Understanding Anthem Blue Cross CA 2014 Plans & Networks

Anthem has not yet rolled out all of the plans/networks/information for 2014 ACA plans but I want to update what we will all be seeing in the near future as choices for health insurance enrollment with Anthem Blue Cross.  


Some areas will not have a PPO option like LA county/Orange county and will have an EPO and HMO option.  Other areas will have a PPO option.  The Anthem program for 2014 will break down like this:

Networks:

The ACA networks for Anthem individual plans will be called "PATHWAY" and all participating providers will need to be contracted with the appropriate Pathway network.

Pathway PPO
Pathway HMO
Pathway Tiered (EPO)

Provider searches (once available online) will show two versions of Pathway for searching, Pathway and Pathway-X.  Pathway indicates off-exchange and Pathway-X indicates on-exchange.

EPO will be a tiered network with lower costs for inpatient & outpatient services in tier 1.

Plan names will reflect if plan is on-exchange or off-exchange as follows:

On-Exchange: Bronze, Silver, Gold, Platinum
Off-Exchange: Core, Essential, Preferred, Premier

Anthem will offer a total of 26 health plans across California (not all in all regions).  These will include:

On Exchange and "Mirrors" Off-Exchange
Bronze - 4
Silver - 3
Gold - 3
Platinum - 3
Catastrophic - 1

Off Exchange Only not Mirrored
Core (Bronze) - 8
Essential (Silver) - 4
Preferred (Gold) - 0
Premier (Platinum) - 0
Cat - 0

PPO and EPO Plans will be referred to as "Direct Access" and HMO will be "Guided Access".



Dave
www.davefluker.com

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