Introduction to Blue Shield HMO Trio ACO & PPO Plans
We’ve represented Blue Shield for 40 years and have been quite happy. There is no charge for you to have our expertise as Blue Shield pays us. It helps them too!
Check out the rest of this page for more information and enrollment.
Blue Shield Individual
#PPO Plans 2024
- Understanding Health Care Coverage Rev 1/24
- Summary of Benefits 2024
- Disclosure
- HSA Health Savings Accounts – HDHP Plans – High Deductible Health Plans Usually Bronze
- 56,212 doctors 329 hospitals BS Website *
- Paper Application, but online is better, email us for one [email protected]
Try turning your phone sideways to see the graphs & pdf's?
- What’s on this page?
All our plans are Guaranteed Issue with No Pre X Clause
Quote & Subsidy #Calculation
There is No charge for our complementary services
Watch our 10 minute VIDEO
that explains everything about getting a quote
- Our Quote Engine Takes all the complexity out of using pencil and paper to figure out the premiums per the Obamacare/ACA rules under CFR §1.36B-3 *
- Get more detail on the Individual & Family Carriers available in CA
Blue Shield of California Authorized Agent - Broker
TRIO ACO HMO
Blue Shield’s #Trio ACO HMO
Trio ACO’s are a new family of limited network HMO plans: these plans are focused on delivering choice, affordability, and access to high-quality care with lower premiums.
The Trio ACO HMO plans are designed to help break down barriers, enhance care coordination, reduce duplication of services, and improve your overall experience.
Trio plans are designed to help:
- Link you to the right services
- Create cross-organizational focus on patients with complex needs
- Improve discharge processes and programs to reduce hospital readmissions
- Learn More==>
- Blue Shield Website on TRIO *
- FAQ’s
- Just scroll down our page
- Blue Shield Website on TRIO *
- Blue Shield is committed to leveraging their robust and innovative care models to fundamentally change healthcare delivery.
- An accountable care organization (ACO) is a network of doctors and hospitals that shares responsibility for providing coordinated care to members and limiting unnecessary spending. As with a traditional HMO plan, each member’s care is centered around a primary care physician.
-
Learn More===> Section 3022 ACA
- Blue Shield’s ACO framework is based on a proven record of delivering integrated care to more than 200,000 Californians.
- Be sure to enroll on our Blue Shield affliate website. Blue Shield pays us to help you, at no cost to you, as it saves them time and $$$.
- Please email us if any of the links require passwords or are not up and running yet. Trio Provider Finder
- Print a temporary ID card and more – Member Services Center and Registration
- FAQs / Ask Us a Question
FAQ’s “2022 Trio HMO ACO”
- Do I have to get a referral from my PCP to see my heart specialist?
- Blue Shield has two options to see a specialist
- 1. Get a referral from your PCP Primary Care Physician
2. See a specialist in the same medical group…
This is a SIMPLISTIC answer, see the actual policy for exact details.- Do NOT quote our summary!xxx
- What hospitals are covered with silver 87 HMO trio… do you have a list you could forward to me please?
- All Trio Plans from Bronze to Platinum and Enhanced Silver have the same network, both in and out of Covered CA.
- I don’t know what county you are in, so I can’t forward you a list. Try this page on Blue Shield’s website blueshieldca.com/trio-network
- See also our page on how to use the Blue Shield Provider Finder.
- How about appointing us as your agent, Covered CA – Direct Not Covered CA no extra charge so that we get paid for helping you.
- I’m on SSDI and my agent set me up with Blue shield/Covered California silver 94 HMO trio… I notified her that my income had increased…and without notifying me signed me up for silver 87 HMO trio starting 9/1/2018!! My question is…can I possibly have this new insurance [silver 87 vs 94] changed or postponed?
- When you get subsidies from Covered CA you are mandated to report changes of income within 30 days. When you changed your income to show an increase, Covered CA automatically changes the subsidy and the Silver Level. If your income decreases, you can report that change.
- The main change is that your specialist visits go from $8 to $25.
- You can also use our quote engine to double check income, silver level, premium, benefits, etc.
