I'm a federal employee with Blue Cross/Blue Shield, am I affected?
I have CalPERS, which plan can I use to go to NorthBay?
For the calendar year of 2017, your answer is in two parts.
- The CalPERS Care, Choice, and Select are the PPO options that use the Anthem Blue Cross network, of which NorthBay Healthcare is “in network”.
- For Retirees, United Healthcare (Medicare Advantage PPO plan) is accepted with NorthBay Healthcare.
How much is NorthBay Healthcare insurance?
NorthBay Healthcare is the provider of care, we do not sell health insurance plans. Instead we contract with health insurance companies like Western Health Advantage, Blue Shield and Tri Care for Life to provide care.
What should I look for in a health plan?
First, decide what is important to you about the care you currently receive. Some questions to ask yourself are:
- Do you have specific physicians you want to continue to see or are you willing to change physicians if necessary.
- Do you prefer to pay a higher monthly premium and have little to no out of pocket expenses as you seek out care or would you rather have a lower monthly premium and pay more when you receive care?
- Do you prefer a HMO or PPO plan design?
- What is your approximate monthly budget for healthcare?
What is an HMO?
HMO = Health Maintenance Organization. This kind of plan requires you to receive care from only providers within its network. You are typically not reimbursed for out-of-network care. You are also required to have a Primary Care Physician and you must receive a referral from that specific doctor in order to see a specialist.
What is a PPO?
PPO = Preferred Provider Organization. This type of plan covers care from a network of a wide variety of doctors and hospitals. If you decide to select a provider outside of this network, you may do so, but for a higher cost. You are also not required to have a Primary Care Physician, and consequently do not need a referral from one in order to see a specialist.
I don’t qualify for Covered California, what plans do you have?
Everyone qualifies for Covered California (also known as ObamaCare), it is whether or not you will qualify for a subsidy from the government. You can still purchase your health insurance through Covered California. To get assistance with enrolling into Covered California, we encourage people to contact either Solano Coalition for Better Health at 1-800-978-7547 or email@example.com or local health insurance broker.
My son/daughter is away at college, are they covered with NorthBay?
NorthBay Healthcare is the provider of care, not the health insurance plan. Depending on their health insurance plan your benefits may vary. Contact your health insurance company to see how they cover out of area urgent and emergency care.
Does NorthBay accept Medicare?
Yes, NorthBay Healthcare, both the hospitals and outpatient clinics accept Medicare.
What is a Medicare Supplement Insurance (Medigap)?
Medicare has deductibles and coinsurance fees that you would have to pay if you only have Original Medicare. To help cover these costs, you may purchase a Medicare Supplement Insurance (Medigap) policy, sold by private companies, and they will help pay some of the health care costs that Original Medicare does not cover such as deductibles and coinsurance. Additionally, Medicare supplemental plan also offer coverage for services that Original Medicare doesn't cover, like coverage for medical care outside of the U.S. Please note that Medigap policies don't cover everything, for example they don't cover long-term care, vision or dental care, or hearing aids.
What Medicare Supplemental plans does NorthBay accept?
NorthBay Healthcare accepts all Medicare supplemental insurance plans, such as AARP, Mutual of Omaha, etc.
How do I choose which Medigap plan to purchase?
We recommend working with a health insurance broker that specializes in Medigap policies.
Every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as "Medicare Supplement Insurance." Insurance companies can sell you only a "standardized" policy identified in most states by letters. All policies offer the same basic benefits but some offer additional benefits, so you can choose which one meets your needs.
Each insurance company decides which Medigap policies it wants to sell, although state laws might affect which ones they offer. Insurance companies that sell Medigap policies:
- Don't have to offer every Medigap plan
- Must offer Medigap Plan A if they offer any Medigap policy
- Must also offer Plan C or Plan F if they offer any plan
My employer is changing plans, I must leave Kaiser which is the only plan I have ever had, my new plan is a PPO that covers a percentage of the medical care, how much will I have to pay for an office visit, maternity care, etc? Where can I see a listing of prices?
This is one of those situations where we should talk, as there are many questions I would have for you. Also, I would want to help prepare you for the many differences between coming from a classic HMO insurance plan to changing to a PPO that gives you much more flexibility and options when receiving medical care. Let’s plan for at least a 30 minute conversation.
Some example questions are:
- What plan are you changing to?
- Is it a PPO with a Health Savings Account tied to it?
- What are the plan benefits?
- What is the maximum out of pocket?
If we are in-network with your PPO, NorthBay Healthcare and the health plan have contracted discounted rates and unfortunately those discounted rates are not publicized anywhere.
Additionally, should you be hospitalized, due to the possibility of complications it is very challenging to quote exact prices, but rather a range of pricing. I explain how a PPO works, and how the maximum out of pocket limit helps a family plan for approximation of possible cost.
After we talk, then I can help you in selecting physicians to care for you and your family.
Still have questions?
If you still have questions about open enrollment, please feel free to contact our open enrollment specialist at krhoadsposton@NorthBay.org or directly by phone at (707) 646-3280.