Optum / HealthCare Partners Insurance Accepted

If you use an Optum or HealthCare Partners doctor, the important question is not simply whether the doctor “takes” your insurance company. You need to make sure your exact health plan, provider network, medical group and doctor work together.

• Optum is not an insurance company.
  • Optum is a group of doctors and medical providers that contracts with many insurance plans. See Optum California — Health Insurance Plans Accepted.
• Optum participates with HMOs, PPOs, Original Medicare, Medicare Advantage, Medicare Supplement plans and other coverage,  scroll down for definitions, but participation can vary by doctor, office location and specific plan.
• Before enrolling, use my web page — Provider Finder to help check your doctors, hospitals and medical groups.
• Do not rely on the insurance-company name alone. A doctor who accepts one Blue Shield, Health Net or other plan may not participate in every network offered by that company.

Covered California Plans Accepted by Optum

For people buying their own health insurance, provider networks can be especially important. Optum’s current California information specifically lists the following under Covered California:

• Ambetter from Health Net — Optum identifies this as a limited network. See my web page — Health Net Individual & Covered California Plans.
• Blue Shield HMO and PPO — see my web page — Blue Shield Individual HMO & PPO Plans.
• L.A. Care Covered — Optum identifies this as available in Los Angeles County. See my web page — L.A. Care Covered California Plans.
• Always verify the current information with Optum California — Accepted Health Plans before enrolling.
• Plan availability and provider participation can change. Check the exact plan name and network, not simply whether Optum accepts the insurance company.

Employer & Other Under-65 Health Plans

• Optum also contracts with numerous my web page — Employer Group Health Plans, HMO, PPO and EPO networks.
• Optum’s current California list includes various arrangements involving companies such as Anthem Blue Cross, Blue Shield, Cigna, Health Net, UnitedHealthcare and others.
• However, some Optum arrangements are employer-only, limited-network or available only in certain counties.
• That’s why seeing the insurance-company name on a list is not enough. Check Optum California — Accepted Health Plans and Networks for the current plan-specific information.
• If keeping a particular Optum doctor is important, verify the doctor with the insurance company before changing or enrolling in coverage.

Medicare & Optum

• Original Medicare: Optum states that it accepts most Medicare plans, including Original Medicare.
• Medicare Supplement / Medigap: Optum also states that it accepts Medicare Supplement coverage. Learn more at my web page — Medicare Supplement / Medigap Plans.
• Medicare Advantage: Optum participates with numerous Medicare Advantage HMO plans. See my web page — Medicare Advantage Plans for an explanation of how Medicare Advantage networks work.
  • Anthem Blue Cross Select HMO MediBlue Plus & SNP
  • Blue Shield 65 Plus – Inspire HMO
  • Dual SNP Medi Cal & Medicare Medi Medi
  • MAPD UnitedHealthCare
  • SCAN MAPD Medicare Advantage
• SNP Special Needs Plans Medicare Advantage
• Optum’s current Medicare Advantage list includes Alignment, Anthem, Blue Shield, Central Health Plan, Health Net, Humana, SCAN, UnitedHealthcare, WellCare and certain regional or dual-eligible plans.
• Medicare Advantage is plan-specific. Do not assume that because Optum accepts one Medicare Advantage plan from an insurance company it accepts every plan that company offers.
• Check the current list at Optum California — Medicare Plans Accepted.
• You can also use Medicare.gov — Plan Compare to review Medicare Advantage plans available in your ZIP code.  We can also shop your coverage with broker only tools too.  Email us  [email protected] 

Medi-Cal & Optum

• Optum participates with certain Medi-Cal managed-care plans, but availability depends heavily on the county, plan and Optum location.
• Optum’s current California accepted-plan page lists CalOptima Medi-Cal, IEHP and Molina in its Medi-Cal section.
• Do not assume that every Optum office accepts every Medi-Cal plan.
• Check Optum California — Current Medi-Cal Plans Accepted and confirm with the particular Optum office before selecting or changing a Medi-Cal managed-care plan.

How to Verify Your Optum Doctor Before You Enroll

• Start with my web page — Provider Finder.
• Look up your exact doctor — not just “Optum.”
• Verify the doctor’s medical group or IPA.
• Verify the exact insurance plan and network you are considering.
• For an HMO, verify that you can select the correct primary care physician and medical group.
• Check the hospitals and specialists you want to use.
• Check Optum California — Accepted Health Plans.
• Then check the insurance company’s own provider directory for the exact plan.
• If keeping the doctor is critical, contact the doctor’s office and the insurance plan before enrolling. Provider directories and contracts can change.

Why HMO vs. PPO Matters With Optum

• HMO: You generally select a primary care physician and medical group/network that coordinate your care. Specialists and hospitals usually must participate in that network except for emergencies.
• PPO: You generally have more freedom to see doctors without referrals and may have out-of-network benefits, although using out-of-network providers can cost substantially more.
• Optum itself is neither an HMO nor a PPO insurance plan. It is a medical organization that contracts with insurance plans.
• See Optum — HMO, PPO and Accepted Insurance Explanation.

Want Help Checking Optum & Your Insurance?

• Before selecting a health plan, I can help you look at the insurance plan, doctor, medical group and hospital together.
• For Individual & Covered California coverage, send me your:
  • ZIP code
  • Doctor names
  • Medical groups
  • Preferred hospitals
  • Plans you are considering
• For Medicare Advantage, also send your prescription medications and current Medicare coverage. See my web page — Medicare Advantage Plan Comparison.
• Email Steve — usually the best way to reach me.
• Schedule a Zoom Meeting.

Resources

• My web page — Provider Finder
• My web page — Blue Shield Individual HMO & PPO Plans
• My web page — Health Net Individual & Covered California Plans
• My web page — L.A. Care Covered California Plans
• My web page — Medicare Advantage Plans
  • Anthem Blue Cross Select HMO MediBlue Plus & SNP
  • Blue Shield 65 Plus – Inspire HMO
  • Dual SNP Medi Cal & Medicare Medi Medi
  • MAPD UnitedHealthCare
  • SCAN MAPD Medicare Advantage
  • SNP Special Needs Plans Medicare Advantage
• My web page — Medicare Supplement / Medigap Plans
  • Anthem Blue Cross
  • Blue Shield – Medi-Gap – Any Medicare Provider
  • Guaranteed Acceptance – Medi-Gap – Supplemental Plans
    • Medicare Assignment – Find MD’s
    • Plan G High Deductible – Saves Premium
    • Price Advantage of Plan G compared to Plan F
  • Health Net Medi Gap
  • UnitedHealthCare – Medi Gap
• Optum California — Accepted Health Insurance Plans
• Medicare.gov — Plan Compare

Health Care Partners – #OPTUM Insurance Accepted 

• Who is Optum
  • optum.com/business/employers 
  • fierce health care.com/why-xyz-sees-combined-powers-its-health-plan-optum-as-a-competitive-advantage
  • beckers hospital  review.com/optum-closing-clinics-laying-off-500
• Broker ONLY Tools