- 1. Get a referral from your PCP Primary Care Physician
- Blue Shield has two options to see a specialist
Pick a PCP Primary Care Physician
How to go about #Picking a HMO or PPO Primary Care Physician PCP – MD
PPO members for all Covered CA plans and maybe all? plans will now have a central point of contact PCP – Primary Care Physician, in the health system for receiving long-term, comprehensive, coordinated care for most health needs. PPO members are able to switch PCPs at any time. There is no action for members to take. Blue Shield will provide additional details on this new feature in the coming weeks.
Members of non-grandfathered PPO plans will continue to have the freedom to choose specialists and other providers – without referrals inside or outside the network – as they do now.
- PPO Primary Care MD – member communication from Covered California
- HHS offering $1 million to strengthen link between primary care and health equity
FAQ’s
- What is a primary care physician?
- Why is it important to have a PCP?
- How did we select your PCP match?
- When will I receive information about the PCP that I was matched with?
- I’ve been matched with a PCP. Now what?
- What should I consider when evaluating my PCP?
- How do I change my PCP?
- I already have a doctor that I like. How do I know if my preferred PCP is part of my plan’s network?
- I can’t find my preferred PCP in the Exclusive PPO Network. What do I do now?
- Will my PCP appear on my ID card?
- What happens if I make a change to my PCP?
- How often can I change my PCP?
- Provider Finder
- Primary Care & PPO VIDEO
- Understanding your plan VIDEO
- chcf.org/primary-care-matters * More readable summary * Health care systems with strong levels of primary care investment have better and more equitable health outcomes, lower care costs, and better care quality. We can build a healthier future for all Californians by focusing resources back to patients and their relationship with primary care providers.
- 7 tips for choosing a primary care doctor UHC
- Cedar's Sinai Provider Finder
Blue Shield Rx Prescription -#Pharmacy Drugs
Blue Shield of California
Provider #Finder -
Dentists, Doctors & Hospitals
All Plans - Medicare Advantage, Employer Group, Individual & Family - Covered CA
Find a doctor near you
Blue Shield Find a Provider
VIDEOS
- Blue Shield Exclusive PPO Your new ppo * PPO Primary MD FAQ’s * has 50k+ doctors and 320 hospitals statewide, plus Blue Card benefits out of state & country. 2020 Agent Guide * Member Outreach Bulletin *
- Providence Issues 2024
- How to use the Finding a provider tool above VIDEO
- Understanding Your Plan pdf
- Nurse Help 24/7, Heal and Teladoc save on prescriptions ER vs. urgent care.
- Use your online account to review claims, copays or deductibles and take advantage of other member benefits.
- Explanatory VIDEOS on everything… from Blue Shield
- chcf.org/primary-care-matters * More readable summary * Health care systems with strong levels of primary care investment have better and more equitable health outcomes, lower care costs, and better care quality. We can build a healthier future for all Californians by focusing resources back to patients and their relationship with primary care providers.
- Medicare Advantage Provider Print Directories BROKER ONLY
- Email us [email protected] if you want a pdf print directory
- Enroll and get full details on our
- What do I have to do to see a specialist if I’m in an HMO or Medicare Advantage Plan?
- Generally, just ask your PCP Primary Doctor.
- Check your Evidence of Coverage for details. Email us, [email protected] if you want a copy of it.
- What if my PCP won’t give a referral.
- Check the procedure in your Evidence of Coverage, email us and see our webpage on appeals & IMR Independent Medical Review.
- Generally, just ask your PCP Primary Doctor.
Dental
Blue Shield Individual & Family #Dental Plans
Ask us about Medicare Supplemental Dental Plans
Blue Shield Dental Plans 1.2024
- Blue Shield offers affordable and comprehensive dental plans available to clients with and without a Blue Shield health plan.1
- Specialty Duo 2025
- best of both worlds – dental and vision – with one plan. Specialty DuoSM dental + vision package* is an affordable option that provides: • Comprehensive dental benefits like diagnostic, preventive, basic, and major services • Vision coverage, which includes an annual eye exam and optometric and ophthalmologic visits
- They also offer a dental and vision plan package, Specialty DuoSM,* which includes comprehensive dental and vision coverage.
