Can California Health Insurance Unify Group And Individual Coverage?

As many as 4.57 million California residents either have no health plan or inadequate coverage. According to the UCLA Center for Health Policy Research, most of these people are between the ages of 18 and 44 and are male. The study also indicated that the majority of these people are healthy in spite of reduced access to health care.

Among those in need of California health coverage, a mere six percent had diabetes and only one or two percent showed signs of heart disease. Asthma rates among this group were similarly low. Only a tiny portion of these people might have been refused coverage based on pre-existing conditions, so why don’t they have coverage?

Many of them have been deprived of access to health care because they’re unemployed or work for businesses that don’t provide health insurance plans as an employment benefit. The UCLA Center evidence pointed out poor access to health care among both the uninsured and people covered with individual plans in contrast to those with group coverage.

Specifically, problems getting prescription medications hit those without group coverage the hardest. As the lead author of the study, Nadereh Pourat said, “The data show that there is a yawning divide between those who get insurance through an employer and the rest of the state.”

Changes In Health Insurance For California Expand Access To Health Care

It’s not surprising that a lack of group coverage through work hits recent graduates the hardest. According to the Commonwealth Fund, almost 40 percent of college graduates and 50 percent of high school graduates who aren’t going to college go without health coverage for at least part of their first year following graduation.

Many of the insured and the underinsured will be eligible to participate in the California health insurance exchange in 2014 when health care reform finally reaches full momentum, but that’s a long time to wait. Even healthy, young people are at risk from accidents. Maybe they don’t have to wait.

California Health Insurance Seeks A New Generation

One particular insurer is promoting a plan to get attention from young, healthy Californians. In exchange for low premiums, Anthem Blue Cross of California is offering a PPO plan called Tonik.

With a PPO, which stands for Preferred Provider Organization, you can see any doctor in the Anthem Blue Cross PPO Prudent Buyer Network. Since that’s the largest network in California, coverage is quite extensive.

Unlike HMOs, a PPO plan doesn’t make you pick a primary care provider (PCP). You are free to see specialists or get a second opinion without having to get a referral from your PCP in order to be able to file a claim.

Unlike most PPOs, Tonik has coverage for basic dental services, eye exams, and contacts or glasses. In addition, Tonik provides $15 generic prescription drugs, but it does not cover brand-name prescriptions. It does include coverage if you travel outside of California, though.

This type of health coverage for California has been available since 2004. About 78 percent of those currently covered with Tonik were previously uninsured, but an estimated 1.6 million between the age of 19 and 29 still need California health coverage.