you want to then, too.
posted by brainmouse at 2:37 PM on July 30 [1 favorite]


PAMF/Sutter Health seems to take most of the major policies. Covered California (when I looked) only offered a few options in each region of the state. I would pick the best plan and a second choice of the ones offered on Covered California and then call the business office at PAMF to make sure they take them. You need the name of the specific plan since sometimes providers can be on the panel of one version but not accept another policy from the same company.
posted by metahawk at 2:42 PM on July 30 [1 favorite]


Just as a note, as someone who is trying to get coverage through Covered California, it took some time to get all the information needed and put into the online form, a little more time to actually get access to the plans, and you also need to have selected a plan by the 15th and paid for it in advance (I think they said 4 days before the start date) in order to be covered for the following month. So if your plan ends on October 31st, make sure that you've already picked out coverage by the 15th. You have 60 days to sign up for coverage, so you should be able to go ahead and deal with the paperwork (either online or on the paper form) in advance. Also, if you need to call them for whatever reason, be aware that that the wait times have always been really long when I've called-- over 30 minutes-- and yesterday I tried to call around 5:20 only to get a recorded message that the wait times were long enough that I wouldn't get an agent before they closed. So I would suggest phoning them as early in the day as possible.

On the plus side, the information online about the plans is actually pretty good and very legible; in LA, I have been offered different ranks of HMOs, EPOs, and PPOs from a ton of companies in various price points, the latter of which vary based on age and location and I suspect other variables. I suspect the list of local doctors who actually accept them isn't as great as some of them suggest, given the reviews online, so definitely check with your medical providers as to which level of coverage they accept, and then look at what level of coverage you need. (For example, EPOs, which I hadn't seen before, require no referrals but offer no subsidy at all for out-of-network medical providers except in emergency situations. But it has a better list of doctors than the HMO within the same company.)

Definitely don't worry about the marriage and your plan now-- pick what's good for you, since plan options and situations might change in the next year. If you move, your premiums might change anyway, or you might want to switch to a different network.
posted by jetlagaddict at 4:35 PM on July 30


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