- Blue Shield’s dental provider networks are among the largest in the state. The dental PPO plans include nearly 47,000 providers in California and nearly 400,000 nationwide. The dental HMO network includes more than 22,000+ providers in California. Check out the dental network map for an overview of county coverage.
PPO
Dental
- No waiting period for diagnostic or preventive services
- Covered diagnostic and preventive services, such as X-rays and routine cleanings, do not count toward the annual coverage limit for dental PPO and Specialty Duo dental plans, providing more coverage for other services before reaching the annual limit
- A wide range of dental benefits, including most diagnostic and preventive services and oral cancer screening, at no additional cost when using a dental network provider
- Implants coverage available in our dental PPO plans with a $1,250 calendar-year benefit maximum
- Orthodontic benefits are available for both children and adults
- Choice of $25 or $50 deductible per member, per calendar year
- Choice of a $500, $1,000 or $1,250 calendar-year benefit maximum per member
- Coverage even when your clients use a non-network dentist. Our plan reimburses your clients up to an allowed amount for covered services, and your clients pay the remaining balance of the total billed charges.
HMO
- No deductibles and no calendar-year maximums
- Orthodontic services available with or without a 12-month waiting period, for both children and adults
- Affordable fixed copayments for basic and major services
- Specialty care available with a referral from a primary dentist
Dental Benefit Summaries
2024
Dental Vision Life Brochure 1/24
Specialty Plans
Summary of Benefits are available for dental plans while Benefit Summaries are available for vision plans. Dental and vision plans sold through Blue Shield can be purchased with a Blue Shield medical plan or as stand-alone policies. Family Dental Plans are sold only through Covered California and can only be purchased when enrolling in a medical plan sold through Covered California.
Dental Plans Underwritten by DMHC
Click here for disclosure.
Plan Name | Summary of Benefits | |
Dental PPO | English (PDF, 1.2 MB) Spanish (PDF, 1.2 MB) |
|
Enhanced Dental PPO 50/1250 | English (PDF, 2 MB) Spanish (PDF, 2 MB) |
|
Enhanced Dental PPO 50/2000 | English (PDF, 2 MB) Spanish (PDF, 2 MB) |
|
Enhanced Dental PPO 50/2000 Lifetime Ortho 1500 | English (PDF, 2 MB) Spanish (PDF, 2MB) |
|
Dental HMO | English (PDF, 2 MB) Spanish (PDF, 2 MB) |
|
Dental Standard HMO | English (PDF, 2 MB) Spanish (PDF, 2 MB) |
Dental Plans Underwritten by CDI
Click here for disclosure.
Plan Name | Benefit Summary | |
Specialty Duo dental (sold with Duo vision below) | English (PDF, 2 MB) Spanish (PDF, 2 MB) |
Family Dental Plans (sold exclusively through Covered California) – Underwritten by DMHC
Plan Name | Summary of Benefits | |
Family Dental PPO | English (PDF, 2 MB) Spanish (PDF, 2 MB) |
|
Family Dental HMO | English (PDF, 2 MB) Spanish (PDF, 2 MB) |
- Summary of Benefits Individual and Family Vision Plan Ultimate Vision 15/25/120
- Vision Disclosure
- Specialty Duo℠ Dental Plan
- Broker Section on Vision
- Broker Page for Dental on Blue Shield Site
- Click here for disclosure.
#Importance of Dental Coverage
Dental & General Health
Insurance 101?
We suggest that you check out Life Insurance, Disability, Long Term Care and Retirement as these risks may cause much more financial devastating to your budget than dental bills.
Picture of Oral Health
- Dental For #Everyone, Instant Quotes - Online Enrollment
-
Delta Dental - Get Quotes & Enroll
- Dental care reduces likelihood of hospitalization for people with diabetes or coronary artery disease Medical Press 5.6.2022
- The 2022 State of America’s Oral Health and Wellness Report Commissioned by Delta Dental Plans Association
- What drives buyers of individual Delta Dental plans?
