Health Insurance Guys: My premiums are too high. Now what? – Napa Valley Register

Health Insurance Guys: My premiums are too high. Now what? - Napa Valley Register

I’m 62 and have been on the Health Net PPO for a few years. They told me my rate was going to be all the way up to $1,700 per month beginning January 1.

That kind of payment, just for me is outrageous, so I switched to the Blue Shield PPO starting this month. I need a PPO so that I can go to Stanford Medical Center where most of my doctors are.

They just told me that Stanford is “out of network” which means the coverage is less and my deductible (already huge) is doubled. How can that be?


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Tom: Very understandable that you are ticked off. Your previous Health Net PPO plan would have been grandfathered in for this year if you had stayed with it and with that outrageous premium.

Preferred Provider Organizations (PPOs) have historically offered the largest network of providers. Exclusive Provider Organizations (EPOs) are the same idea but fewer providers.

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This year, Health Net plans are all EPOs in our area. The least expensive Health Net plan for our reader would be $1,364.25 (don’t know if Stanford is in-network).

Alan: Anthem Blue Cross has returned to the individual and family market in California. Their plans are also EPOs with the least costly plan for our reader being $1,063.50 per month.

In the first year of the Affordable Care Act (ACA) in California, Anthem changed the Prudent Buyer Network to the Pathway Network. Unfortunately, virtually none of our local doctors were contracted. I don’t know if Stanford is in Anthem’s EPO network.

Kyle: OK, about Blue Shield of California. It used to be that you were in-network just about anywhere in the U.S. Then it recently became “out of state is out of network.” Now we’re being told that one of the most prestigious providers in California is not in-network.

Anyway, the least expensive Blue Shield PPO plan for our reader is $1,195.86 each month.

I did a little more looking into the rates for a 62-year-old in our zip code. The very least expensive plans are the Health Maintenance Organizations (HMOs). And, of course, the most popular is Kaiser.

The Kaiser Bronze plan is $914.06. The Kaiser network is large and available in most areas of the state. Obviously, Stanford is not part of the Kaiser network.

The other HMO available in our area is Western Health Advantage (WHA). Their network is in 10 Northern California counties, but alas, not Santa Clara County.

Tom: Very clever, Kyle, because Palo Alto is in Santa Clara County.

I think that the only recommendation we can make is to consider Covered California. The networks don’t change, but at least there is the possibility of a subsidy to help reduce the monthly premium.

For example, assuming a household income of $70,000, the Blue Shield Bronze PPO is reduced to $530.34 per month instead of $1,195.86. Just remember to tell Covered Cal about any changes.

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