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Is your doctor still in network on your health insurance plan?

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2014 has been a year of big changes if you are on a non-grandfathered individual and family health insurance plan.  You are not Grandfathered if you have made any changes to your health insurance since March 23, 2010.

The doctor networks have been severely slashed this year on the new ACA (Affordable Care Act) compliant plans.  Make sure you find out if your doctor takes your plan before March 31st, because that is the deadline to switch to another insurance company that may include that same doctor.

Some big things to note in San Diego County (information current as of today – things are changing daily in this crazy marketplace):

  • The new Anthem Blue Cross EPO that Anthem Blue Cross changed all their non-grandfathered members to this year does NOT include Scripps doctors.  They DO include UCSD and Sharp doctors.
  • The new Blue Shield PPO plans for 2014 and the plans that non-grandfathered members were moved over to do NOT include UCSD or Sharp doctors but DO include Scripps doctors.
  • If your doctor says they take the Anthem Blue Cross EPO or the Blue Shield PPO direct but they do not take the Obamacare / Covered California Blue Shield PPO or Anthem Blue Cross EPO – they do not understand the plans clearly.  The doctor networks are EXACTLY the same inside Exchange and outside of the Exchange.

If you need to change plans for this year to have your doctors covered, you need to make the change by March 31st, or you will be stuck on your current plan for the rest of this year.  The next opportunity to change your insurance plan or insurance carrier will be in October for a January 1, 2015 effective date.  The only exception would be if you have a qualifying event mid year (divorce, marriage, birth of a child, loss of group insurance, loss of Medi-Cal, and a few others).

If you need to make a change during this open enrollment window, there will be no medical underwriting, meaning there are no health questions asked.  You have guaranteed acceptance to any health plan during this time.