Rate Increases for 2017 Medical Insurance Plans

There will be a significant rate increase for 2017 plans. The reasons given are the end of funding that was available in the first three years to offset rates, the rise in specialty medication and claims from those who enroll during Special Enrollment Periods.

In regard to the specialty medication, sometimes pharmaceutical companies are raising prices of medications when the need for a medication increases. Newer specialty medications can approach $100,000 per course of treatment and/or per year.

Below is the press release from Covered California on July 19, 2016

SACRAMENTO, Calif. — Covered California unveiled its rates for 2017 on Tuesday and announced that some health insurance plans will be expanding into new areas throughout the state to compete for consumers in California.

The statewide weighted average change will be 13.2 percent, up from approximately four percent in each of the last two years. However, most consumers will see a much smaller increase — or pay less next year — if they switch to another plan.

“Shopping is going to be more important this year than ever before,” Covered California Executive Director Peter V. Lee said. “Almost 80 percent of our consumers will either be able to pay less than they are paying now, or see their rates go up by no more than 5 percent, if they shop and buy the lowest-cost plan at their same benefit level. That’s the power of shopping.”

Lee said the opportunities to shop and save show that California has succeeded in building a competitive marketplace for health insurance, with rate increases that are still below trends in the individual market before the Affordable Care Act was passed.

“This is a new era of health care, where the consumer is in the driver’s seat with the power to look easily for a better deal, and where subsidies help absorb the impact of rate changes,” Lee said. “These options did not exist before the Affordable Care Act.”

Some consumers who choose to keep their plan will see a significant increase in their premium for 2017, while others will see a more modest increase, depending on where they live and what insurance plan they have. Consumers will begin receiving notices in October, when they will have an opportunity to review their new rates and change plans for their 2017 health coverage.

For many of those insured, the bulk of the premium increase will be absorbed by the subsidy paid by the government to help enrollees buy health insurance. Approximately 90 percent of Covered California enrollees get help to pay for their premiums. The average subsidy covers roughly 77 percent of the consumer’s monthly premium, and while premiums will rise, the subsidies will rise as well.

“Even though the average rate increase is larger this year than the last two years, the three-year average increase is 7 percent — substantially better than rate trends before the Affordable Care Act was enacted,” Lee said.

Lee said the average rate increase reflects the cost of medical care for consumers, not excessive profit.

“Under the new rules of the Affordable Care Act, insurers face strict limits on the amount of profit they can make selling health insurance,” Lee said. “So, while all plans are experiencing different cost pressures, we can be confident their rate increases are directly linked to health care costs, not administration or profit, which averaged 1.5 percent across our contracted plans.”

For consumers who get a tax credit to lower their costs — which is about 90 percent of those who sign up through Covered California — the amount they pay is impacted not only by the premium choice, but by changes in their tax credit. While the average rate increase is higher than past years, Covered California’s risk mix — the ratio of consumers who are healthy vs. sick — remains one of the best in the nation according to the Centers for Medicare and Medicaid Services (https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/index.html).

Other reasons for rate increases include:
A one-year adjustment due to the end of a funding mechanism in the Affordable Care Act known as reinsurance, which was designed to moderate rate increases during the first three years when exchanges were being established. The American Academy of Actuaries estimates this will add between 4 percent and 7 percent to premiums for 2017.
Special enrollment by some consumers who may be enrolling in health insurance only after they become sick or need care, which seems to have had a significant impact on rates for two insurance plans.
The rising cost of health care, especially specialty drugs.
Pent-up demand for health care now being accessed by those who were locked out of the health care system before the Affordable Care Act was enacted.
Lee said Covered California is working to address some of these issues on multiple fronts. The exchange is aggressively marketing to attract healthy consumers year-round, and it is working to ensure special enrollment is available only to those who meet qualifying circumstances. It is also sampling the special enrollment population to better understand how to make any further improvements needed.

“We work hard to build a robust exchange that drives competition by attracting as many consumers as possible,” Lee said. “Now, consistent with the vision of the Affordable Care Act, we will redouble our efforts to make sure our consumers and potential consumers understand the importance of signing up during open enrollment and remaining covered throughout the year.”

