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Sharp Health Plan Review

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UPDATED: Nov 30, 2018

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Sharp Health Plan is a commercial not-for-profit health insurance company located in San Diego. They offer individual, group, and Medicare plans to local residents and businesses.

About Sharp Health

Sharp Health Plan is the insurance branch of Sharp HealthCare, which was founded in 1955 when Donald N. Sharp Memorial Hospital was opened in San Diego. Today Sharp operates seven hospitals, three of which are specialty hospitals. They also operate two medical groups in San Diego. They continue to operate as a not-for-profit.

Sharp Health Plan offers network options both within the Sharp Healthcare group and with access to an extended network of hospitals and medical groups. All of the plans are designed for residents of the San Diego area.

Not surprisingly, Sharp’s headquarters is located in the city of San Diego, CA.

Sharp Health Plans

Sharp offers health plans both on and off the marketplace, at multiple levels. For 2018, plans are offered at the Premier and Performance levels, each with a different network of providers. All are HMO plans, which means there is no coverage for out-of-network care. Plans are offered on and off the Covered California marketplace and may differ in coverage.

Premier Plans

The Premier plans are offered at the Bronze, Silver, Gold, and Platinum levels. These plans have a more limited network in return for lower costs.

The Bronze plan is HSA Eligible and has an individual deductible of $4,800. Services are covered at 60% after the deductible is met, which means the insured pays 40%.

The Silver plan has a $2,500 deductible and a $25 copay for primary care visits, which is not subject to the deductible.

Both the Gold and Platinum plans are $0 deductible plans, with the Gold plan at a $30 primary care copay and the Platinum a $15 copay.

Performance Plans

With a broader network of providers, this plan includes a Catastrophic plan as well as all four metal levels.

The Catastrophic – or Minimum Coverage as Sharp calls it – plan has a $7,150 deductible. All services are subject to the deductible, with the exception of three non-preventative visits each year. Services are covered in full once the deductible is met.

The Bronze plan has a $6,300 individual deductible, and again three non-preventative visits are covered before the deductible applies. After the first three, primary care visits have a $75 copay.

The Silver Plan has an individual deductible of $2,500, with a $35 copay for primary care visits.

Both the Gold and Platinum plans, like the Premier level, have no deductible. Primary care visits are $25 and $15 respectively.

Medicare Advantage

Sharp Direct Advantage plans are available at two levels, Gold and Platinum. They are both HMO plans and are available to all Medicare-eligible individuals.

The Gold plan has no premium in addition to the standard Medicare premium. There is no deductible and a $10 copay for primary care visits and $35 for specialist visits.

The Platinum plan also has no deductible and has an additional monthly premium. Primary care visits are $15, and specialist visits the same as the Gold plan at $35.

Medicare Advantage plans differ for former Sharp employees, with a no-premium Basic plan and a more expensive Premium Plan. Both plans have a $5 copay for primary care visits, while specialist visits cost $20 and $10 respectively. Neither plan has a deductible.

Finally, Sharp also offers a specialized Medicare Advantage plan for retirees of the City of San Diego. This plan does have a monthly premium but again has no deductible. Both primary and specialist visits have a $10 copay.

Rates

Sharp’s online quoting system is a multi-step process that could be shortened by asking multiple questions in one step – some visitors may find the process unnecessarily drawn out. The many steps are designed to narrow down the selection of plans, although this makes it more difficult to readily see all of the available options.

We ran a quote for a 30-year-old single male in good health. The system returned several options, the cheapest of which is the Bronze Premier plan at $245 per month. The most expensive plan is the Performance Platinum with a rate of $466 per month. That is only about $10 more per month than Premier plan option, but with the wider network.

Since Sharp operates solely in San Diego County, it is difficult to compare these rates to nationwide companies.

Claims

Sharp is an HMO, which means that claims with providers will be handled directly and internally. Without out-of-network coverage offered, policyholders should not need to deal with claims.

Ratings and Consumer Reviews

Sharp Health Plan has an A+ rating with the Better Business Bureau (BBB) with zero complaints on file in the last three years.

The National Committee for Quality Assurance gives Sharp Health Plan an overall 4.5 rating. Most of their ratings in underlying categories are fairly high, although they rank at a 2.0 for ease of getting care as well as in several preventative care categories.

There are 32 reviews of Sharp Health Plan on Yelp, which is quite a high number for a health insurance company – Yelp is not the first place most people go to complain about insurance. Most of the reviews are negative, with the odd positive review among them. Most complaints center on refusal to pay for services the insured believed to be covered. In Sharp’s favor, the company responds to negative Yelp reviews.

The Bottom Line

For residents of San Diego County who have no problem with the limited network of an HMO, Sharp may be a good choice. Sharp has a relatively good reputation, and the health system gives access to several hospitals and medical groups. Those who are seeking access to a wide network of providers may wish to look elsewhere for their health coverage.

For a list of companies that we recommend, visit our Best Insurance Companies page.

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About Eric Stauffer

Author: Eric StaufferI am a former insurance agent and banker turned consumer advocate. My priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.

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