Shopping for a Health Plan? Tips to Get the Provider You Want

Are you shopping for a Covered California or private health plan?  Here are some tips to make sure the health plan includes your doctors:

Do your homework
. Use the carrier provider links and check directly with the both the health plan by calling their toll-free number and your doctors and hospitals, especially if your plan choice depends on keeping the doctors you want. You’ll need to check each carrier’s provider finder tools  to find the doctor you want.

Don’t be afraid to buy now and switch plans later.
Open enrollment ends March 31, 2014. If you’re unhappy with the plan you selected or learn that you don’t have access to the doctors you want, you can change plans up until the end of open enrollment. To compare plans, you can use online websites like


Enlist the help of a Covered California Certified Insurance Agent. Look for insurance agents that have been certified by Covered California. Certified Insurance Agents are there to assist you compare and select a plan that is best suited for your needs. Not all insurance agents are certified by Covered California, however. Of the 50,000 agents licensed to sell health insurance in California roughly 20% are certified. Websites like have certified staff to help you.

Consider a PPO plan if all else fails.
If you can’t find a health plan that includes your doctor, consider selecting a PPO plan. Blue Shield of California , Health Net and CIGNA offer PPO plans, however some are limited to one of the metal tiers or are available only off-exchange through a private health plan. Check consumer websites like PPO plans offer at least some coverage for out of network providers.


Before selecting your health insurance plan through Covered California or with a private health insurance company, it’s important to see if your doctors and hospitals are in the plan’s network.


If you qualify for and choose to accept a premium subsidy from the federal government to help reduce your costs, you will be limited to the policies sold by Covered California or referred to as “on-exchange”. If you do not qualify or choose a premium subsidy, there is no reason to purchase a plan through Covered California. Some health insurance carriers are offering more plan choices than those offered in Covered California, known as “off-exchange” plans. Affordable CA can help you compare both on-exchange and off-exchange plans.


AUTHOR - Ali Nagy