California Must Make a Sustained Enrollment Effort

Covered California is touting positive enrollment figures leading up to the enrollment deadline. But, the state needs to make a continuous effort to enroll people and keep people in coverage, according to a Kaiser Family Foundation report. People will continue to move around within the insurance system as their income or job situations change. With this challenge in mind, California has sought federal grants and other investments for ongoing outreach, enrollment, and education efforts.

Californians may face challenges in comparing costs, services, and provider networks, which have typically varied greatly across plans in the past. Insured adults in California say they did not have difficulty comparing their plan choices, but 38% found some aspect of plan choice to be difficult, such as comparing services, comparing costs, and comparing providers.

Eighty-five percent of insured adults in California rate their pre-ACA coverage as excellent or good. But 20% have needed a service that was not covered by their plan — typically ancillary services, such as dental, vision care, and chiropractor services. Twenty-four percent have been denied coverage for a service they thought was covered, and 35% say out-of-pocket costs were higher than expected.

The ACA requires exchange plans to provide detailed, standardized plan information so consumers can compare coverage options. As a result, uninsured Californians should have fewer challenges making plan choices. The state is also trying to improve the Medi-Cal enrollment process. It calls for reorienting Medicaid management, systems, and caseworker training away from having welfare-style gate keeping toward encouraging participation.

Given the health profile of California’s uninsured population, there is likely to be some pent-up demand for health care services. Some people who have relied on emergency rooms or urgent care centers may need help navigating the primary care system. But clinics and hospitals that already see a large share of uninsured adults may still play an important role in serving this population once they gain insurance. Newly insured Californians may be surprised to learn that some ancillary services, such as dental coverage, are not included in their plan.

While Covered California plans must accept various forms of payment, direct withdrawal from a checking account is a simple and reliable way to ensure that premiums are paid on time. However, 21% of uninsured adults in the income range for Covered California subsidies don’t have a bank account. For more information, visit http://kff.org.

Last Updated 09/16/2020

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