california guide to health insurance

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California health insurance exchange

CA goal: 1.7 million covered in 2015

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The 2015 open enrollment period is now in process, and Covered California made changes to make the second sign-up period even better than the first.

Covered California led the nation in 2014 with 1.2 million Californians purchasing health insurance. For 2015, it wants those 1.2 million to again evaluate their options and renew their coverage. And, it wants to sign up 500,000 new enrollees.

Consumers who want their coverage to begin Jan. 1 need to complete their Covered California enrollment by Dec. 15.

Covered California improvements

  • 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 provide post-enrollment and retention assistance. Grant recipients were announced in September. 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 new navigator program is to provide a more streamlined, one-stop-shop for California residents.
  • The exchange solicited feedback from consumers throughout 2014 and used it to improve the consumer information portion of the website prior to the start of open enrollment.
  • Pediatric dental is embedded in 2015 Covered California plans. This will simplify the shopping process compared with 2014 and 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.
  • Covered California expanded its call center hours. Representatives will be available 8 a.m. to 8 p.m. Monday through Friday and 8 a.m. to 6 p.m. on Saturdays. For the first month of open enrollment (mid-November to mid-December), the call center will also be open on Sundays.
  • The marketplace opened an additional 200 storefront locations where consumers can get face-to-face either signing up for the first time or renewing their policies from 2014.

Currently covered? Renew by Dec. 15

People who purchased insurance through Covered California in 2014 must renew their policy to remain covered in 2015. The renewal period is open now through Dec. 15. During the renewal process, you can make changes like switching to a different health plan or adding a family member to your plan.

One of the most important things to do during the renewal process is to give consent for Covered California to verify your income. If you do not give your consent, you may lose your premium assistance in 2015. See the Renewal FAQs on the Covered California for more information, including step-by-step instructions for giving consent for income verification and completing the renewal process.

If you don’t complete the renewal process, you’ll automatically be renewed in the same health plan — as long as it is still available. You’ll be billed for the new premium amount, which may be more than the 2014 premium. People who were enrolled in plans that won’t be available in 2015 received letters from Covered California. People who were enrolled in discontinued plans must sign up for a new plan by Dec. 15. If they don’t, their coverage will end on Jan. 1, 2015.

2014 enrollment totals

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 2.2 million Californians have enrolled or been found likely eligible for Medi-Cal, the state’s Medicaid program, since October 2013. Enrollment for Medicaid and the Children’s State Health Insurance Program (CHIP) continues throughout the year.

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.

Where are premiums headed for 2015?

On average, 2015 rates for Covered California plans are increasing 4.2 percent.

According to Covered California, 2015 premiums will be the same or slightly lower for 16 percent of consumers, less than 5 percent higher for about 35 percent of consumers, 5 to 8 percent higher for 36 percent of consumer, and more than 8 percent higher for about 13 percent of consumers.

Detailed rate information is available online via the shop and compare tool and in booklet form.

Insurers participating in 2015

The following ten insurers will offer individual and family plans on Covered California for 2015: Anthem Blue Cross of California, Blue Shield of California, Chinese Community Health Plan, Health Net, Kaiser Permanente, L.A. Care Health Plan, Molina Healthcare, Sharp Health Plan, Valley Health Plan, and Western Health Advantage. All of these insurers participated in the 2014 marketplace.

Contra Costa Health Plan opted to pull out of the exchange for 2015, but only a tiny fraction of the exchange’s enrollees selected Contra Costa in 2014.  The exchange will be reaching out to approximately 1,100 enrollees who have Contra Costa coverage, assisting them in selecting new coverage for 2015 with one of the exchange’s other carriers.

California’s SHOP exchange

California’s Small Business Health Options Program (SHOP) exchange is open to businesses with one to 50 employees. As of Aug. 1, 1,714 small employers covering 11,510 people had enrolled through the SHOP according to the Sacramento Business Journal.

Enrollment through the SHOP is available year round. To have coverage start on the first of a month, small businesses must submit a completed application and the first month’s premium at least five business days before the first.

Online enrollment is not yet available through SHOP. Online enrollment was initially 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. A fall 2014 re-launch of the SHOP enrollment portal was planned. However, as of mid-November the Covered California site continues to direct interested small employers to contact a certified insurance agent.

These insurers are offering 2015 medical plans through the SHOP: Blue Shield of California, Chinese Community Health Plan, Health Net, Kaiser Permanente, Sharp Health Plan, and Western Health Advantage.

History of California’s exchange

California was the first state to authorize an exchange under the Affordable Care Act, with former Gov. Arnold Schwarzenegger signing legislation in 2010.

While Covered California had the nation’s most successful 2014 open enrollment period in terms of the number of signups, it has faced some persistent criticisms and issues.

Enrollment by minorities 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.  To better reach African-Americans, Latinos and Asian-Americans during 2015 open enrollment, Covered California is using targeted advertising in ethnic media and holding outreach events in partnership with organizations that are already established in ethnic communities.

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 2013 and again in February 2014. Covered California has not said if or when the online directory will be restored.

The California Department of Managed Health Care, the state agency that regulates health plans, received more than 300 consumer complaints about limited networks between Jan. 1 and Aug. 31, 2014. In August, the California Legislature passed SB 964, which would limit narrow networks. The bill is opposed by the California Department of Finance as well as the California Association of Health Plans, a trade association. Gov. Brown has not indicated whether he will sign the bill.

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.