Lee said Covered California’s 11 health insurers are competing across the state for its 1.4 million members.

“The sheer number of enrollees and their overall health means consumers in the individual market are benefiting from competition,” Lee said.

Below is the complete list of the companies selected for the 2017 exchange:
Anthem Blue Cross of California
Blue Shield of California
Chinese Community Health Plan
Health Net
Kaiser Permanente
L.A. Care Health Plan
Molina Healthcare
Oscar Health Plan of California
Sharp Health Plan
Valley Health Plan
Western Health Advantage
Rate details by pricing regions can be found in “Covered California’s Health Insurance Companies and Plan Rates for 2017,” posted online at:http://coveredca.com/news/pdfs/CoveredCA-2017-rate-booklet.pdf

The preliminary rates are subject to a 60-day public comment period and regulatory review by the California Department of Managed Health Care. In addition, the California Department of Insurance will review Health Net’s EPO.

Some insurance carriers will be increasing their coverage areas in 2017:
Oscar will be entering the market in San Francisco, Santa Clara and San Mateo counties.
Molina will expand into Orange County.
Kaiser will be available in Santa Cruz County.
With the expansion of its current carriers, almost all consumers (92.6 percent) will be able to choose from three or more carriers, and all will have at least two to select from.

In addition, more than 93 percent of hospitals in California will be available through at least one Covered California health insurance company in 2017, and 74 percent will be available in three or more plans.

Covered California also is improving its patient-centered benefit designs by increasing a consumer’s access to care by reducing the number of services that are subject to a consumer’s deductible.

Starting in 2017, consumers in Silver 70 plans will save as much as $55 on an urgent care visit and $10 on a primary care visit. In addition, consumers in Silver, Gold and Platinum plans will pay a flat copay for emergency room visits without having to satisfy a deductible, which could save them thousands of dollars.

These improvements build on features already in place that ensure most outpatient services in Silver, Gold and Platinum plans are not subject to a deductible, including primary care visits, specialist visits, lab tests, X-rays and imaging. In addition, some Enhanced Silver plans have little or no deductible and very low copays, such as $3 for an office visit. Even consumers in Covered California’s most affordable Bronze plans are allowed to see their doctor or a specialist three times before the visits are subject to the deductible.

In addition, the contract with health insurers for 2017 ensures consumers select or are provisionally assigned a primary care physician within 60 days of effectuation so they have an established source of care.

“Health care reform isn’t just about making insurance affordable, it’s about doing things to make it easier for consumers to get the right care at the right time,” Lee said.

In May, the Centers for Disease Control and Prevention announced that California’s uninsured rate had fallen to 8.1 percent at the end of 2015, down from 17 percent at the end of 2013, right before the Affordable Care Act began offering coverage.

“We can all be very proud of the extraordinary gains we have made in reducing California’s uninsured rate to a historic low,” Lee said.

About Covered California
Covered California is the state’s marketplace for the federal Patient Protection and Affordable Care Act. Covered California, in partnership with the California Department of Health Care Services, helps individuals determine whether they are eligible for premium assistance that is available on a sliding-scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Small businesses can purchase competitively priced health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits.

Covered California is an independent part of the state government whose job is to make the new market work for California’s consumers. It is overseen by a five-member board appointed by the Governor and the Legislature. For more information about Covered California, please visit www.CoveredCA.com.

This article is from the Los Angeles Times date July 20, 2016

California Obamacare rates to jump

Premiums are set to go up an average of 13.2% next year. Rising medical costs are one reason, officials say.

BY MELODY PETERSEN AND NOAM N. LEVEY

Premiums for Californians’ Obamacare health coverage will rise an average of 13.2% next year — more than three times the increase of the last two years and a jump that is bound to stir debate in an election year.

The big increases come after two years in which California officials had boasted that the program helped insure hundreds of thousands people in the state while keeping costs moderately in check.

