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California health insurance exchange

Goal: 1.7 million covered in 2015

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  • By
  • healthinsurance.org contributor
  • September 25, 2014

In preparation for the 2015 open enrollment period, Covered California has been making changes to follow up a strong first open enrollment with an even better second one.

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

Open enrollment begins Nov. 15 and runs through Feb. 15.

Improvements for 2015

  • 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. 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 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 Nov. 15.
  • Covered California is working out the details of the renewal process for people who enrolled in 2014. In October, insurance companies will send letters listing the consumer’s 2014 premium, 2014 federal subsidy (if applicable), and the 2015 rate for the same plan. However, the letters won’t include the 2015 subsidy, which is crucial for making a decision. Covered California is planning to send that information between Oct. 10 and Dec. 15, according to the Los Angeles Times.Covered California wants to streamline renewals to keep the process simple. At the same time, it does want to require at least some action by consumers to ensure they actively engage in selecting a health plan for 2015.
  • 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.

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 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.

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?

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.

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.

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. September 2014 was targeted to have the SHOP back online. However, as of late September the Covered California site continued to note that paper enrollment was the only option for signups.

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. The Covered California website is currently available in English and Spanish. While Covered California is considering making online sign-up functionality available in more languages, 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 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.