Answers to Insurance or Open Enrollment Questions
Navigating health insurance is confusing. Kelly is here to help with that.
The Medicare Advantage health plans accepted at NorthBay Healthcare include:
Good News for Anthem Blue Cross members! NorthBay Healthcare and Blue Cross have signed a three-year contract. This means you can keep your NorthBay Medical Group doctors as well as regain access to our two hospitals: NorthBay Medical Center in Fairfield and NorthBay VacaValley Hospital in Vacaville. The new contract will cover those with PPO, EPO POS and PPO/EPO plans.
Those with an Anthem Blue Cross Medicare Supplement plan options A-N were not impacted by any of the negotiations, you may continue as always.
Yes, your Federal BCBS PPO plans are accepected at our hospitals, NorthBay Medical Center and NorthBay VacaValley Hospital, and with our Medical Group.
For the calendar year of 2021, you have several choices. Western Health Advantage (WHA) offers all NorthBay Healthcare providers in their network, this includes access to the Mayo Care Clinic Network. Also in network are Blue Shield HMO Access+ , CalPERS Care, Choice, and Select PPO plans. For Retirees, United Healthcare (Medicare Advantage PPO plan) is accepted with NorthBay Healthcare. Should you have further questions about this, please feel free to call us at (707) 301-4071.
There are many health plan options through Covered California, we accept the Western Health Advantage health plan.
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 Covered California or a local health insurance broker.
NorthBay Healthcare is the provider of care, not the health insurance plan. The benefits will vary depending on the health insurance plan. Contact your health insurance company to learn how they cover out-of-area urgent and emergency care.
Yes, NorthBay Healthcare, including both our hospitals, NorthBay Medical Center and NorthBay VacaValley Hospital, and our providers in the outpatient offices accept Medicare.
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?
- Do you prefer to pay a higher monthly premium and have minimal out-of-pocket expenses? 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?
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.
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.
NorthBay Healthcare is the provider of care, not the health insurance plan. The benefits will vary depending on the health insurance plan. Contact your health insurance company to learn how they cover out-of- area urgent and emergency care.
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.
NorthBay Healthcare accepts all Medicare supplemental insurance plans, such as AARP, Mutual of Omaha, etc.
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
This is one of those situations where we should talk, as there are many details we need to cover. Also, I want to help prepare you for the many differences between a classic HMO insurance plan and a PPO plan 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 can 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, I can help you select physicians to care for you and your family.