Premiums in the insurance program called Covered California rose just 4% in 2016 after rising 4.2% in 2015 — the first year that exchange officials negotiated with insurers. The program insures 1.4 million Californians.

On Tuesday, officials blamed next year’s premium hikes in the program on rising costs of medical care, including expensive specialty drugs and the end of a mechanism that held down rates for the first three years of Obamacare.

Two of the state’s biggest insurers — Blue Shield of California and Anthem Inc. — asked for the biggest hikes. Blue Shield’s premiums will jump an average of more than 19%, according to officials, and Anthem’s rates will rise more than 16%.

For consumers, the effect will depend on whether they get taxpayer-supported subsidies for their premiums and whether they are willing to switch to less-expensive plans that may come with higher co-pays and deductibles. Changing plans could also mean a new network of physicians, which could be disruptive to care for those with chronic conditions.

The rates vary significantly by region and insurer. Los Angeles and the rest of southwest Los Angeles County will see an average increase of almost 14%.

Blue Shield’s preferred provider organization rate in Los Angeles, chosen by 21% of those using the exchange, is increasing by an average of 19.5%. For a 40-year-old single person making $17,820 to $23,760, choosing a silver level plan, the monthly rate currently is $122, while the government pays Blue Shield $196. Next year that same person would pay $170, while the government would chip in $211 a month.

“We’re paying more for less,” said Jamie Court, president of Consumer Watchdog in Santa Monica. “Insurers are limiting access to doctors and hospitals while also demanding a higher price.”

Horacio Chavez, 34, of Boyle Heights said he made less than $25,000 last year as an education coordinator at a youth center. He currently pays a $100 premium for a Covered California plan that he uses for an annual checkup and a safety net in case of emergencies.

“I do want healthcare — I want the peace of mind that if anything happens to me that there’s some kind of coverage,” Chavez said. But “a 13% hike … that’s going to affect people.”

He said he’s already barely making ends meet trying to pay his rent, student loans from the University of Chicago, car payments and his health insurance premium.

“I’m already living check to check,” Chavez said.

Covered California officials defended the system Tuesday, saying that the competition among insurers offering coverage on the exchange was working to keep rates lower than they otherwise would be.

“California has a very competitive marketplace,” said Peter Lee, executive director of Covered California.

Obamacare has significantly reduced the number of uninsured Californians. Since the state’s health insurance exchange began offering coverage in 2014, the share of Californians without health insurance has fallen from 17% at the end of 2013 to 8.1% at the end of last year, according to officials.

Rates are expected to jump in other states too, although complete details won’t be available until later this year.

An analysis of 14 metro areas that have already announced their 2017 premiums found an average jump of 11%. The changes ranged from a decrease of 14% in Providence, R.I., to an increase of 26% in Portland, Ore., according to the analysis by the nonpartisan Kaiser Family Foundation.

The federal healthcare-  .gov   exchange provides insurance under the Affordable Care Act in 38 states. California and a few other states operate their own exchanges.

Around the country, several insurers, including giant UnitedHealth, have stopped selling health plans on the exchanges, and a number of new nonprofit health insurance co-ops have gone out of business.

Those decisions have fueled charges from the law’s critics that Obamacare isn’t working.

Former Secretary of State Hillary Clinton, the presumptive Democratic presidential nominee, is pushing a number of specific steps to ease price pressure on consumers, including allowing Americans ages 55 to 64 to buy into Medicare.

Republican presidential nominee Donald Trump has argued the health law should be repealed.

The health law’s next enrollment period begins a week before election day.

The state and federal health insurance exchanges provide coverage to about 12 million people nationally, representing just a fraction of the nation’s total insurance market. The vast majority of Americans — more than 250 million people — are in health plans purchased through an employer or provided by a government plan such as Medicare or Medicaid.

But the exchanges are a pillar of the Affordable Care Act’s program for guaranteeing Americans’ insurance coverage. And monthly premiums have become a closely watched barometer of how the law is performing.

Covered California’s Lee told the House Ways and Means Committee on July 12 that 2017 would be “a transitional year” for Obamacare, with rates seeing “significant adjustments” across the nation.