- 77 Million Adults Do Not Have Dental Insurance
- CDA-sponsored bills seek more protections, increased oversight of dental insurance Bills would prohibit plans from imposing arbitrary waiting periods, denying coverage for preexisting conditions; require rate review and ERISA notice Learn More >> CDA * CA Legislature * California Benefits Review Program *
Steve on buying, shopping and best use of premium dollars
Dental Insurance VIDEO
MORE VIDEOS
- What dental Insurance... should I buy???
- VIDEO the dentist attempts to give you some guidance about things to consider before buying a dental insurance plan, finance plans available, negotiating with your dentist
- Sacramento Truck driver sudden dealth from tooth infection Sacramento Bee 1.31.2017
- Health Savings Accounts?
- Video - how bad sugary drinks are for you
Dental Resources, More Info & Links
- More detailed information – Blue Shield dental benefit summaries.
- – dental benefit summaries.
- Specialty Duo – Dental Portion Summary of Benefits Vision Summary of Benefits
- 2018: Ultimate Vision 15/25/120
- | Ultimate Vision 15/25/150
- | Specialty DuoSM
Evidence of Coverages
- 2018: Ultimate Vision 15/25/120
- Blue Shield Dental Home Page
- If any of the above links require a password, email us and we will send you the brochure.
Our other pages on
Dental Coverage
We don't put a lot of effort into selling dental coverage. Generally it's a wash on paying premiums vs getting back claims payments. Unless it's employer group. Then the premiums are tax deductible under IRS Section 106.
Here's more information on how we feel about dental. Here's our page on implants, where we get lots of inquires, but few sales. Most people only seem to want dental coverage, after they've been told they need a lot of dental work. Not profitable for Insurance Companies. See our other pages for details & explanations. See our page on Medical Loss Ratio. Insurance Companies need to take in $1 to pay 80c in claims.
Medicare Plans
- Anthem Blue Cross
- Blue Shield – Medi-Gap – Any Medicare Provider
- Health Net Medi Gap
- UHC AARP Medi Gap
- Scan
Individual & Family Plans
Dental For Everyone,
has an excellent website with full brochures, Instant online quoting and enrollment
One of our colleagues on how Dental for Everyone Works..
Employer Group Plans
- Medi-Cal
Blue Shield Member Portal
Blue Shield
Member #Portal Account
-
Benefits of creating-registering for a Member Portal Account
- Register for an ONLINE Member Portal
- Easily search and view benefit information
- Smart Phone App
- Member Website Overview
-
Learn how to register for 24/7 access to your health plan VIDEO
- Teledoc
- Change methods of payment for paying premiums
-
- eChecks use the Automated Clearing House (ACH) to direct debit from a member’s checking account directly to BSC in this case If a member’s premium is not paid by the 1st of the month – it will show the account as late
- web payments.bill matrix.com/BSC One Time Pay
- Payment methods include Automated Clearing House (ACH) transfers and Credit Card payments
- Use member portal or call 888-256-3650
-
- See claims by family member
- Track deductibles and co payment amounts
- Change PCPs and medical groups
- Renew your plan BlueShieldCA.com/Renew
-
- Print member ID cards – anytime, anywhere!
- Members can follow three easy steps to print a new ID card:
- Go to Member Overview and add New Member ID number (required).
- Click View . . . and Print ID.
The ID card will work at the doctor’s office as soon as your client’s membership becomes effective. The plastic ID card will arrive in seven to 10 business days.
- Members can follow three easy steps to print a new ID card:
- Go deeper into your plan to get more Think your plan is just about health coverage? It offers so much more. Take a closer look and see what else you could be getting from us. Seriously, we want you to.
- Treatment Cost Estimator – for PPO Members
- Cost Helper.com what people are paying
- FAQs / Ask Us a Question
Sample inquiry that you can make through the member portal
Inquiries you can make through the member portal
Blue Shield #Contact Info
- Many of your issues can be resolved for our clients by emailing us [email protected] and we can help immediately or in a few days via email rather than calling and waiting on hold with Blue Shield.
