Covered CA 2013

EPIC's Medical Groups to Accept HealthNet's Plan Offered Through Covered California Marketplace

November 01, 2013

  • Individuals who purchase insurance through California’s new Health Marketplace, Covered California, can see any of the hundreds of doctors affiliated with EPIC Management if they choose a Health Net plan.
    All of the doctors at EPIC Management’s client medical groups – Beaver Medical Group, Redlands-Yucaipa Medical Group, Pinnacle Medical Group, Tri-Valley Medical Group, Alliance Desert Physicians and Chaffey Medical Group are contracted only with the Health Net individual plans offered through Covered California. Health Net offers all levels of plans (Bronze, Sliver, Gold and Platinum) on the Marketplace. The medical group doctors will not accept any of the other plans offered by other insurance companies through Covered California.
    Covered California, the State health care marketplace put into place as a result of the federal Affordable Care Act, will offer health plans to all Californians needing insurance beginning in 2014.

  • Facts about the new Health Marketplace:

• All Californians can qualify for insurance in 2014. People with pre-existing conditions will be accepted, at no additional charge.

• People on Medicare cannot choose plans on the new marketplace. Many Medicare Advantage and PPO plans are available for Medicare beneficiaries.

  • • There are 3 financial assistance programs to buy insurance at Covered California based on income:
         o Premium assistance (up to $45,960 single/ $94,200 family)
         o Cost-sharing subsidies to reduce deductibles & co-pays
         o More people to qualify for Medi-Cal

  • • A cost calculator that includes financial assistance information is available at:

  • • Options to enroll are:
         o Through Covered California at or 800-300-1506
         o Through Health Net by calling  1-877-527-8409 or visit:
         o Calling a local insurance agent certified by Covered California. A few local partners include: George Litchfield: (909) 792-3300, Dave Nash: (909) 792-4410 and Barich and Associations: (909) 793-0385

  • • Open Enrollment is October 1, 2013 – March 31, 2014. If you do not enroll during this period, you will not be assured a health plan will cover you. The next open-enrollment period begins in October 2014 for coverage in 2015.

  • • Coverage begins January 1, 2014, or the month following enrollment (to April 1, 2014)
  • • Four plans types of plans are available. Platinum, Gold, Silver and Bronze. They will offer co-pays at different rates per each type of plan, depending on the monthly premium cost. Basically, the higher the monthly premium you pay, the lower the co-pays and deductibles will be.

  • • There will be a tax penalty for not having insurance:  In 2014, an individual who does not have health coverage will face a penalty of  1 percent of income. In 2014, a family will be charged a penalty of $95 per uncovered adult and $47.50 per uncovered child (up to $285 for a family) or 1 percent of the family's income, whichever is greater. These will increase in 2015. However, some individuals may be exempt from paying a penalty, including: 1) People who would have to pay more than 8 percent of their income for health insurance. 2) People with incomes below the threshold required for filing taxes -in 2013, $9,750 for a single person and $27,100 for a married couple with two children.  3) People who qualify for religious exemptions. 4) Members of federally recognized American Indian tribes and Alaska Natives.

  • • People can enroll for Medi-Cal now, or through the Marketplace. Individuals making up to $15,415 a year or families making up to $31,810 a year pay qualify for Medi-Cal insurance at no cost to them. To apply for Medi-Cal and other state programs now, go to  Pinnacle Medical Group accepts patients on Medi-Cal insurance plans such as IEHP and Molina.

  • • If you have a life-changing event such as the loss of a job, death of a spouse or birth of a child, you would be eligible for special enrollment period within 60 days of the event.