Is Blue Shield of California an HMO?

Asked by: Addie Block  |  Last update: September 2, 2023
Score: 4.3/5 (26 votes)

Blue Shield of California is an HMO and PDP plan with a Medicare contract. Enrollment in Blue Shield of California depends on contract renewal. This information is not a complete description of benefits. Call Member Services at (800) 776-4466 (TTY: 711) for more information.

What is the difference between Blue Shield HMO and PPO?

Choosing between an HMO or a PPO health plan doesn't have to be complicated. The main differences between the two are the size of the health care provider network, the flexibility of coverage or payment assistance for doctors in-network vs out-of-network, and the monthly payment.

How can you tell the difference between an HMO and a PPO?

HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.

What type of insurance is Medi Cal HMO or PPO?

Almost all Medi-Cal plans are “managed care plans” which means they function similar to an HMO. Medi-Cal Plans can be found in the Medi-Cal Managed Care Health Plan Directory. A managed care plan means you'll have a primary care physician, and they're the one person you'll see if you need medical care.

What is California HMO?

An HMO is a health maintenance organization. The Department of Managed Health Care (DMHC) oversees all HMOs in California and some other kinds of health plans. An HMO is a kind of health insurance that has a list of providers, such as doctors, medical groups, hospitals, and labs.

Blue Shield health insurance plans in California all you need to know to get the best insurance

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Why do people choose an HMO over a PPO?

Many choose an HMO plan simply because the monthly premium is lower than PPOs, and the out-of-pocket costs are lower. It is worth noting you will still be able to go to your nearest emergency room and receive coverage in the event of a medical emergency.

Is Blue Shield California good insurance?

Blue Shield of California is seventh on's list of the Best Health Insurance Companies for 2023. The company received an impressive 4 out of 5 stars from the National Committee for Quality Assurance. NCQA evaluates healthcare plans on, among other things, member satisfaction.

Does Blue Shield have a Medi-Cal plan?

Blue Shield of California Promise Health Plan currently serves Medi-Cal members in Los Angeles and San Diego counties. In Los Angeles County, we are contracted with L.A. Care Health Plan. In San Diego County, we are contracted with the Department of Health Care Services.

Is HMO the same as Medi-Cal?

Health insurance, Health Plans (HMOs), and public programs like Medicare and Medi-Cal are all different. They each follow their own set of rules. Different government agencies regulate each one. We have put together this list of healthcare coverage options, descriptions, and the agency that regulates each one.

What is another name for Medi-Cal insurance?

Medi-Cal is California's version of the Federal Medicaid program. Medi-Cal offers no-cost and low-cost health coverage to eligible people who live in California. The Department of Health Care Services (DHCS) oversees the Medi-Cal program.

Is PPO more popular than HMO?

PPOs are the most common plan type. Forty-nine percent of covered workers are enrolled in PPOs, followed by HDHP/SOs (29%), HMOs (12%), POS plans (9%), and conventional plans (1%) [Figure 5.1]. All of these percentages are similar to the enrollment percentages in 2021.

What is the downside to Kaiser Permanente?

The downside of Kaiser health insurance is that most plans have no out-of-network coverage except for urgent care or emergencies. If you prefer an insurance plan with more flexibility, then we suggest choosing Anthem or Blue Cross Blue Shield, which is accepted by 90% of doctors across the country.

Is HMO or PPO better for pregnancy?

Is it better to have HMO or PPO when pregnant? It depends on your specific needs and preferences. HMOs typically have lower out-of-pocket costs but limit your choice of doctors and hospitals. PPOs typically have higher out-of-pocket costs but offer more flexibility in choosing doctors and hospitals.

What does HMO mean in insurance?

A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage.

Does California have PPO plans?

In California, everyone needs health insurance, but navigating your plan options can be confusing. Most health insurance plans in the state are either Health Maintenance Organization (HMO) plans or Preferred Provider Organization (PPO) plans.

Is Kaiser HMO a good plan?

Kaiser Permanente is a good choice if it's available where you live. Its health insurance plans earned an average grade of 4.3 out of 5 from the National Committee for Quality Assurance, which is the highest of any company in our analysis.

Is Medi-Cal better than Covered California?

Medi-Cal provides benefits similar to the coverage options available through Covered California, but often at lower or no cost to you or your family. All of the health plans offered through Covered California or by Medi-Cal include the same comprehensive set of benefits known as "essential health benefits.”

Is HMO always Medicare?

What's an HMO? A type of Medicare-approved health plan from a private company that you can choose to cover most of your Part A and Part B benefits instead of Original Medicare. It usually also includes drug coverage (Part D). offered by a private insurance company.

Can I go to any hospital with Medi-Cal insurance?

Emergency Rooms: As stated above, if you have an emergency and you cannot find a doctor right away, you can go to the emergency room at any hospital. If you show your BIC to staff at the emergency room, Medi-Cal will pay for the services you receive.

Is Blue of California Medicaid?

Coverage that is all about you. At Blue Shield of California Promise Health Plan, we know that health care is more than a doctor's visit. That's why we provide extra care and support. We offer Medi-Cal in Los Angeles and San Diego counties and have many doctors to choose from.

Is Blue Shield of California the same as Blue Cross?

Blue Shield of California is a Registered® mark of the BlueCross BlueShield Association, an association of independent Blue Cross and Blue Shield plans. Blue Shield of California and Mylifepath are service marks of Blue Shield of California.

What type of plan is Blue Shield of California?

Blue Shield of California is an HMO and PDP plan with a Medicare contract. Enrollment in Blue Shield of California depends on contract renewal.

What is the best medical insurance in California?

In California, the best health insurance rates are through L.A. Care and Molina. A Silver plan from L.A. Care averages $330 per month, and one from Molina plan averages $384. That's much cheaper than the statewide average of $541 for a Silver plan.

Is Blue Shield of California only for California?

Blue Shield of California, based in San Francisco, has been providing health coverage to California residents since 1939. Today, Blue Shield of California is one of only two preferred provider organizations that offers plans to all California ZIP codes and counties.