Covered California Announces Health Plans & Rates

CoveredCAAnnouncementThirteen health insurance plans will offer health care coverage through the Covered California health exchange in 2014. The plans are a mix of large non-profit and commercial plan leaders, along with well-known Medi-Cal and regional plans.

The rates for individual plans through the exchange vary from 2% above to 29% below average 2013 premiums for small employer plans in California’s most populous regions. Additionally, exchange plans limit annual out-of-pocket costs to $6,350. Covered California plans include the largest health insurers in the individual market as well as new entrants, regional plans, and local MediCal plans. The following health plans will participate in the exchange:
• Health Net
• Kaiser
• Anthem Blue Cross
• Blue Shield
• Alameda Alliance for Health
• Chinese Community Health Plan
• LA Care Health Plan
• Molina Healthcare
• Sharp Health Plan
• Valley Health Plan
• Ventura County Health Care Plan
• Western Health Advantage

Three of the nation’s largest players in the employer-sponsored insurance market – UnitedHealthCare, Cigna, and Aetna – will not be selling plans through the California exchange.

Brokers will be able to sell any plan in the exchange, according to Michael Lujan of Covered California who spoke at the LAAHU conference in Los Angeles last week. He urged brokers to get familiar with the plans in order to be ready for open enrollment in October. Renee Casserly of Blue Shield said that, as a broker, you should maintain contact with your clients and let them know that you are able to help them purchase plans under the exchange. She noted that carriers will begin sending out information about the exchange to individual policyholders in September.

Consumers will have a choice of HMOs, PPOs, and exclusive provider organizations (EPOs). Plans that were chosen for the exchange agreed to reduce profit margins down to 2% and 3% and embrace ACOs and medical homes.

In Los Angeles, Orange, San Bernardino, San Diego and Riverside counties, Health Net expects to offer its new tailored-network HMO exchange product, “CommunityCare,” which will be built around local health care providers. Steve Sell, president of Health Net’s Western Region Health Plan said the company will work to ensure that the medical groups, individual physicians and hospitals are committed to comprehensive care coordination and offer freedom of choice in selecting eligible in-network primary care physicians. Health Net Life expects to offer individuals PPO exchange products in the Northern California counties of Contra Costa, Kern, Marin, Mariposa, Merced, Monterey, Napa, San Benito, San Joaquin, San Francisco, San Mateo, Santa Clara, Santa Cruz, Solano, Sonoma, Stanislaus and Tulare.

Molina Healthcare will participate in Los Angeles, San Diego, Riverside, and San Bernardino counties. “Our goal is to work with low-income or uninsured,” said J. Mario Molina, MD, president and chief executive officer for Molina Healthcare.

Kaiser Health news reports that nearly three dozen health plans submitted bids to sell their products in the competitive marketplace, and 13 were selected. Exchange officials rejected bids that were priced too high or failed to have robust networks of doctors and hospitals.

Premiums vary depending on the geographic region, the consumer’s age, and the richness of benefits. For example, a 25-year-old in Los Angeles could choose a Health Net catastrophic plan for $117 a month or choose a Bronze plan for $147 a month from L.A. Care, the nation’s largest public health plan. If the 25-year old earns less than about $45,600 per year, they would qualify for a subsidy to bring the cost of the premium down further.

More than half of Californians will be eligible for federal income tax credits for exchange plans. A 40-year-old in Los Angeles who earns $1,915 a month, or 200% of the federal poverty level, would pay a monthly premium of $90 for a Health Net HMO Silver plan in 2014.

The monthly premium would be $332 to $476 for a Silver plan for a 40-year-old individual in Sacramento. That includes federal subsidies, on a sliding scale, for a man or woman with income up to $45,960. Individuals who are eligible for the highest subsidy ($276 per month) would have out-of-pocket premium costs as low as $56 per month. Californians would receive federal subsidies on a sliding scale, extending to a family of four earning up to $94,200. For more information, visithttp://www.healthexchange.ca.gov.

Last Updated 10/21/2020

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