One Medical FAQ: Health Insurance Exchanges

The Health Insurance Marketplace (aka health insurance exchanges) facilitates the purchase of health insurance in every state in accordance with the Patient Protection and Affordable Care Act (ACA). These exchanges provide a place for health insurance companies such as Blue Cross to sell insurance plans directly to consumers, and where consumers can price compare insurance plans by insurer and/or plan type.

A core principle of the ACA is that people will be healthier if they have access to affordable insurance coverage and high-quality primary care, which is why the federal government has mandated creation of these exchanges in every state.

Many people are still confused about how health insurance exchanges work; according to a recent poll by the Kaiser Family Foundation, 45 percent of Americans say they still don’t have enough information to understand the impact the ACA will have on their family.

To reduce the confusion, One Medical is committed to arming you with the information you need to make smart decisions. To that end, here are answers to a few of the most frequently asked questions we hear about One Medical and the Health Insurance Marketplace.

One Medical is currently in-network with a number of different exchange plans. We’ll continue to expand this list over time, and update this page with the latest plans.

Boston

• Blue Cross Blue Shield of Massachusetts
• Harvard Pilgrim Health Care
• Tufts Health Plan

California – Northern

• Health Net (which offers only SHOP small business plans)
• Blue Shield
• Chinese Community Health
• Oscar

California – Southern

• Blue Shield
• Health Net (which offers only SHOP small business plans)

Chicago

• BlueCross BlueShield of Illinois (PPO and HMO)

New York

• Oscar

Phoenix

• None. Health Net’s Ambetter plan is the only offering in Maricopa County. Health Net chose Banner Health as its exclusive network for 2018 which, unfortunately, leaves us out of network.

Washington, DC

• Aetna (which offers only SHOP small business plans)
• UnitedHealthcare (which offers only SHOP small business plans)

We participate with exchange plans that provide us with the best opportunity to provide the high level of care and service you expect from One Medical. Our goal is to participate with as many plans as possible, and we expect to continue to expand the list of participating plans over time.

If you don’t see your exchange plan listed here, we will do all we can to continue to provide you top-quality care. We offer reasonable out-of-pocket payment options, and depending on your insurance coverage, you may be able to submit these out-of-pocket expenses for reimbursement. Please contact your local One Medical office for more information.

Within each state’s exchange there are a number of insurance plans that vary by cost and benefit level. You’ll need to carefully review the offerings to find the premiums and level of coverage that are right for you. You may also wish to make sure your preferred physicians and hospitals are in-network with the plan you’re considering: Not all physicians and hospitals are included in each exchange plan. In addition, keep in mind that coverage can differ by plan, even if the insurer is the same. For example, an exchange product might not offer the same coverage as other plans under the same insurer.

Each state’s exchange has a customer service center to assist you, and each state also offers official “Navigators” and enrollment counselors who can help you select coverage. In addition, licensed agents or brokers can also assist you if they are registered with the exchange in their state.

Here’s more information for the Health Insurance Marketplaces for each state or region where One Medical currently practices:

Boston

Massachusetts Health Connector Service Center: 877.623.6765
One Medical: 617.903.5000

California

Covered California Service Center: 800.300.1056
One Medical: 415.578.3100 (Bay Area)
One Medical: 323.305.7150 (Los Angeles)

Chicago

Get Covered Illinois Service Center: 866.311.1119
One Medical: 312.219.2230

New York

NY State of Health Service Center: 855.355.5777
Navigators and Other Resources One Medical: 212.530.0624

Phoenix

Arizona Affordable Care Act Service Center: 855.889.4325 One Medical: 602.218.4077

Seattle

Washington Healthplan Finder Service Center: 855.923.4633
Navigators and Other Resources One Medical: 206.267.4392

Washington, DC

DC Health Link Service Center: 855.532.5465
Navigators and Other Resources One Medical: 202.660.0005

Additional Resources

In addition to the state Marketplaces, two privately run online resources we’ve found particularly helpful are ehealthinsurance and Health Sherpa. Both sites offer free assistance for consumers to shop and compare premiums, subsidies, and coverage for health insurance in all 50 states.