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Daily Archives: July 19, 2016

What Do Covered California’s Big Rate Hikes Mean For You?

Covered California, the state’s Obamacare health insurance exchange, said Tuesday that its premiums will balloon by a statewide average of 13.2 percent next year — more than triple the roughly 4 percent increases in each of the previous two years.

But the average rate hike doesn’t tell the full story for individual consumers. Health plan prices vary across the state, and within regions. How much you’ll pay depends on a variety of factors: where you live, how much money you make, what level of coverage you want and which insurer you choose.

Keep in mind that these premium increases affect only a fraction of insured Californians — not the majority, who get their coverage through work or a government program such as Medicare or Medi-Cal.

Here are some key questions and answers to help you better understand what today’s announcement means for you.

Q: When do these premium hikes take effect?

They start in January for 2017 policies.

Q: Are all Covered California plans going up 13.2 percent?

No. California is divided into 19 pricing regions, and not all 11 plans that participate in the exchange are offered in each region. Your options will depend partly on where you live and what plans are available in your area.

In some regions, the rate increase is higher than the statewide average. In others, it’s lower.

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Within regions, rate hikes vary by insurer. For instance, in the greater Sacramento area, rates will rise an average of 13.4 percent overall. However, rate increases within the region range from an average 5.8 percent for a Kaiser Permanente plan to 23.1 percent for a Blue Shield of California plan.

Anthem Blue Cross and Blue Shield of California account for the highest rate increases statewide, said Covered California Executive Director Peter Lee. Blue Shield said its average hike was 19.9 percent, the biggest among all insurers participating in the exchange. Anthem Inc. said its average increase in California was 17.2 percent, the second biggest.

Q: Where are the biggest increases and what accounts for them?

The biggest rate hike will be in the region that includes Monterey, San Benito and Santa Cruz Counties, coming in at a whopping 28.6 percent. Covered California premiums in Northeast Los Angeles County will rise an average of 16.4 percent. Exchange enrollees in San Luis Obispo, Santa Barbara and Ventura Counties will see a 15.8 percent average increase. San Francisco rates are increasing an average of 14.8 percent.

Lee attributed the increases to several factors, including the rising cost of health care —in particular the steep jump in specialty drug prices.

Q: Will I be able to keep the same plan I have this year?

It depends on where you live. United HealthCare, after just one year of limited participation in Covered California, is pulling out in 2017.

Other plans, including Oscar, Molina and Kaiser Permanente, are expanding into some regions.

But even if you can keep your plan, a rate hike could put it out of your financial reach.

To find a better price, more Covered California enrollees will have to switch plans, which means they could lose their current doctors. According to Lee, about 80 percent of Covered California consumers will be able to pay less than they do now or cap their rate increases at 5 percent if they shop around and buy the lowest-cost plan at their current benefit level.

Q: If the premium on my plan rises by 10 percent, does that mean I’m going to have to pay 10 percent more out of my pocket than I did this year?

Not necessarily.

About 90 percent of Covered California enrollees receive tax credits that help defray the cost of their premiums.

As premiums rise, so do tax credits, which means that, all things being equal, the tax credits will absorb at least some of the rate hike.

Consumers are eligible for sliding-scale tax credits if they make between 138 percent and 400 percent of the Federal Poverty Level. This year, that’s between $16,394 and $47,520 for an individual and $27,820 and $80,460 for a family of three. The more money you make, the smaller the tax credit you receive.

Remember, the size of the tax credit you receive may vary from year to year as a result of changes in your income, age or family size.

“It is a complex calculation based on a lot of factors,” said Amy Palmer, director of communications at Covered California.

Q: When can I shop for my 2017 coverage?

Open enrollment for individual and family plans begins Nov. 1 and ends Jan. 31, 20DZ. These dates apply to plans purchased through Covered California or the open market.

But you won’t be able to research your specific situation until the fall. Because Covered California is revamping its online shopping tool, which offers personalized searches, it won’t be available and updated for 2017 health plans until early October, Palmer said.

If you already have a Covered California plan, you will receive a notice from Covered California in October explaining how much your current plan’s premium will change and what your tax credits — if any — will be for next year. If your plan is being offered again next year, you can keep the same plan at the new rate or switch plans during open enrollment.

