Frequently Asked Questions About Covered California and the Affordable Care Act
You have probably heard a lot about the federal government's Affordable Care Act (ACA), and you may have a few questions about what it means to you.
If you receive insurance from your employer and see a Sharp-affiliated physician, the ACA will have little or no effect on your access to the services and facilities of Sharp HealthCare. If you are uninsured or purchase your own insurance, the ACA provides new opportunities to begin a relationship with Sharp.
How to choose Sharp.
Open enrollment for health insurance plans through Covered California begins each year on Nov. 1 and ends Jan. 31 of the following year. If you do not qualify for a subsidy and want to enroll in a Covered California plan, visit Sharp Health Plan to learn more. Also, learn more about how to choose Sharp. Read below for more information about subsidy qualifications.
Below you will find answers to frequently asked questions about the Affordable Care Act and the health insurance marketplace, Covered California.
What is the Affordable Care Act/health care reform?
In 2010, Congress passed the Affordable Care Act (also known as "Obamacare"), intended to provide affordable health care options and increased access to high-quality medical care. Health care reform refers to the federal act and laws enacted by states to follow it. Those who did not have health insurance from their employer or another government program are now able to purchase insurance through the open market or the new health insurance marketplace, Covered California, during open enrollment periods.
How does this affect me?
If you are currently insured in your employer's health plan and see a Sharp-affiliated physician, you do not need to do anything. Simply make sure the plan you choose during your annual benefits enrollment will continue your access to your Sharp-affiliated doctor. The best way to verify your coverage is to contact your insurance carrier directly. If you are uninsured or purchase your own insurance, you may remain or become a Sharp patient by selecting a plan that is accepted by Sharp through the Covered California insurance marketplace.
The current health plans accepted by Sharp HealthCare and the levels of coverage offered through Covered California are:
Sharp Health Plan
Sharp HealthCare's own health plan offers a variety of options for individuals and families. Both Sharp Rees-Stealy and Sharp Community Medical Group accept all Sharp Health Plan exchange plans.
HMO: Bronze, Silver, Gold and Platinum
Anthem Blue Cross
Sharp Rees-Stealy accepts all Anthem plans. Sharp Community Medical Group physicians accept EPO plans; however, please verify with your doctor's office and with Anthem Blue Cross.
HMO: Silver, Gold and Platinum
EPO/PPO: Bronze, Silver, Gold and Platinum
Sharp Rees-Stealy accepts all Health Net PPO plans, including Covered California plans. Sharp Community Medical Group physicians may accept Health Net PPO plans; however, please verify with your doctor's office and with Health Net.
What is a health insurance marketplace?
As part of the new health care law, the state of California has established Covered California, a health insurance marketplace (sometimes referred to as an "exchange") created to help bring affordable health insurance options to the uninsured and individuals who buy their own coverage. Those who do not have health insurance from their employer or another government program can purchase insurance through Covered California. Depending on your household size and income, you may be eligible to receive a subsidy to help you pay for your insurance.
Who can shop in the Covered California marketplace?
Legal residents of the state of California who purchase their own insurance or who are uninsured may shop for health care coverage through Covered California.
When does open enrollment for Covered California begin?
Open enrollment for health insurance plans through Covered California begins each year on Nov. 1 and ends Jan. 31 of the following year.
I already receive health insurance through my employer. Do I need to do anything?
If you participate in your employer's health plan, simply renew your coverage for access to a Sharp-affiliated physician during your company's annual benefits enrollment period, which generally takes place October through November. Check with your employer for exact dates. If you have questions about covered services, copays or deductibles, please call your insurance company to confirm your coverage and to confirm that your Sharp-affiliated physician participates in its network. Learn more about employer-based health insurance.
Can I continue visiting my Sharp-affiliated physician?
If you currently see a Sharp-affiliated physician, continue your access to Sharp by renewing your existing health insurance plan during your plan's annual enrollment period. Use our Find a Doctor tool to check what insurance plans your doctor's office accepts and confirm coverage with your insurance carrier to ensure you can continue seeing your Sharp-affiliated physician. Check with your agent or broker for details and any exceptions.
I purchase my own insurance. How can I get access to a Sharp-affiliated physician?
If you purchase your own insurance, simply verify that your selected insurance plan is accepted by Sharp-affiliated physicians. You can become a Sharp patient through the Covered California program by selecting Sharp Health Plan, Anthem Blue Cross or HealthNet for your insurance plan. You may even be eligible for a subsidy.
I'm uninsured. How can I get coverage for access to a Sharp-affiliated physician?
If you are uninsured or qualify for financial assistance, you can remain or become a Sharp patient by selecting Sharp Health Plan, Anthem Blue Cross or HealthNet insurance through Covered California, the state's health insurance marketplace. Learn more about buying health insurance.
I've heard about financial assistance. Do I qualify?
Depending on your household size and income level, you may be eligible to receive a subsidy to help pay for your insurance. You and your family may qualify for a subsidy if you meet one of the qualifying items below*:
- 1 person in household - annual family income of $45,960 or below
- 2 people in household - annual family income of $62,040 or below
- 3 people in household - annual family income of $78,120 or below
- 4 people in household - annual family income of $94,200 or below
- 5 people in household - annual family income of $110,280 or below
- 6 people in household - annual family income of $126,360 or below
- 7 people in household - annual family income of $142,440 or below
- 8 people in household - annual family income of $158,520 or below
*Source: Covered California. Subsidy will be based on estimated 2015 modified adjusted gross income.
I am covered under Medicare. Do I need to do anything?
How can I find a Sharp-affiliated physician?
How can I get more information?
Choose the best doctor in San Diego for you.
View doctors specializing in primary care in San Diego.
"The patient is my top priority and providing excellent patient care is my goal."
"I provide a top-notch team approach to delivering patient care with attention to comfort."
"My goal is to provide comprehensive continuing care for patients and their families."
"The Sharp Experience represents quality patient care delivered with compassion and respect."
"My mission is to teach patients how better health habits can prevent many diseases."
"I believe in providing personalized care that patients can't find anywhere else in San Diego."