- Here’s the form to appoint us as your broker for Individual & Medicare with Blue Shield, no extra charge!
- Customer Service (800) 393-6130
- Technical Support
- Claims Department
- phone: 888-256-3650
- fax: 209-371-3049
- mail: P.O. Box 272540 Chico, CA 95927-2540
- BROKER ONLY 877 806-7688
- Provider – Pre Authorizations Website
- Pre-admission (800) 541-6652
- More Contact Info
- Tech Support (800) 393-6130
- Website Technical Support 877 932-3375
- Contact Info on Blue Shield’s website
- Get a Member Portal
#Financial Strength
- news.blues hield ca.com/
- Blue Shield Mission Report 2022
- Financials on Blue Shield Website
- Blue Shield Story
- Wikipedia
- CA Department of Insurance
- AM Best Guide
Blue Shield Medi Cal
Public Service ONLY – We do not get compensated to help you
Health Insurance unfortunately is very complicated
President Trump February 27, 2017
- Thus, if we haven't simplified and explained in PLAIN ENGLISH what you are looking for:
For more information - Also see our desktop version
FAQ’s
FAQ’s “Blue Shield CA Information & New Enrollment”
- My Wife just delivered and we have plan purchased outright blue shield platinum PPO 90, will it cover the baby’s NICU stay as it was required because of pre-term labor?
- Also, I make around 80k a year for a family of 4, is she or new baby boy eligible for temporary medi-cal to cover her for NICU?
- Thanks so much, looking forward to starting conversation and perhaps talking more as it relates to ObamaCare and our family business.
- The full EOC’s and polices for Blue Shield are on our benefits page. If anything requires a log in, send us an email and we will send to you. Here is the 7 page summary of benefits for the platinum plan. I will email you the full eoc. We have a specimen platinum plan here.
- On page 2 of the summary, semi private room and board along with medically necessary services and supplies. See also page 84 of the Specimen EOC. Thus I do not see a problem with NICU – Neo Natal Intensive Care being paid, since you state it was required.
- I’m not qualified nor do I get paid to help you with Medi-Cal. Here’s more information on the Medi-Cal access program for those who are pregnant with up to 322% of Federal Poverty Level, that you can see from our Covered CA Income Chart. Note that Medi-Cal includes the fetus as a dependent. I don’t see why you would need this program. Medi-Cal would deduct payments that Blue Shield makes, under dual coverage rules.
- We urge you to get a free quote and subsidy calculation here. You might qualify for subsidies and enhanced silver, which in some cases, is better than platinum.
- Here’s the form to appoint us as your agent, no charge to you, so that we get paid for our time, research and education.
- how much would be monthly payment on a individual plan for a 2 year old
- I’m interested on the silver 70 PPO plan.
- Please use our FREE quote engine above and get answers from every company and plan. Or use the one above for Blue Shield.
- We don’t know your zip code or date of birth. Also, since enrollment is online, we need to make sure you can do that, as we don’t get paid to fill out the application for you. The application under ACA is just your name, dob, address and credit card information.
- What is your special enrollment reason?
- What does it mean when it says, Blue Shield “exclusive ppo for ifp”?
- IFP = Individual Family Plans
- Get started with the basics of your Preferred Provider Organization (PPO) plan
As a PPO plan member, you have a lot of flexibility. The benefits of being a PPO plan member are: - You can see any doctor or specialist that you want without a referral. Plus, there are many other ways you can access care.
You are not required to see a primary care physician (PCP).
You will get the benefit of a discounted rate and pay less out of pocket when you see a doctor in your plan’s network.
You have access to our Exclusive PPO Network, which includes more than 46,000 doctors and 350 hospitals across California.
You don’t need to visit a PCP first to receive care.
You are covered for routine, urgent and emergency care when traveling throughout the country and abroad. [Citation to follow-Cached Version of Blue Shield Page, as the site is down for maintenance] - It’s the network you select to find your participating providers.
- I want to continue with my current plan.
