At J.C. Lewis Insurance we genuinely care about the quality of healthcare that our customers receive as well as the quality of coverage they are provided.
As professional and specialized brokers and agents serving Northern California and Sonoma County, we also understand that, not only are all insurers “created equal” but neither are the needs of individual customers.
To that end, we have been profiling the major healthcare coverage providers operating in California in order to provide you with informative “snapshots” of each of these insurance giants.
In this article, we provide an overview of UnitedHealthcare.
Who is UnitedHealthcare in California?
UnitedHealthcare is the health benefits business arm of UnitedHealth Group, a diversified health care company dedicated to advancing health care. UnitedHealth Group also includes Optum, a leading information and technology-enabled health services business.
According to the CoveredCalifornia website,
“UnitedHealthcare has the claim to fame of being the largest single health carrier in the nation. It operates as a division of its parent company UnitedHealth Group Inc. The headquarters is in Minnetonka, Minnesota. Counting all subsidiaries and divisions of UnitedHealthcare, they serve approximately 70 million members across the U.S.
For 2015 Fortune 500 ranked ‘UnitedHealth Group’ the top insurance and managed care sector company of its ‘World’s Most Admired Companies’ list. This was the fifth year in a row that they ranked the number one in their sector overall.
The National Committee of Quality Assurance (NCQA) has awarded the NCQA Health Plan Accreditation to many of UnitedHealthcare’s health plans. These health plans are the Commercial HMO, HMO/POS, and PPO plans and the Marketplace HMO and PPO plans.”
Unlike many of the larger healthcare insurance providers operating in California, UnitedHealthcare is relatively young. It was founded at the start of 2006 and consists of several subsidiaries including MetraHealth Cos. Inc., Vivify Health, HealthWise of America, and Rocky Mountain Health Plans.
In California, UnitedHealthcare does offer individual plans as well as employer group plans. However, it is not a participant of the state’s health exchange marketplace, Covered California.
As the Health For California/Covered California website notes,
“In 2016 UnitedHealth joined 11 other health insurance carriers to offer plans in the California State Exchange: Covered California. It was short lived. They announced in May of 2016 that they would be leaving California’s individual market including Covered California in 2017. This would affect approximately 1,200 California exchange members they had acquired in 2016. Members would have coverage until the end of 2016, when they would be given the option to switch to a different carrier for 2017. UnitedHealth cited the reason for leaving as heavy losses and Obamacare marketplaces as risky business.”
UnitedHealthcare for Individual Plans
For those looking to buy individual or family coverage through UnitedHealthcare, there are essentially two options to consider in California: Their HMO plan or PPO.
According to UnitedHealthcare,
“If your doctor’s already in-network, or you’re flexible about where you get care and can easily stay in-network, then choosing an HMO… may mean a lower cost for you each month. If you need the freedom to go outside a narrow network and still get some benefits from your coverage, then look at PPO.”
How Well Does UnitedHealthcare Health Score?
To assist residents, the State of California’s Office of the Patient Advocate (OPA) provides annual Health Care Quality Report Cards. This information is intended to help California health care coverage consumers in making a choice for health care insurance.
These reports include Health Plan Report Cards for each health insurance provider operating in the state of California.
Here are the results of the OPA report card for UnitedHealthcare of California – HMO 2020-21 Edition:
- QUALITY OF MEDICAL CARE – Good
- Appropriate Use of Tests, Treatments and Procedures – Very Good
- Asthma and Lung Disease Care – Poor
- Diabetes Care – Very Good
- Heart Care – Fair
- Maternity Care – Fair
- Behavioral and Mental Health Care – Fair
- Preventive Screenings – Very Good
- Treating Adults – Excellent
- Treating Children – Good
The state’s report card also includes a patient rating scorecard:
- PATIENTS RATE OVERALL EXPERIENCE – Good
- Getting Care Easily – Poor
- Satisfaction with Plan Services – Very Good
- Satisfaction with Plan Doctors – Fair
Keep in mind that the UnitedHealthcare of California HMO only serves the counties of Solano, Sonoma, Yolo in Northern California. Counties served by UnitedHealthcare PPO includes all of California.
Here is the state’s OPA report card for UnitedHealthcare of California – PPO 2020-21 Edition:
- QUALITY OF MEDICAL CARE – Good
- Appropriate Use of Tests, Treatments and Procedures – Very Good
- Asthma and Lung Disease Care – Fair
- Diabetes Care – Good
- Heart Care – Good
- Maternity Care – Good
- Behavioral and Mental Health Care – Good
- Preventive Screenings – Good
- Treating Adults – Excellent
- Treating Children – Good
In addition, here are the state’s reported patient ratings:
- PATIENTS RATE OVERALL EXPERIENCE – Fair
- Getting Care Easily – Poor
- Satisfaction with Plan Services – Fair
- Satisfaction with Plan Doctors – Fair
Your Best and Local Experts for Health Insurance in California
For California health insurance plans only from the leading health insurance carriers licensed to do business in California, you need look no further than J.C. Lewis Insurance.
As a family-owned and operated California health insurance agent located in beautiful Sonoma County, we specialize in medical insurance plans for small businesses, for individuals and families, and for people with Medicare.
We are expert brokers, and we are also licensed and certified by each insurance carrier. This allows us to offer coverage to individuals, families, and small group employers, along with Medicare supplemental and prescription drug plans for seniors.
If you are self-employed, or your employer doesn’t provide health benefits, an individual or family plan may be the best option for you or you and your family.
And, if you are looking to purchase medical insurance coverage for you or your family, you will likely have many questions and concerns. We invite you to bring those questions about health coverage insurance and you can be confident that JC Lewis Insurance Services will help you find the right solution.
