Health Insurance at Hoag

With the changing landscape of healthcare insurance last year, you may have found yourself a bit lost and confused about your health insurance coverage and how to ensure access to all of Hoag.

We have comprised the tools below to help guide you through the 3 easy steps to ensure you are choosing the right insurance to access Hoag’s trusted services.

Depending on your individual needs you may be acquiring health insurance through your employer, or individually through a broker or through Covered California or perhaps if you are a senior you may be accessing Medicare or Medi-Cal for the first time or want to check on annual updates. Regardless of your particular situation, we’re here to help navigate you through this changing landscape to get you access to the entire Hoag Network.

*Hoag does not participate in medical discount cards (cash pay) or consumer card programs such as Care Entrée’, Care IQ, Galaxy Health Network, Integrated Health Plan, MedicalConnect1, etc. that may be offered by these or any other networks.

The following plans are not contracted with Hoag: Kaiser, Medi-Cal, and Three Rivers Provider Network (TRPN). In some cases, patients can access Hoag services if their plan and/or IPA pre-authorizes the care.

If you currently purchase a private health insurance policy on your own you may:

• Purchase a plan directly through a health insurance website or insurance agent

• Purchase a plan through Covered California

Options available outside of Covered California:

Hoag accepts several health insurance plans and networks. To view a list of accepted insurance plans, click here.

Access to Hoag as an “In-Network” provider through the following Covered CA Plans:

California State Health Marketplace frequently referred to as “the exchange”. Designed as a resource for families, individuals and small businesses to learn about their health insurance options and enroll in coverage. Additionally certain income eligible participants may qualify for premium assistance and subsidies through the federal government.

Choose your plan carefully. Not only do you want to ensure the hospital of your choice is “In-Network” you’ll want to confirm with the health plan you choose that your physicians are “In-Network” as well.

• Blue Shield of California PPO (Southern California)

• Blue Shield PPO Bronze Plans on Small Business Health Options Program (SHOP) Exchange

• Blue Shield of California Trio HMO (exclusive to Orange County)

Please note that Hoag will be out of network for any Covered California plan that is NOT listed above.

Learn more about Covered CA. >

Grandfathered Plans:

A grandfathered plan is a group health plan that was created — or an individual health insurance policy that was purchased — on or before March 22, 2010. Grandfathered plans provide the same access to the facilities and physicians you have grown accustomed to.

If you’ve had an Anthem Blue Cross or Blue Shield individual policy since March 22, 2010, you may be able to keep your current benefits through “grandfathering.” Please call the member services phone number on the back of your insurance card to see if you qualify.

Plans for Seniors:

Whether you choose Medicare alone, and/or supplemental senior health plans, you may notice some changes year and after year. Choosing supplemental plans in addition to Medicare can help ensure you achieve the same level of coverage or better than what you had prior to turning 65.

Hoag offers community education classes to assist with Medicare enrollment and finding the plan that best fits your needs. For a list of upcoming classes please click here .

Learn more about Medicare and Accessing Hoag >

In order to ensure your access to Hoag Hospital and our trusted physicians, you will need to verify that your employer is offering insurance plans accepted by Hoag. Be sure you select a plan that is contracted with Hoag Hospital. If you have an HMO, you will also need to select Hoag Hospital as your preferred hospital to ensure access.

View all PPO, POS, HMO, and EPO plans contracted with Hoag*

*Eligibility and benefits are determined by the health insurance plans; Hoag encourages you to confirm your network choices directly with the health plan. This would include physicians and facilities.

Employer Group Plans for Seniors:

Some employers offer retired employees health insurance benefits after retirement. It’s important to understand your coverage benefits since the senior insurance plan may have different coverage and access benefits.

You can learn more about ensuring your access to Hoag by attending one of our Medicare classes, offered free to the community.

Step 1:

Visit the Hoag Guidelines Webpage

Step 2:

• Read and accept the terms and conditions.

• Enter your first and last name. Choose which category best fits your interest in the guidelines.

• Choose your preferred way to receive a verification code (text, email or telephone).

• Enter your verification code when you receive it.

• We’ll show you a list of Hoag’s care guidelines content

• Choose the guidelines you want to review in your web browser.

• You won’t be able to print the guidelines.

These guidelines are proprietary to MCG. You can’t copy or print them. We can’t distribute them without MCG’s permission. The MCG Cite Transparency tool allows accounts and regulators to view multiple guidelines at once through a web browser.