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Are your local hospitals and doctors covered?

The following insurers offer health plans with coverage in the North County area AND access to our facilities:

  • Aetna
  • Anthem
  • Blue Shield
  • Health Net
  • Sharp Health Plan
  • UnitedHealth

Choose the right type of health plan

Your employer may offer different types of health plans, whose different rules may affect the way that you receive care.

Some common types of plans your employer could offer include:

  • PPO: Preferred Provider Organization A type of health plan in which you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.
  • HMO: Health Management Organization A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
  • POS: Point of Service Plan A type of plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.
  • EPO: Exclusive Provider Organization A managed care plan in which services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).
  • HDHP: High-Deductible Health Plan A health plan that features a limited amount of covered services.

Source: Healthcare.gov

How much will I pay for healthcare this year?

The amount you pay will be a combination of the following items:

  • Your monthly premium, which may or may not pay for your Medicare Part B coverage
  • The care you receive and any co-pays for doctors, facilities, tests, or procedures
  • Very importantly, the cost of the care you receive can go up if you utilize providers that are out-of-network for the plan you select or do not follow all of the plan’s rules
  • Your deductible, or how much you will pay before insurance covers any additional amount
  • The co-insurance rate, or the percentage you will pay for any medical care you receive after your deductible but before you reach your yearly out-of-pocket maximum or limit
  • Your out-of-pocket maximum or limit, which is the most you have to pay for medical care in a plan year—after you spend your out-of-pocket maximum on deductibles, co-payments, and co-insurance, your health plan pays 100% of the rest of covered benefits