He said one reason for the increase was the end of a program designed to keep rates down during the insurance exchange’s first three years. The program had assessed a fee on all health insurers and then redistributed those funds among carriers whose members had the highest medical expenses, Lee said.

Lee added that some insurers had also not charged enough in the first two years because they didn’t have full data on the medical costs or health status of those signing up. Now they’re adjusting to account for those higher costs.

Mia Campitelli, a Blue Shield spokeswoman, said Tuesday that the insurer’s average 19.9% premium increase was “driven by our members using more healthcare services than we expected,” as well as the phaseout of the federal mechanism that had kept rates down in the law’s early years.

Anthem spokesman Darrel Ng said: “Factors such as increased use of medical services and added costs of drugs and medical therapies put upward pressure on rates and underscore the additional work that needs to be done to moderate the growth in healthcare costs.”

The financial pain for most Californians getting insurance through the exchange will be muted because 90% get taxpayer assistance to cover the premiums.

Americans making less than four times the federal poverty level — about $47,000 for a single adult or $97,000 for a family of four — qualify for the assistance.

Nonetheless, Americans who make too much to qualify for subsidies are likely to feel the brunt of the higher premiums. That will probably increase pressure on the new president — Democrat or Republican — to review the exchanges in 2017 for ways to make health plans more affordable.

A year ago, Lee wrote an op-ed in The Times saying that Covered California’s power in negotiating with insurers was allowing Obamacare to work in the state.

“We now have the full picture in California, where we are proving that health insurance exchanges can keep prices in check,” he wrote.

Though the Affordable Care Act has improved care for millions of Americans — for example, insurance companies can no longer set lifetime limits on care or exclude anyone because of a preexisting condition — the 6-year-old law contains few controls on overall costs.

Spending on the country’s medical system averages more than $10,000 for every American, according to statistics released by the Obama administration this month, far higher than any other nation. melody.petersen

@ latimes.com   noam.levey@latimes.com   Times staff writer Soumya Karlamangla contributed to this report.

RICH PEDRONCELLI Associated Press

“CALIFORNIA has a very competitive marketplace,” said Peter Lee, executive director of Covered California. Above, Lee discusses the program last year.

Open Enrollment for 2015 Individual Health Plans

If you would like to review your plan options for 2015 we need to set up a phone appointment during Open Enrollment. Open Enrollment begins November 15th and will continue until December 15th for a January 1, 2015 effective date. Open Enrollment will close on February 15, 2015 with the last effective date being March 1, 2015. Individual health insurance policies cannot be purchased beyond March 1, 2015 unless one qualifies for a Special Enrollment Period.

If you would like to set up a phone appointment please let me know. Here is what I will need before setting the appointment;

If you think you are eligible for a subsidy, send me your ESTIMATED 2015 MODIFIED ADJUSTED GROSS INCOME (MAGI). Your tax consultant should be able to help you determine the amount.

If you know you do not qualify for a subsidy or are not interested please let me know.

I will send you several options of dates and times for an appointment once I have this information. Please understand that appointments book very quickly so I encourage you to respond as soon as possible.

Insurance Sticker Shock

 

Following is an article from the Los Angeles Times dated October 27, 2013 which discusses the premium increases that have resulted from the Affordable Care Act.

I have two comments on the article. First, Peter Lee, The Executive Director of Covered California, The Health Insurance Exchange/Marketplace is quoted.

“People could have kept their cheaper, bad coverage, and those people wouldn’t have been part of the common risk pool,” Lee said. “We are better off all being in this together. We are transforming the individual market and making it better.”

None of my clients have cheaper bad coverage. My clients who have older grandfathered plans will in general have good coverage at a lesser premium with a more extensive network of doctors and hospitals than those who have been forced to move to newer plans. Personally, I am losing my plan and I wish that my plan was grandfathered.

I disagree with another quote.  “We believe the prices are higher than they should be,” said Jamie Court, president of Consumer Watchdog, a Santa Monica advocacy group. “This is giving a bad name to the Affordable Care Act.”

