One of the lovely terms you'll come across while researching and shopping for California health insurance is "Primary Care Physician". Health insurance loves its codes and secret language. What exactly is a primary care physician? To understand, we'll first have to revisit the slowly disappearing world of HMO's on the market. Let's start there.
HMO stands for Health Maintenance Organization and it was pretty effective in holding down the medical inflation that ran rampant in the 80's (yes...decades ago). The HMO put the onus of controlling costs on the doctors and hospitals. Essentially, a health carrier would contract with a group of doctors and hospitals to provide medical services to enrolled members for a fixed or "capitated" amount per month. For example, a given carrier may pay an HMO medical group $300 monthly to handle health care maintenance and care for a given individual. The HMO group is banking on the fact that a percentage of the total pool of enrolled will need a certain level of care in any given month and they will be able to make a business out of this arrangement. The whole purpose of this arrangement is that it is now in the interest of the doctors and hospitals to manage the care and most importantly, manage the cost. It's that's simple and it worked. The HMO's could offer very rich benefits at an affordable price for years. The cost inflation has quickly caught up with the model since then but the benefits on HMO plans still tend to be richer than PPO plans.
The focus in the HMO model is on health care cost containment and care management. If you're an HMO member, you can't go in and have whatever you want done with doctors and hospitals. In order to affect this control, there needs to be a gateway...a person who manages your care. This is the Primary Care Physician. The PCP is usually one of the general practitioners (GP, Internal Medicine, OBGyn, Pediatrian, etc). When you enroll in an HMO plan, you choose your PCP from a list in your area and in a certain medical group. In the case of a PCP, the group is called an IPA or Independent Physicians Association as opposed to a PMG or Primary Medical Group. With a PCP, the doctors and hospitals are independent and have agreed to participate in the group. You need to select a PCP up front and this is primary point of contact for services within the HMO group. This person is needed to refer you out to specialists although some carriers have made certain specialties available to speedy or self-referrals such as OBGyns.
You can usually change your PCP as long as
you're not in a course of treatment. For
example, if you select a PCP when enrolling and
go in for the initial visit only to find that
you don't care for the doctor or staff, you can
usually request a change to a new provider. The
HMO networks are generally much smaller than the
PPO networks and you have to choose from a
IPA/PMG and a PCP within a certain radius from
where you live. HMO plans have taken quite a hit
lately as their ability to "manage" care has
been slowly eroded by State legislation to where
they are prohibitively expensive on the
individual/family California health market and
slowly going that direction on the group side as
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:
With Existing Account
We can help you:
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|
"My sincere thanks for making a miracle happen- 2014 health insurance !! Many thanks for your expertise and advice yesterday !!"
"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..."
"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."
"I thank you very much for the time that you have invested in handling everything
"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."
"You are awesome... takes a huge worry off my back, thank you for your kind. thanks for your time and kindness. !!"
"Wow, I can't thank you guys enough for your help...I couldn't imagine trying to tackle this on my own!"
"You are my new best friend. A HUGE thank you again.
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
We'll quickly see if you have the best priced plan available and if you qualify for a tax credit800-320-6269
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.