california guide to health insurance

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California health insurance exchange / marketplace

CA special enrollment period thru 4/30

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Covered California is allowing a special enrollment period for people who are just learning about the tax penalty for not being insured. The penalty-related special enrollment period is open through April 30, 2015. To qualify, consumers should select “Informed of Tax Penalty Risk” when filling out an application.

The requirement for most people to have health insurance went into effect Jan. 1, 2014. However, many people are only learning about the penalty as they file their 2014 return. While consumers can’t do anything about the 2014 penalty at this point, a special open enrollment period enables them to get 2015 coverage and avoid a penalty the next time tax season rolls around.

Enrollment update

More than 474,000 new consumers selected health plans through Covered California between Nov. 15, 2014, and Feb. 15. Covered California set a goal of 500,000 new enrollees for 2015.

In addition to new enrollees, about 92 percent of people who were eligible to re-enroll have done so. Approximately 386,000 people actively shopped for a renewal policy while about 576,000 people were automatically re-enrolled in the same plans from 2014. Another 85,000 people who were enrolled in private coverage in 2014 qualified for Medi-Cal (Medicaid) in 2015.

Covered California is touting better signup rates among Latinos and African-Americans during the 2015 open enrollment period. Enrollment by minorities lagged in 2014, prompting a reallocation of marketing dollars, the launch of a Spanish-language enrollment website, and an increase in bilingual customer service representatives.

What happens if you don’t sign up?

The Affordable Care Act now requires most people to have health insurance. Those who don’t have insurance — and don’t qualify for an exemption — have to pay a penalty when they file their income tax return.

Penalties are increasing for 2015: 2 percent of your household income or $325 per adult ($162.50 per child under 18), whichever is more. Use this calculator to see how much you may owe.

2015 premiums up slightly

A study published by the Commonwealth Fund shows 2015 rates for Covered California plans increased 1 percent on average. The overall average is weighted and considers all metal tiers. The average cost of individual bronze policies is up 1 percent, the average cost of individual silver policies is flat, the average cost of individual gold policies is up 1 percent, and the average cost of individual platinum policies is up 2 percent.

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

Insurers participating in 2015

The following ten insurers are offering 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.

Not all insurers are available in all parts of the state. In fact, in some ZIP codes just a single company offers plan options. Approximately 29,000 Covered California customers have only one choice of insurance carrier. Peter Lee, executive director of Covered California, says the exchange is trying to address the problem, but the lack of competition in rural areas is a long-standing issue and not one created by the formation of Covered California.

UnitedHealthcare, the nation’s largest health insurance company, asked to join Covered California and sell policies statewide in 2016. However, the Covered California board agreed to let United into just five regions where competition is currently limited. The board’s new policy applies to established insurers, but not startups.

United previously sold individual policies in California, but decided not to participate in California’s marketplace for its first two years of operation. Lee indicated that United and other established insurers who avoided the uncertainty of the early years shouldn’t be allowed immediate, statewide access to potentially undercut insurers who have been with the exchange since its launch.

Oscar Health also wants to join Covered California for 2016. Oscar was formed in 2014 and currently operates in New York and New Jersey.

California’s SHOP exchange

California’s Small Business Health Options Program (SHOP) exchange is open to businesses with one to 50 employees. Small businesses can sign up and offer coverage to their employees year round. Small businesses must submit a completed application and the first month’s premium at least five business days before the end of the month to have coverage starting the first day of the following month.

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 January 2015 the Covered California site continues to instruct 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.

2014 enrollment

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 between Oct. 15, 2013, and April 19, 2014.

About 800,000 Californian households received premium subsidies to help pay for 2014 coverage. On average, each household received $5,200 in subsidy assistance. About 480,000 of the households also received cost-sharing assistance valued at about $1,200.

The Gallup-Healthways Well-Being Index found that California’s uninsured rate dropped 6.3 points, from 21.6 percent to 15.3 percent, from 2013 to 2014.

History of California marketplace

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 was low in 2014. To address the issue, Covered California boosted funding and resources to better reach minority communities. According to a Covered California press release, the exchange spent more on advertising that targets Latinos, launched a Spanish-language enrollment website, added more than 200 bilingual customer service representatives, and partnered with several organizations for improved outreach.

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.

Class-action lawsuits were filed against several insurers in July and September 2014 alleging that the companies provided incomplete or inaccurate information about networks or provided network information too late to allow consumers to switch to other plans. In November 2014, the California Department of Managed Health Care (DMHC), the state agency that regulates health plans, ruled that Anthem Blue Cross and Blue Shield of California misled consumers about the size of their physician networks. Both companies disputed the findings.

In August 2014, the California Legislature passed SB 964, which authorizes the DMHC to scrutinize the networks for plans sold on Covered California as well the networks of Medi-Cal plans. Gov. Brown signed the bill in October 2014, despite opposition from the California Department of Finance as well as the California Association of Health Plans, a trade association.

In January 2015, the California Department of Insurance issued emergency regulations to address network access. The regulations specify standard wait times for various medical procedures, require insurers to provide information about physicians, and mandate that provider directories be updated weekly and that directories be available online and in hard copy. The regulations also require insurers to arrange out-of-network care if an in-network provider isn’t accessible. The emergency regulations must undergo a legal review before going into effect.

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.