california guide to health insurance

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California health insurance exchange

1.4 million Californians buy QHPs during first enrollment period

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Open enrollment for 2014 coverage through Covered California has ended for 2014, but will begin again on November 15 for policies effective in January. People who get married or divorced, change jobs, have a child or experience another qualifying event may be eligible for a special enrollment period prior to regular open enrollment. Enrollment for Medi-Cal (California’s Medicaid program) continues throughout the year.  Get more information on Covered California’s FAQ page.

Individuals who don’t have health insurance that provides “minimum essential coverage” may have to pay a penalty: $95 or one percent of income, whichever is greater.

In preparation for the 2015 open enrollment period that runs from November 15, 2014 to February 15, 2015, Covered California has been making improvements and changes to follow up a strong first open enrollment with an even better second one.

  • Covered California rolled out a Navigator Grant Program earlier this year, with $16.9 million to be allocated to 135 organizations that will help people enroll and also provide post-enrollment and retention assistance.  Recipients of the grant will be announced at the end of August, and Covered California has provided an extensive list of FAQs regarding the new Navigator Program.  For 2014, many people worked first with a certified educator, but then had to receive assistance from a second person to complete the enrollment process.  The idea behind the Navigator Program is to provide a more streamlined, one-stop-shop for California residents.
  • The exchange has been soliciting feedback from consumers throughout 2014, and utilizing it to improve the consumer information portion of the website.  The changes and upgrades from this process will all be completed by November 15.
  • Covered California is still working out the details of the renewal process for people who enrolled in 2014, but renewal will be available starting in October, so that already-enrolled members can beat the enrollment rush that will start in November.  The exchange has said that they didn’t think auto-renewal would be fair to members, since benchmark plans – and thus subsidies – could be changing for 2015.  So there will be at least a short process that members will need to complete in order to renew.
  • Preliminary 2015 rates are already available on Covered California’s website, using their shop and compare tool.  The rates have not yet been finalized by regulators, but they are a good approximation of what consumers will see when renewal and open enrollment begin.  State-wide, the average 2015 rate increase submitted for Covered California plans is only 4.2 percent, with some carriers asking for rate decreases of up to 8.5 percent.
  • Pediatric dental will be embedded in all 2015 Covered California plans.  This will simplify the shopping process compared with 2014, and will ensure that all children have access to pediatric dental, which is one of the ACA’s essential health benefits.  The exchange will also be offering stand-alone family dental coverage for 2015.

The U.S. Department of Health and Human Service’s final 2014 enrollment report showed that 1,405,102 Californians signed up for commercial health insurance as of April 19. In addition, about 1.7 million Californians have enrolled or been found likely eligible for Medi-Cal, the state’s Medicaid program, since October. About 1.1 million applied through the marketplace or county offices, with the balance working through the California Department of Health Care Service. Enrollment for Medicaid and the Children’s State Health Insurance Program (CHIP) continues throughout the year.

While Covered California had the nation’s most successful open enrollment period in terms of the number of signups, it has faced some persistent criticisms and issues.

Enrollment by minorities has lagged. To address the issue, the board of directors committed additional resources to online enrollment capabilities and outreach to minorities ahead of the 2015 open enrollment period. The Covered California website is currently available in English and Spanish. While Covered California is considering making online sign-up functionality available in more language, a spokesperson quoted in The California Report didn’t commit to a timeline or which languages would be supported.

Limited physician networks and inaccurate physician directories have been an issue for Covered California and for individual health plans. Covered California removed its online physician directory due to errors for several weeks in October and again in February. Covered California has not said if or when the online directory will be restored. Many physician directories available directly from health insurers are also apparently riddled with errors. According to a study by the California Health Report, more than 50 percent of the primary-care doctors in three counties were either not accepting new Medi-Cal patients or could not be reached.

The Small Employer Health Options Program (SHOP), the marketplace for small businesses, has also been problematic for Covered California. First, online enrollment capabilities were delayed until late November 2013, nearly two months after individual enrollment began. Then, the SHOP was taken offline in mid-February as it “was not meeting the needs of agents or small employers,” according to a Covered California press release. The online SHOP will not be unavailable until September 2014. In the meantime, small employers can use paper applications, working with an agent or the SHOP Service Center. The Service Center is available 8 a.m. to 6 p.m. Monday through Friday at 1-877-453-9198. As of June 20, 1,519 small employers covering 10,704 people had enrolled through the SHOP.

Anthem Blue Cross, Blue Shield of California, Kaiser Permanente, and Health Net — already the biggest players in the California market — attracted the vast majority of consumers during the first open enrollment period. Even so, a Kaiser Family Foundation study found that Covered California has made the state’s individual insurance market more competitive.

Insurers submitted preliminary rates for the 2015 plan year in June. Covered California will negotiate with the insurers and release final rates in late July. According to a Los Angeles Times article, Anthem anticipates its rates will increase less than 10 percent. Kaiser said increases would be “modest,” while the other two large players declined to comment.

California health insurance exchange links

Covered California
888-975-1142

California Health Benefit Exchange
Information about exchange planning and development

State Exchange Profile: California
The Henry J. Kaiser Family Foundation overview of California’s progress toward creating a state health insurance exchange.