Covered California Resources for Physicians

Covered California

California’s health benefit exchange, Covered California, is now in full swing. Nearly 50,000 San Franciscans enrolled in Covered California plans over the last two years, over 80% of whom were eligible for federal subsidies. With that figure expected to grow with the Fall 2015 enrollment period, it is critical that physicians and their staff know what to expect.

SFMS has developed several resources to help educate physicians and practice managers on the exchange and ensure that they are aware of important issues related to exchange plan contracting.

What Physician Practices Should Know for 2016

Click here for SFMS' guide to 2016 Covered California changes in products offered in San Francisco, and information to verify participation status.

Health Care Reform: The ACA, Your Practice, and You

Click here for SFMS' short 3-part blog series about practical issues of what Covered California patients—and their doctors—can expect from the Affordable Care Act.

Payor Information 

Click here for the SFMS guide on health plans participating in Covered California specifically for the San Francisco region. View exchange & mirror product names and access contact information for each plan.

Click here for information released by Anthem Blue Cross, Blue Shield, and Health Net about their Covered California and "mirror" products. Notices include plan name guide, sample ID cards, explanation of copayment, coinsurance and deductible information.

Click here for new FAQ to assist physician practices with identification of mirror products that utilize the same narrow provider network as Covered California products. Includes sample ID cards.

Physician Resources

Small Business Coverage

FAQIf you practice has 50 or fewer full-time equivalent employees, you may be able to purchase employer-sponsored health coverage through Small Business Health Options Program (SHOP). Click here for SFMS' 1-page guide for answers to some of the commonly asked questions practice owners have about the SHOP option.

Patient Resources

Webinars and Seminars

CMA offers on-demand webinars that are complimentary to member physicians and their office staff, and is $99 for non-members.

SFMS can provide live educational seminars on the exchange and what physicians and their staff can do to prepare for contracting with exchange plans. If you are interested in attending a seminar in your area, please contact SFMS.

External Resources

Additional Questions?

TelephoneSFMS members and their staff have free one-on-one access to practice management experts through the CMA reimbursement helpline at (888) 401-5911.

Assistance is provided on any questions about the exchange, other reimbursement issues, and contracting or general practice management issues.

Follow Us On

I am a SFMS member because I believe—when I joined SFMS as a new doctor 25 years ago, and still believe now—that physicians need the advocacy of organized medicine to represent them and their patients with insurance companies, legislators, and public policy. The SFMS has often led the way with health initiatives that benefit our patients and our profession.

Toni Brayer, MDCEO of Sutter Pacific Medical Foundation