Everyone wants lower insurance premiums, however, the Affordable Care Act dictates how insurance companies set premiums. I posted a blog on June 24, 2013 which addresses this issue. It is hard to defend the Affordable Care Act in this regard.

Many middle-class Californians with individual health plans learn the new law requires policies that cover more — and cost more

BY CHAD TERHUNE

Thousands of Californians are discovering what Obamacare will cost them — and many don’t like what they see.

These middle-class consumers are staring at hefty increases on their insurance bills as the overhaul remakes the healthcare market. Their rates are rising in large part to help offset the higher costs of covering sicker, poorer people who have been shut out of the system for years.

Although recent criticism of the healthcare law has focused on website glitches and early enrollment snags, experts say sharp price increases for individual policies have the greatest potential to erode public support for President Obama’s signature legislation.

“This is when the actual sticker shock comes into play for people,” said Gerald Kominski, director of the UCLA Center for Health Policy Research. “There are winners and losers under the Affordable Care Act.”

Fullerton resident Jennifer Harris thought she had a great deal, paying $98 a month for an individual plan through Health Net Inc. She got a rude surprise this month when the company said it would cancel her policy at the end of this year. Her current plan does not conform with the new federal rules, which require more generous levels of coverage.

Now Harris, a self-employed lawyer, must shop for replacement insurance. The cheapest plan she has found will cost her $238 a month. She and her husband don’t qualify for federal premium subsidies because they earn too much money, about $80,000 a year combined.

“It doesn’t seem right to make the middle class pay so much more in order to give health insurance to every- body else,” said Harris, who is three months pregnant. “This increase is simply not affordable.”

On balance, many Americans will benefit from the healthcare expansion. They are guaranteed coverage regardless of their medical history. And lower-income families will gain access to comprehensive coverage at little or no cost.

The federal government picks up much of the tab through an expansion of Medicaid and subsidies to people earning up to four times the federal poverty level. That’s up to $46,000 for an individual or $94,000 for a family of four.

But middle-income consumers face an estimated 30% rate increase, on average, in California due to several factors tied to the healthcare law.

Some may elect to go without coverage if they feel prices are too high. Penalties for opting out are very small initially. Defections could cause rates to skyrocket if a diverse mix of people don’t sign up for health insurance.

Pam Kehaly, president of Anthem Blue Cross in California, said she received a recent letter from a young woman complaining about a 50% rate hike related to the healthcare law.

“She said, ‘I was all for Obamacare until I found out I was paying for it,’ ” Kehaly said.

Nearly 2 million Californians have individual insurance, and several hundred thousand of them are losing their health plans in a matter of weeks.

Blue Shield of California sent termination letters to 119,000 customers last month whose plans don’t meet the new federal requirements. About two-thirds of those people will experience a rate increase from switching to a new health plan, according to the company.

HMO giant Kaiser Permanente is canceling coverage for about half of its individual customers, or 160,000 people, and offering to automatically enroll them in the most comparable health plan available.

The 16 million Californians who get health insurance through their employers aren’t affected. Neither are individuals who have “grandfathered” policies bought before March 2010, when the healthcare law was enacted. It’s estimated that about half of policyholders in the individual market have those older plans.

All these cancellations were prompted by a requirement from Covered California, the state’s new insurance exchange. The state didn’t want to give insurance companies the opportunity to hold on to the healthiest patients for up to a year, keeping them out of the larger risk pool that will influence future rates.

Peter Lee, executive director of Covered California, said the state and insurers agreed that clearing the decks by Jan. 1 was best for consumers in the long run despite the initial disruption. Lee has heard the complaints — even from his sister-in-law, who recently groused about her 50% rate increase.

“People could have kept their cheaper, bad coverage, and those people wouldn’t have been part of the common risk pool,” Lee said. “We are better off all being in this together. We are transforming the individual market and making it better.”

Lee said consumers need to consider all their options. They don’t have to stick with their current company, and higher premiums are only part of the cost equation. Lee said some of these rate hikes will be partially offset by smaller deductibles and lower limits on out-of-pocket medical expenses in the new plans.

