<p>For this guy, because he lives in San Diego and this county only has a EPO network for Anthem, he cannot go to any providers outside his area. Some of the other regions have PPO networks, which would allow broader coverage, but if you live in one of these regions, I am not sure you could receive coverage in these other areas that have EPO networks. Blue Shield has PPO networks, but they definitely don’t include UC hospitals.</p>
<p>Currently, the PPO networks for Anthem and Blue Shield cover the entire state and even the country; in 2014, that will not be the case.</p>
<p>Tatin, although you are correct that he could move to Santa Clara County to be seen at Stanford, I am not sure he was suggesting this is one of his options.</p>
<p>If the rural county has a PPO network, he could see doctors in other regions with PPO networks. If it has an EPO network, he’s got serious problems.</p>
<p>Edit: The potential problem I have is that I might not be able to go to any providers in LA, San Diego, Orange County and San Francisco because they all have EPO networks. Dstark is going to call an agent tomorrow to ask about this.</p>
<p>Not enough choices, NJ has no PPO plan on the individual market, on or off exchange. A few HMO’s, a few POS and all the rest are limited EPOs. Even if you are willing to pay more, they are not available.</p>
<p>Actually there are three carriers offering plans in Goldenpooch’s region. He just doesn’t like one of them (Kaiser), but that doesn’t negate the fact that it is offered.</p>
<p>I’m just pointing this out because there’s a tendency for people to post incomplete information on internet blogs, or for news reports to be incomplete – and then people take those incomplete accounts as if they are gospel. It doesn’t just come from online. I had an experienced insurance broker tell me over the phone that there were NO carriers at all offering insurance in a particular state – that is, a person who lived in that state could not get insurance at all under ACA. I don’t know what the source of that rumor was, but 5 minutes on the internet was all it took for me to confirm that in fact there were carriers continuing to do business in that state.</p>
<p>Calmom, technically you may be right, but in reality your wrong. My region includes a number of counties, probably encompasses 120 miles north to south. Kaiser really has no presence in my town to speak of; you would have to drive 45 miles to see a Kaiser doctor. Their presence in my region is very limited. It is not a realistic choice for people who live where I do.</p>
<p>Yes, busdriver, that is correct, although they probably feel pressure from the state to not go hog wild, which is the reason for the narrow networks. Should be interesting to see what the rates will be in 2015, after they have a year of experience under their belt.</p>
<p>Yes, that’s what I wonder, also. If there is no more competition in the marketplace, who knows what will happen. I should have bought some insurance stocks.</p>
<p>Goldenpooch, how many insurance companies were active in your region before ACA?</p>
<p>The UNH story is terrible. UNH only insured 10,000 people in the whole state. Aetna only insured 50,000. Health Net had a small presense.</p>
<p>Kaiser has 40 percent of the individual market in California. Anthem and Blue Shield are the other large players. Those three firms form an oligopoly in Ca. Health Net is expanding coverage but let’s get real…</p>
<p>There are 3 main players in California.</p>
<p>I dont know the out of state network for Anthem PPOs and you dont either GP. Can we find out first before we pretend we know?</p>
<p>dstark, yes, those are the dominant players, but we also have Aetna, Cigna, Health Net and United Healthcare (I think) until the end of this year. All those plans were very competitive. Every so often I would check them out on ehealthinsurance.</p>
<p>It’s not entirely clear to me that only having three major insurance carriers in CA, with Kaiser operating their own facilities, will drive up prices. The problem is that in California we have big hospital chains. If a small insurer with few customers tries to negotiate with a big hospital chain, the chain can just tell them, “These are our prices, take it or leave it, we don’t care about your paltry 2% of the market anyway.” But if the chain tries to do that to a carrier representing 40% of the people in the market, the carrier can start remarking about how pretty those new expensive birthing suites are and what a pity it would be if there were no new mothers to give birth in them.</p>
<p>dstark, I actually think that Anthem will cover out-of-state, although I could be wrong. My greater concern is will we have access to doctors and hospitals in San Francisco, Los Angeles, San Diego, and Orange County. Hopefully, we will get a good answer from the agent tomorrow.</p>