Answers to Insurance or Open Enrollment Questions
Navigating health insurance is confusing. Kelly is here to help with that.
General Health Insurance Questions
Yes! With your Federal BCBS PPO plans you can see any primary care doctor or specialist in our Medical Group and receive treatment at both our hospitals.
Yes, NorthBay Health accepts many options through Covered California. You’re welcome to explore our health plan search to discover and compare all accepted Covered California plans and the access to NorthBay doctors they provide.
Everyone can purchase health insurance through Covered California — and it’s now more possible than ever to qualify for a subsidy. Reach out to Covered California or your local insurance broker to see if you qualify now for a subsidy.
You’re welcome to explore our health plan search to discover and compare all accepted plans and the access to NorthBay doctors they provide. Remember that NorthBay Health is the provider of care; we are not the health insurance plan
NorthBay Health is the provider of care; we are not the health insurance plan. You’re welcome to explore our health plan search to discover and compare all accepted plans and the access to NorthBay doctors they provide.
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 stands for “Health Maintenance Organization”. HMO plans require you to receive care from providers within its network. Unless it’s an emergency, they won’t cover your out-of-network care. HMOs require that you have a Primary Care Physician who will provide you a referral to all specialty care.
PPO stands for “Preferred Provider Organization”. PPO plans allow you to use a wide network of providers and hospitals. You have the ability to see providers outside of the network too, but will face higher out-of-pocket costs.
With a PPO you’re not required to have a referral from a Primary Care Physician (PCP) in order to see a specialist, but in practice some specialists will still ask for one. If you decide a PPO plan is right for you, stay vigilant and check often to make sure a doctor or hospital is still considered “in-network” for you
This will depend on the benefits offered by the health plan you chose to see NorthBay Health as your care provider. Contact your health insurance company to learn how they cover out-of-area urgent and emergency care.
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 Health 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.
Medicare and Medicare Advantage Questions
Yes, NorthBay Health, including both our hospitals, NorthBay Medical Center and NorthBay VacaValley Hospital, and our providers in the outpatient offices accept Medicare.
Yes! See all the accepted Medicare Advantage plans available for this year.
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.