Still, many are frustrated at being forced to give up the plans they have now. They frequently cite assurances given by Obama that Americans could hold on to their health insurance despite the massive overhaul.

“All we’ve been hearing the last three years is if you like your policy you can keep it,” said Deborah Cavallaro, a real estate agent in Westchester. “I’m infuriated because I was lied to.”

Supporters of the healthcare law say Obama was referring to people who are insured through their employers or through government programs such as Medicare. Still, they acknowledge the confusion and anger from individual policyholders who are being forced to change.

Cavallaro received her cancellation notice from Anthem Blue Cross this month. The company said a comparable Bronze plan would cost her 65% more, or $484 a month. She doubts she’ll qualify for much in premium subsidies, if any. Regardless, she resents losing the ability to pick and choose the benefits she wants to pay for.

“I just won’t have health insurance because I can’t pay this increase,” she said.

Most Americans are required to have health coverage starting next year or pay a fine of $95 per adult or1% of their income, whichever is greater. The fines increase over time.

A number of factors are driving up rates. In a report this year, consultants hired by the state said the influx of sicker patients as a result of guaranteed coverage was the biggest single reason for higher premiums. Bob Cos-way, a principal and consulting actuary at Milliman Inc. in San Diego, estimated that the average individual premium in 2014 will rise 27% because of that difference alone.

Individual policies must also cover a higher percentage of overall medical costs and include 10 “essential health benefits,” such as prescription drugs and mental health services. The aim is to fill gaps in coverage and provide consumers more peace of mind. But those expanded benefits have to be paid for with higher premiums.

The federal law also adjusts how rates are set by age, a change that gives older consumers a break and shifts more costs to younger people. Rates by age can vary by only 3 to 1 starting next year as opposed to 6 to1 in some cases now in California. People in their 20s just starting their careers may earn so little they qualify for subsidies. But that might not be the case for consumers who are slightly older and earning more.

“It has the effect of benefiting people in their 50s and 60s and shifting costs to people in their 20s and 30s,” said Patrick Johnston, president of the California Assn. of Health Plans. “Benefits are being increased for all, but it’s not government subsidies for all. Some will pay more.”

Rates would be going up regardless of changes from the healthcare expansion. The average individual premium will climb 9% next year because of rising healthcare costs and increases in medical provider reimbursement, according to Milliman’s estimates.

Some consumer groups have questioned whether insurers are inflating their rates under the guise of the healthcare law changes.

“We believe the prices are higher than they should be,” said Jamie Court, president of Consumer Watchdog, a Santa Monica advocacy group. “This is giving a bad name to the Affordable Care Act.”

State regulators checked the insurance companies’ math and underlying cost projections for next year, but they don’t have the authority to deny increases. Under federal rules, insurers can be ordered to issue rebates if they don’t spend a minimum amount of every premium dollar on customers’ medical care.

“The rates aren’t going up because insurance companies are pocketing more money,” Lee said. “That is what it takes to pay the claims and deliver the healthcare.”

Javier Lopez, 38 and a self-employed aerospace engineer in Huntington Beach, pays about $750 a month for an Anthem Blue Cross plan for his family of four. His premiums may rise nearly 20% next year for a new policy because his current plan is being phased out.

Lopez says he’s willing to absorb that one-year jump if it means the government can rein in future rate hikes.

“I’m hoping with this reform,” Lopez said, “we won’t see big increases year after year.” chad.terhune@latimes.com   Twitter: @chadterhune

Cigna Individual and Family Plan Insurance

The following information is what I know as of today and is subject to change.

Cigna will not participate in Covered California the Health Insurance Exchange/Marketplace. Insurance companies look at many factors in deciding whether to be in an Exchange/Marketplace. I do not look upon Cigna’s decision negatively, other insurance companies have made the same choice. United Health Care will not participate in the individual or small group (SHOP) exchange. Anthem Blue Cross and See Change will not participate in the SHOP exchange. Health Care Reform is in its infancy and situations will change with time.

