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California health insurance exchange

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California health insurance exchange

By contributor
July 24, 2014

Open enrollment for 2014 coverage through Covered California has ended. People who get married or divorced, change jobs, have a child or experience another qualifying event may be eligible for a special enrollment period. Enrollment for Medi-Cal (California’s Medicaid program) continues throughout the year. Covered California, the state-run marketplace, is also allowing a special enrollment period for people on COBRA; that enrollment period ends July 15. 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. Open enrollment for 2015 coverage runs from Nov. 15, 2014, to Feb. 15, 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

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.

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California Governor Jerry Brown
State Capitol Building
Sacramento, CA 95814
PHONE: 916-445-2841
FAX: 916-558-3160
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