Can Individuals and Families get access to Stanford?

We field some pretty anxious calls.

People shopping for their own California health insurance often hit a frustrating dead end pretty quickly and it usually comes down to one thing: Stanford Health Care isn't in the network.

At the moment (though this can change, so connect with us to confirm), there may not be a single individual or family plan available ... whether through Covered California or purchased directly through a carrier ... that includes Stanford Health Care and its network.

Stanford is just the most prominent example. Countless specialty groups and individual physicians affiliated with Stanford face the same situation.

The question we hear over and over is this- is there any legitimate way for individuals and families to get access to Stanford and its network of providers?

Yes ... there is.

Below we'll walk through a little know secret we use with clients on a regular basis.

It opens the door to networks that actually contract with Stanford, plus broader access to out-of-state providers if you divide your time between states or travel often.

Here's what we'll cover:

• Why Stanford sits outside individual and family plan networks
  
• What's required to qualify for a California small group plan
  
• How to get quoted and enrolled in a plan that actually includes Stanford

This is a general overview ... every situation has its own quirks and we're glad to look at yours directly.

There's no cost for our assistance, and we set these plans up for individuals and families all the time.

Let's get into it.

Why Stanford Isn't Available on Individual and Family Plans

When the ACA went live in 2014, carriers rebuilding their individual market networks made some significant cuts ... and prestigious academic medical centers like Stanford Health Care ended up outside many of those networks.

The reality is that Stanford commands premium reimbursement rates. Carriers building lower-cost individual plans often couldn't make the economics work, so Stanford simply wasn't included.

The result: even if you find a perfectly good PPO on Covered California, there's a solid chance Stanford still isn't in it.

For families living near Stanford, or counting on it for specialized or complex care, this has been genuinely frustrating.

But there is another route and when we show people what's possible, the reaction is almost always relief.

If you own a business in any form: sole proprietorship, LLC, corporation, or partnership, there's a reasonable chance we can get your family onto a small group plan whose network actually includes Stanford.

We walk people through this regularly. Here's what it takes.

What's Required to Qualify for a California Small Group Plan

Some background is useful here.

The original ACA legislation put significant pressure on the small group market ... widely believed to be an effort to push small business owners and their families onto the exchanges.

The rule that tends to trip people up is this:

There must be at least one person involved in the business ... either as a W-2 employee or a documented owner ... who is neither the primary owner nor their spouse.

Two spouses running a business together won't meet the threshold on their own. You need one additional qualifying individual in the picture.

How realistic is that for most people?

Pretty realistic, in our experience.

Adult children working part-time in the business, a parent or sibling with an ownership stake or on payroll, a longtime employee in even a modest role ... any of these can satisfy the requirement.

The position doesn't need to be full-time or well-compensated. It simply needs to reflect a real and documented employment or ownership arrangement.

Worth knowing: if that additional person already has coverage through another source ... Covered California, Medicare, or a separate employer ... they can submit a qualified waiver and opt out of the plan entirely. No obligation to enroll.

We can talk through how to structure everything like contributions, plan selection, eligibility to make sure it fits your actual goals and situation.

If Stanford is a must-have for your family, it's worth a quick conversation to see whether this door is open to you.

Reach out at 800-320-6269, help@calhealth.net, or pick a time on our calendar.

Getting Quoted and Enrolled in a Plan That Includes Stanford

This piece is simple.

To pull together your options, we just need:

• Your business zip code
• Zip codes and dates of birth for employees and any dependents you want to cover

You can also request your quote here if you think we can qualify.

From there we'll compile the strongest options across bronze, silver, gold, and platinum ... drawn from a wide pool of available plans ... and send you a complete quote with benefit summaries and individual cost breakdowns included.

One thing worth keeping in mind: business owners typically don't qualify for Covered California subsidies as income is too high.

What we find consistently is that small group plan rates are often in the same ballpark ... and sometimes better ... than unsubsidized individual plan premiums.

So the comparison tends to be more favorable than people expect.

We're happy to run both sets of numbers so you can see the full picture.

Once you've confirmed there's a qualifying employee or owner in place and you're ready to explore further, we'll put together a complete enrollment package and guide you through the process from start to finish.

Small group insurance has its own rules and vocabulary in California ... but this is what we do, and we'll make sure it's clear every step of the way.

Reach out to get your quote or ask any questions.

Stanford Health Care can be a real option for California individuals and families. It just takes knowing where to look.

We love being the ones to make that happen.

Reach out with any questions at help@calhealth.net or request a time to talk.