Cigna will more than likely offer you a choice to continue your plan benefits for another year up until January 1, 2015. This may be advantageous. It is probable that individual health insurance rates will increase on January 1, 2014 with the required Health Care Reform benefits.

I encourage you to set up a phone appointment with me between October 1, 2013 and December 1, 2013 to review options. If you are eligible for a Federal subsidy and premiums and benefits are to your advantage we will enroll you in the Covered California the Health Insurance Exchange/Marketplace.

Small Business Health Options Program Releases Important Information

Covered California has just announced important information for the Small Business Health Insurance Options Program (SHOP). This program is designed for businesses with fifty employees or less. Employers are not required to provide health insurance unless there are more than fifty full time equivalent employees.

The companies participating in the plan are a combination of statewide and regional providers.

The statewide providers are;

Blue Shield of California

Health Net

Kaiser- in their service area

The regional providers are;

The Chinese Community Health Plan in the San Francisco Area

Sharp Health Plan in the San Diego area

Western Health Advantage in Sacramento and North Bay Areas

Below are some of the carriers that will not participate in the SHOP Exchange;

Anthem Blue Cross

Aetna

Cigna

United Health Care

See Change

The plans will have standard benefit designs to allow for comparisons. According to Covered California the rates are comparable or lower than the anticipated small group rates of the carriers that will not participate in the SHOP. Rates are currently being reviewed by the State of California for an open enrollment date of October 1, 2013 and January 1, 2014 effective dates.

Tax credits may be available to groups participating in the SHOP Exchange. Groups that enroll with carriers that do not participate in SHOP will not be eligible for a tax credit.

Insurance brokers are unable to access or discuss specific benefit designs or rates until the completion of Covered California Certification which is scheduled for September.

Following is the official announcement from Covered California.

Today, Covered California™, the state’s new health benefit exchange, announced the insurance carriers and rates for its small-group market, the Small Business Health Options Program (SHOP). With nearly half of all Americans receiving their health insurance from their employer, small businesses play an important role in ensuring Californians have health insurance coverage. Most business owners understand the competitive advantages of providing quality health insurance to their employees, as it helps businesses find and keep the best employees — keeping them healthier, happier and more productive.

Below are key facts about Covered California’s SHOP.

 While rates vary by regions, the Covered California SHOP premiums are generally comparable to 2013 small-group market rates and, in some cases, can save small businesses money on their premiums.

 Covered California will offer health insurance options to small businesses from six carriers: Blue Shield of California, Chinese Community Health Plan, Health Net, Kaiser Permanente, Sharp Health Plan and Western Health Advantage. The plans were selected by a competitive bidding process.

 Small-business owners, with 50 or fewer employees, may enroll in the Covered California SHOP plans when the health benefit exchange is launched on Oct. 1, for coverage effective Jan. 1, 2014. Like the health insurance plans in Covered California’s individual market, Covered California’s SHOP plans were negotiated to bring a standardized set of benefits, a robust provider network, a broad choice for employers and their employees, and competitive prices.

 Covered California’s SHOP anticipates making a broad choice of health plans available to more than half a million small businesses and more than 1 million uninsured workers in 2014.

 Small businesses are eligible for a federal health care tax credit if they have fewer than 25 full-time-equivalent employees for the tax year, pay employees an average of less than $50,000 per year and contribute at least 50 percent of their employees’ premium cost. Employers with 10 or fewer full-time-equivalent employees with wages averaging $25,000 or less per year are eligible for the maximum amount of tax credits. To be eligible for the federal tax credits, small businesses must purchase coverage through Covered California’s SHOP.

 The plans will be sold through licensed agents who are trained and certified by Covered California.

About Covered California

Covered California is the state’s marketplace for the federal Patient Protection and Affordable Care Act. Covered California was charged with creating a new health insurance marketplace in which individuals and small businesses can get access to affordable health insurance plans. With coverage starting in 2014, Covered California will help individuals compare health insurance plans and choose the plan that works best for their health needs and budget. A sliding scale of financial subsidies in the form of premium assistance will be available to help reduce costs for people who qualify. Small businesses will be able to purchase competitively priced health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits.

