Physician And Hospital Networks Offered By Plans Through Covered California

Published Dec. 11, 2013

FACT SHEET

Covered California™ announced that its insurance plans will offer a broad choice of available providers, including physicians, hospitals, clinics, medical groups and community health centers.

Physician Networks
Covered California’s plans offer more than 58,000 physicians, representing from 80 percent to 90 percent of practicing physicians in California, based on figures from two of the state’s largest and most inclusive commercial networks. This means that these physicians are accessible to consumers through one or more of the Covered California health insurance plans.
  • 43,000 physicians in the statewide Health Net preferred provider organization (PPO) network.
  • 14,000 physicians in the Kaiser Permanente network.
  • 35,000 physicians in the Blue Shield of California network.
  • Anthem Blue Cross of California has 25,000 physicians in its exclusive provider organization (EPO) and PPO networks combined. Further, Anthem offers a health maintenance organization (HMO) in several regions, which has more than 15,000 physicians.
  • Western Health Advantage, Sharp Health Plan and Contra Costa Health Plan offer their full physician networks, while L.A. Care Health Plan has expanded its network by adding broad medical groups.
  • Molina Healthcare has a network of 5,668 physicians available to its members.
Consumers have a choice of six of the largest plans offering services through Covered California — Health Net Exchange PPO, Anthem Exchange PPO, Anthem Exchange EPO, Blue Shield Exchange PPO, Blue Shield Exchange EPO and Kaiser Exchange HMO — allowing enrollees to get care in multiple regions outside of a consumer’s residential area.
  • Kaiser Permanente allows access throughout its entire network, subject to existing guidelines within Kaiser Permanente. 
  • Health Net’s entire Exchange PPO is open to Health Net Exchange PPO enrollees regardless of where they live. 
  • Blue Shield allows Blue Shield Exchange PPO enrollees to go to any Blue Shield Exchange PPO physician, and Blue Shield Exchange EPO enrollees (offered in four regions) can select Blue Shield Exchange EPO physicians in those four counties.
  • Individuals who select the Anthem Exchange PPO can access the Anthem Exchange PPO and the Anthem Exchange EPO networks in any regions at the highest benefit levels. This offers broader access for those enrollees not residing in San Francisco, Los Angeles, Orange and San Diego counties. Enrollees selecting the Anthem Exchange EPO can access the Anthem Exchange PPO at the highest benefit level.
Regional Example
In many regions of the state, the Covered California plans have added providers to the initial networks that were submitted. For instance, in Los Angeles, the networks offered by plans providing services include:
  • Anthem: 9,000 physicians (excluding hospital-based) in its EPO and HMO networks.
  • Blue Shield: 7,328 physicians (excluding hospital-based), reflecting a substantial increase since the May filing of plan rates.
  • Health Net HMO network: 3,200 physicians and health care providers, more than double the individual and group network number since the May filing.
  • Health Net PPO: 17,000 physicians, representing 100 percent of Health Net’s contracted PPO providers.
  • Kaiser Permanente offers its full network of providers.
  •  L.A. Care: 5,187 physicians organized around independent practice associations (IPAs) and medical groups, reflecting a network using quality, access and efficiency criteria for inclusion, with intentional overlap with the existing Medi-Cal network to ensure continuity of care and language access. L.A. Care added physician groups that have historically not been a part of its directly contracted network in the past, including at least three that are either Pioneer ACOs (accountable care organizations) or part of Commercial ACOs offered in the market to non-exchange consumers.
  • Molina Healthcare’s current count of physicians in Los Angeles county is 3,265.
Hospital Networks
More than 360 hospitals are available through Covered California health plans. This represents the vast majority of full-service hospitals in California. Specifically:
  • Leading academic and research-oriented health care organizations are accessible through one or more exchange plans, including the University of California, San Francisco; Stanford University; the University of California, Davis; the University of Southern California; the University of California, Los Angeles; Cedars-Sinai; the University of California, Irvine; Loma Linda University; the University of California, San Diego; and Scripps.
  • All member hospitals of the California Children’s Hospital Association are available through one or more health insurance plans, including Children’s Hospital of Orange County, Lucile Packard Children’s Hospital, Miller Children’s Hospital, Children’s Hospital and Research Center Oakland, Children’s Hospital Central California, Loma Linda University Children’s Hospital, Rady Children’s Hospital San Diego and Children’s Hospital Los Angeles. Children’s hospitals are those hospitals specifically named as children’s hospitals in Welfare and Institutions Code Section 10727. 
  • 228 hospitals designated as “essential community provider” hospitals — recognized by federal regulations as 340B or Disproportionate Share Hospitals.
What People Are Saying
“We applaud the work being done at the state and federal level to extend health care coverage to low- and moderate-income families, and we are encouraged to see that children’s hospitals are included in some of the plans offered through Covered California. We look forward to continued collaboration with Covered California, state regulators and state policymakers, as more work needs to be done to ensure inclusion of these essential providers in all plan networks so that children with medically complex health care needs can be assured access to quality care.” — Ann-Louise Kuhns, President and CEO, California Children’s Hospital Association

“Covered California has assembled a wide range of high-quality insurance options for consumers at competitive prices, while also focused on ensuring enough primary care providers and specialists and a range of hospitals in each region. In addition, its standardized benefits and comprehensive provider directory make it much easier to shop for coverage and really know what you’re buying.” — Betsy Imholz, Special Projects Director, Consumers Union


“Covered California has the potential not only to drastically broaden access to care in our state, but also increase the quality of that care. One of the best ways to improve quality is to allow patients the opportunity to find a doctor they can trust. Through their network, consumers will have the ability to choose the hospital or physician that best meets their needs. This is of particular importance to communities of color and limited-English speaking populations, who often face additional barriers to care when they cannot access culturally or linguistically appropriate care. We applaud Covered California for putting together such a robust network, and we see this as a great step toward helping everyone get covered.” — Ellen Wu, Executive Director, California Pan-Ethnic Health Network

About Covered California
Covered California is the state’s marketplace for the federal Patient Protection and Affordable Care Act. Covered California, in partnership with the California Department of Health Care Services, was charged with creating a new health insurance marketplace in which individuals and small businesses can get access to affordable health insurance plans. With coverage starting in 2014, Covered California helps individuals determine whether they are eligible for premium assistance that is available on a sliding-scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Small businesses can purchase competitively priced health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits.

Covered California is an independent part of the state government whose job is to make the new market work for California’s consumers. It is overseen by a five-member board appointed by the Governor and the Legislature. For more information on Covered California, please visit www.CoveredCA.com.