- Based on our last conversation all I need to do is continue making payments.
- Is that true?
- Here’s an excerpt of an agent bulletin dated 11.16.2018 9:09 AM:
- Keep in mind that we will renew your customers automatically if they continue to pay their premium
- Here’s an excerpt of an agent bulletin dated 11.16.2018 9:09 AM:
- What about Blue card 2019 cut backs
- How come completed my boyfriends Covered CA application for Blue Shield yet you simply gave me the direct affiliate link above asked me to do everything on my own with the application process for Blue Shield direct. This process has been anything but convenient.
- One reason we get so involved in Covered CA applications, is that Covered CA wants you to wait on hold and call them directly. Their process for one to select an agent is not what they promised us at their mandatory training. Your boyfriend had already partially completed an application with us a few years back. We can also be of more help during the year… The last day of open enrollment is not a good day to expect a lot of personal attention.
- When you use OUR affiliate link, we get notified of the progress of your application. If you just go to Blue Shield’s website, we are not your agent, nor do we know anything about your application. If you want us as your agent… got confused as to which link to use… Not Covered CA etc. we can send you a Broker of Record letter to send to us, then we will send to Blue Shield.
- The Blue Shield ONLINE application above, is rather simple, no income or medical questions. We already discussed the plans with you. You didn’t want Medi-Cal, nor did you qualify for subsidies at your income level. IMHO the complex part is the time and effort selecting a plan, going over coverages and definitions. The hardest part of the application is reading the disclosures and putting in your credit card information. Our website is full of intricate policy details. We feel we can help our clients with that, better than filling out your name and address and going over 16 digit credit card numbers.
- The next thing is that as a Blue Shield member, you can get a member portal to give you instant 24/7 information on your policy, claims and premiums.
- It looks like health Net Silver 70 Enhanced Care PPO and Blue Shield Silver 70 PPO offer the exact same benefits.
- However, Health Net is $593.48 and Blue Shield is $740.13.
- Is that correct?
- When one wants to get into very detailed comparisons, it’s quite helpful to check the actual summary of benefits for each plan. This is the page to find Blue Shield’s. Here’s the summary for the Blue Shield Silver 70 PPO with 73% Enhanced Silver – Cost Sharing Reduction.
- Health Net summaries are here. Here’s the 73 Enhanced Care PPO.
- Here’s the standard metal level chart that all ACA – Obamacare compliant plans must use.
- IMHO the difference you will find, is that Blue Shield’s network is bigger. Here’s what I have on Blue Shield’s network, including their provider finder. Here’s Health Net’s.
- 1. I am now debating between the Blue Shield Bronze PPO Mirrored plan and Health Net’s Bronze 60 Enhanced Care PPO.
- 2. Their benefits look identical and they have similar doctors on their preferred provider network (I was able to locate drs directly on their website not through the quote website).
- 3. The big difference is the premium, about $350 more per month for Blue Shield.
- 4. Online reviews aren’t bad for this company (Blue Shield’s are higher) but do you know anything about this company?
- 5. Would you recommend them?
-
- 2 The plans look identical as they are based on the metal level chart. See reply to the prior anonymous visitor. The doctor lists can be accessed through our quote engine, our webpage for each company, whatever it all goes to the same Insurance Company provider finder link
- 4 Online reviews don’t necessarily mean a lot – see a similar question about Oscar.
- 5. Yes, I’ve done business with Health Net for years. Get more details about HN on the webpage I have for them. Use this link to enroll in Health Net.
FAQ’s
- I have Silver 70 Trio HMO. I don’t like the prior authorization hassle. If I get a PPO would there be less problems?
- Looks like HMO’s have less problems with getting Prior Authorization.
- See our video and links below
- Medical Necessity
- Blue Shield Member Portal
- Our Trio HMO Page
.
- How are durable medical goods paid, because I am in insulin. I’ll need a glucose monitor and it’s expensive How would silver 73 PPO pay for it?
- Video Explanation
- Use Ctrl F to search through EOC & Formulary
- Formulary
- Medicare Durable Medical Equipment
- Medicare coverage for diabetes
.
