Individual & Family
Group health
Medicare Supplement

Best rates GUARANTEED

Free Assistance 800-320-6269

California health insurance  -  Understand health insurance in California  -  California HMO individual plans

What happen to individual California HMO health insurance plans?

ACA UPDATE:  The HMO model has been re-invigorated by Covered California with new options available which you can quote here.

HMO history before the ACA law

There was a time when HMO's looked to be the dominant type of plan on the California health insurance market and for good reason. They offered very rich benefits (relative to the indemnity plans on the market) at much lower cost. To paraphrase the cheesy sales pitchman, "Is that something you would be interested in?". The number of enrollees on this new type of "managed care" plan exploded on the both the individual and group health insurance plans across California with the most saturation in more populated areas. Oh, have things changed. Let's take a quick look at how the HMO revolutionized the health insurance market in California, what has occurred since, and what Health Reform means for these plans.

Let's step backwards and see what was happening when HMO or Health Maintenance Organizations came on the scene. In the 80's, you primarily had indemnity plans. Indemnity plans are pretty straight forward. As long as the medical expense is covered by the plan, the plan pays according to the benefits. There was no concern for networks. This worked well for decades but the 80's put a stop to that. Medical cost inflation spiraled out of control primarily due to new diagnostic technology and increased utilization. Managed Care was the answer and the lead candidate was the new HMO.

SO what is an HMO?

Essentially, an HMO is when doctors in a certain geographic area group together with a specific relationship with health insurance carriers. Essentially, the California health carriers will pay this group to provide health care to all HMO enrollees within that group (usually called an IPA for Independent Provider Association or PMG for Primary Medical Group). This was the revolutionary design change behind HMO's...the doctors where financial responsible for providing medical care to the HMO enrollees. If they gave out too much or excessive care, they would lose money as a group. There was a built in mechanism to provide cost effective care directly at the doctor's level. This was also the root of much of HMO's flack over the years. It was definitely more structured and strict in terms of accessing care. This did however allow for low costs and rich benefits albeit with more control over health care decisions. So what happened?

If you look at the individual family California health insurance market, the HMO plans have been completely priced out of the market. They make no sense now and this trend started during the last decade as the HMO's were faced with more regulation (translated as less ability to keep down costs) and increased utilization of services. The rates exploded. If you run your individual health quote here, you'll find that the HMO's are double to triple the mid-level PPO plans and they still have deductibles built in. It's hard (if not impossible) to justify the cost. There are still competitive HMO plans available on the group market but they have also been trending up so that won't last long. In fact, it will be interesting to see how the HMO model fares Jan 1st 2014 with Health Reform. We have a suspicion that the cost containment and narrow networks of HMO's will be alive as well as that's the only thing the carriers can control any longer. In the mean time, PPO's are the way to go on the individual family health market in California.

Related Pages:

Difference between HMO and PPO
 

You can run your California Health Plan Quote here to view rates and plans side by side from the major carriers...Free.

Again, there is absolutely no cost to you for our services.  Call 800-320-6269 Today!

YOU MAY STILL BE
ABLE TO ENROLL

In just 15 minutes:

  • - Get the most tax credit available
  • - Find the best plan for your needs
  • - Enroll right over the phone!




Call 800-320-6269

Our Services are FREE to You!

Need Help
With Existing Account

We can help you:

  • -Get required docs to covered Ca.
  • -Make changes to income and other info
  • -Choose and finalize plan enrollment
  • -Make sure you get right tax credit
  • -Payment/membership issues with carriers

Call to Enroll over the Phone in 15 Minutes

If Your Income
Is In This Range

Current Years Estimate; All those that file together on one 1040:


Single Person: $16k - $47k
2 People $22k - $64k
3 People $27k - $80k
4 People $33k - $97k

Call 800-320-6269
Anthem Blue Cross California
Blue Shield of California under Covered California
Kaiser of California
Health Net of California
Aetna
and more
Thousands of Californians
Hundreds of California Companies
SUCCESSFULLY
ENROLLED
Thousands of Californians
Hundreds of California Companies

from SC

"My sincere thanks for making a miracle happen- 2014 health insurance !! Many thanks for your expertise and advice yesterday !!"

from SD

"Thanks again for your help - I had absolutely no idea how to get this done when I got up this morning. You've made it remarkably easier than I expected. I hope you're not stuck at the office all night..."

from KV

"Anyway, I hope you got some time off this past week! Thank you again for your help and efforts on my behalf! I was very lucky to find you."

from EK

"I thank you very much for the time that you have invested in handling everything

from SR

"I truly appreciate the quick response and will think of you in the future if I need to make any changes to my insurance plans."

from VH

"You are awesome... takes a huge worry off my back, thank you for your kind. thanks for your time and kindness. !!"

from SA

"Wow, I can't thank you guys enough for your help...I couldn't imagine trying to tackle this on my own!"

from LM

"You are my new best friend. A HUGE thank you again.

SUCCESSFULLY
ENROLLED
Find out what customers are saying about our services
About Calhealth.net

20 years of experience in the California health insurance market has taught us one thing...Competent and experienced guidance is Invaluable

We can quickly (very important) size up your health insurance needs and clearly explain the options available to you. Our focus is finding the most coverage at the best cost to you.

We are licensed Covered Ca agents with in-depth knowledge of their plans, process, and tax credits.

Call us...you will be Pleasantly Surprised.  800-320-6269

Request a 10 Minute Health Plan Check-up

We'll quickly see if you have the best priced plan available and if you qualify for a tax credit

800-320-6269
calhealth website

Our Services are FREE to You

Calhealth.net is a Goodacre Insurance Services Website

This website is owned and operated by Goodacre Insurance Services, which is solely responsible for its content. This site is not maintained by or associated with Covered California, and Covered California bears no responsibility for its content. The email address and phone numbers that appear throughout the site belong to Goodacre Insurance Services, and cannot be used to contact Covered California.