Covered California is an independent part of the state government whose job is to make the new market work for California’s consumers. It is overseen by a five-member board appointed by the Governor and the Legislature. For more information on Covered California, please visit www.CoveredCA.com

Health Care Reform

CALIFORNIA HEALTH INSURANCE EXCHANGE

Covered California, The California Health Insurance Exchange, now being called the Marketplace has announced the insurance companies and health plans that will participate. Rates have been filed and general information has been released.

The formation of the California Exchange/Marketplace has been a monumental task. Consider that the population of California was thirty-eight million in 2012. The population of Canada was thirty-four million in the same year. The Marketplace will not be the appropriate vehicle for everyone to purchase health insurance, for the most part those who qualify for a subsidy based on income will purchase through the Marketplace.

The health plans that will participate in the Marketplace are;

  • Anthem Blue Cross
  • Blue Shield of California
  • Alameda Alliance for Health
  • Chinese Community Health Plan
  • Contra Costa Health Services
  • Health Net
  • Kaiser Permanente
  • LA Care Health Plan
  • Molina Health Plan
  • Sharp Health Plan
  • Valley Health Plan
  • Ventura County Health Care Plan
  • Western Health Advantage

These are a mix of commercial for profit , non profit, Medi-Cal and regional plans.

Cigna, Aetna and United Health Care will not participate in the Marketplace but will continue to sell plans in California.

Rates have been filed with the State and are lower than expected. This is not to say that the Marketplace rates will be lower than your current coverage. It is not possible to make exact comparisons to current rates and benefits as the Marketplace benefits are generally more comprehensive than today’s plans. Furthermore, I am prohibited by law to discuss specific rates with anyone until I have completed the Marketplace certification process which will probably occur in late August according to the timeline of Covered California.

The lower than anticipated rates seemingly comes at a huge cost to the consumer. Networks of hospitals, doctors, imaging facilities, etc., are said to be reduced significantly. In my opinion this reduction of choice amounts to rationing of care.

In a previous blog I indicated that smokers will be required to pay a higher premium. This is no longer the case, everyone’s rate will be the same depending on the plan chosen, age and geographic area.

A public education campaign will occur in July and August. Open enrollment for a January 1, 2014 effective date will begin on October 1, 2013.

There will be a Marketplace for small businesses with up to fifty employees called the Small Business Health Options Program or SHOP. The participating health plans will be finalized in June.

The California Marketplace will not affect Medicare.

According to the Los Angeles Times, Covered California Board Member Robert Ross said “The Law is now in the hands of Californians and the clock has begun to tick toward implementation. We are the ones who have to make it work. It is not going to be perfect on January 1. We will have bumps, we will have bruises but we will continue to move forward”.

As a reminder, utilizing my services as a broker is of no charge to the consumer. I will be available to help with your health insurance needs.

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The Dennis L. David Insurance Agency | Long Term Care Insurance, Los Angeles Medical Insurance, Anthem Blue Cross Healthcare Insurance, Whole & Term Life Insurance Policies, Cigna, Disability Insurance, Blue Shield of CA, Group Health Plans, Aetna, Group Medical Insurance, Skilled Nursing Insurance, Medicare Supplement Insurance, Medicare Part D Prescription Drug Plans, In-Home Care, Disabled Work Insurance, Disability Benefits, Culver City Health & Life Insurance, Family & Individual Health Insurance, Health Care Reform & Affordable Care Act Assistance, Obamacare, Covered CA Health Insurance, Health Plans, Kaiser Insurance, Genworth Life, John Hancock Life, Culver City Long Term Care & Disability, Employee Benefits, Beverly Hills, Hollywood, West Hollywood, Santa Monica, Pacific Palisades, Marina Del Rey, West Los Angeles, Los Angeles, El Segundo, Sherman Oaks, Encino, Los Angeles, Manhattan Beach, Los Angeles County CA, California

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