- I clicked on the pay now [In the Covered CA portal] and it had me put in my card info but I don’t think it processed the payment yet. Is there anyway for you to check?
- Did you get a confirmation
- Did you check with your ONLINE Banking?
- I can check with Blue Shield – Broker Services, but that may take a few days.
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- I’m considering Bronze HDHP with an HSA vs Gold Plan with no deductible. I have hardly any claims. I do have Rx though with very little Co Pays. Is there a way to know what my Rx cost would be if I had the $7k deductible in Bronze Plan?
- Here’s where we did some research a while back on Rx reimbursement in the Bronze Plan
- Shop & Compare Tools Part D Rx
- Video of how we used the Medicare Tool
- See our module on Blue Shield Rx Above
- See our metal level page on comparisons of the plans, how they relate to Medical Loss Ratio, etc.
- My video on what plan to buy if you are going to have a big surgery next year
.
- I just got my renewal notice from Blue Shield. How & when do I shop & compare?
- To shop with Blue Shield, use the links above, starting November 1st.
- Or go into your member portal.
- To get quotes from all other companies and get subsidy calculation, here’s our quoting tool.
- Here’s our Open Enrollment Webpage for more details on dates and deadlines.
- We pride ourselves on accurate information not the SWAG method.
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- What ACA/Obamacare plan – Metal Level has the most diverse coverage For breast cancer care
- We will answer your question on our Cancer Page
.
- We will answer your question on our Cancer Page
- What are the monthly and maximum out of pocket costs that I have to incur on Gold vs the other Metal Levels?
- Check out the Metal Level Chart
- Check out our webpage on OOP – Out of Pocket Maximums, Deductibles, Co Pays & Co Insurance
- Does Blue Shield PPO cover Memorial Care?
- See the link to the provider finder in the webpage above. See our page with more detail on searching for a provider.
- Memorial Care
- If a doctor or facility is not participating, since you are using a PPO, you can go out of network at a higher cost. Please review the Gold PPO Summary of Benefits
- select the Provider and scroll to the bottom on the screen there is a selection called: “Plans Accepted by Provider” that will show you a list of the current plans they accept.
- Trying to verify coverage with a doctor, hospital or medical group can be VERY trying. The Medical Groups listing of Insurance Companies, does not mean that you as an individual, employer group, medi-cal or Medicare can buy it! Learn more
.
- what is the difference between blueshieldca and subsidy need to clear this then can renew my plan gold 80 ppo
- Please use our quote engine and enter your expected MAGI income.
- Then appoint us as your Covered CA agent, so that we can get compensated for helping you. No extra charge to you. Covered CA pays us.
- Depending on your subsidy, Gold 80 might not be good for you as Silver 97 and 87 provide MORE benefits, lower Co Pays, deductible, etc.
- Open Enrollment doesn’t start till the 15th of October. Deadline is December 15th for January 1st.
BROKER ONLY
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I was Diagnosed with Stage 4 Breast Cancer and SSI 0automatically enrolled me into Medi Cal
• I DO NOT WANT Medi Cal
•I had Been paying for Blue Shield PPO (~250/mo) with subsidy through Covered California (without subsidy = ~800-/mo)
• Need to remove Medi Cal IMMEDIATELY (running out of cancer pain meds, and getting scared) from SSI
• SSI says cannot have disability without Medi-Cal
Is what they’re telling me correct (last bulletpoint)?
If not, would love you to help resolve and resume my Blue Shield coverage right away.
You can keep your Blue Shield coverage, BUT no subsidies. Here’s how dual coverage works…
Get a quote here.
Did you want to look at Blue Shield Promise for Medi Cal?
Do your MD’s take Medi Cal?
We’ve also answered this question on the dual coverage page.
Google on Medi Cal vs Covered CA
california health plus.org/CA_Healthier_California_Starts_With_Coverage
The Medi-Cal Maze: Why Many Eligible Californians Don’t Enroll
Comparison of Medi-Cal Benefits and Covered California Essential Health Benefits