If you want to get a general idea of average rate increases across the state, check out Covered California’s 2017 rate plan booklet.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

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Insurer Mega-Mergers To Be Challenged By Justice Department On Antitrust Concerns

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Covered California Announces Sharp 2017 Rate Increases

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Covered California Health Plan Rates To Jump 13.2 Percent In 2017

California’s Obamacare premiums will jump 13.2 percent on average next year, a sharp increase that is likely to reverberate nationwide in an election year.

The increase, announced by the Covered California exchange Tuesday, ends the state’s two-year respite from double-digit rate hikes.

The announcement comes as major insurers around the country seek even bigger rate increases for open enrollment this fall, and the presidential candidates clash over the future of President Obama’s landmark health law.

California won plaudits by negotiating 4 percent average rate increases the past two years for its 1.4 million enrollees. But that feat couldn’t be repeated for 2017, as overall medical costs continue to climb and two federal programs that help insurers with expensive claims are set to expire this year.

Health policy experts said California is rejoining the pack after outpacing much of the country during the launch of Obamacare.

“This puts a chink in the armor of the California story,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation. “It’s still a more stable market than other states, and by most measures the Affordable Care Act is working quite well in California.” (California Healthline, an editorially independent program of the California Health Care Foundation, is produced by Kaiser Health News, which is part of the Kaiser Family Foundation)

Critics of the health law, including Republican presidential candidate Donald Trump, have been quick to seize on these rising costs as further proof that the Affordable Care Act is failing the average consumer and warrants repeal.

The Obama administration counters that federal subsidies spare most consumers from the full impact of the premium increases and the health law enables people to shop around for a better deal.

Last week, consulting firm Avalere Health found that the average rate increase being sought for widely sold silver plans was 11 percent acrossಎ states. But consumers could limit the increase by choosing one of the lower-cost silver plans, which are set to go up only 8 percent.

These rate increases apply to people who purchase their own coverage in the individual market, not the majority of Americans who get their health insurance through work or government programs such as Medicare and Medicaid.

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Peter Lee, executive director of Covered California, said prices for 2017 reflect some one-time adjustments and don’t necessarily portend similar increases in the years ahead. “2017 will be a transitional year for premium rates across the nation,” Lee told a Congressional committee last week.

Two federal programs that have helped health insurers offset costly medical claims and cover sick patients in general end this year. They were intended as a temporary cushion for insurers who are now required to accept all applicants regardless of their medical histories.

Health insurers and Covered California said rates also reflect the ever-increasing cost of care, particularly for expensive specialty drugs.

“The rising trend of health-care costs remains a constant driving factor in health-care premiums,” Lee said.

Insurers have also complained about lax rules for special enrollment outside the designated signup period that have allowed some people to game the system by waiting until they need care to enroll . Those people tend to generate more claims and higher costs, insurers say. Federal and state officials say they have tightened the rules to address these complaints.

To press their case for higher rates, health insurers said they had the benefit of detailed data on exchange customers and their medical claims for the first time since these marketplaces opened in 2014.

Many consumer advocates in California had hoped that UnitedHealth Group Inc. would become another formidable competitor on the state-run exchange. But the nation’s largest health insurer is leaving Covered California after just one year of minimal participation — part of a broader pullback nationwide after the company posted heavy losses on individual plans.

The top four insurers in Covered California, led by Blue Shield of California and Anthem Inc., control more than 90 percent of enrollment.

The premium increases in California will vary widely by region and by insurance company, and could pinch the pocketbooks of cost-conscious consumers like David Arnson.

Arnson, 57, of Los Angeles, qualifies for a federal subsidy and pays just $32 each month for a Molina Healthcare policy he purchased through Covered California. He relies on the coverage to help pay for treatment for ankle and knee problems.

Arnson, who works at a record store and plays in a band, said he worries about his monthly premium increasing next year.

“I make a marginal living. Like anything, you want to pay as little as possible,” he said. “I need healthcare — it is at the top of my pyramid of necessities.”

The higher rates in California may spur more consumers to switch health plans. Only 14 percent of Covered California enrollees who returned this year chose a different insurer. On the federal exchange, 43 percent of people switched plans for 2016.

However, the proliferation of narrow networks can make shopping complicated since certain doctors and hospitals may only be available through one or two insurers, and provider directories are often inaccurate.

Since 2014, California has benefitted from having a healthier mix of enrollees compared to other states. One reason for that is state officials defied the Obama administration by requiring insurers participating in Covered California to cancel existing individual policies at the end of 2013.

That unpopular decision quickly moved people into coverage that fully complied with the health law and created one giant risk pool for rating purposes. Those previously insured customers were generally thought to be healthier, since at the time insurers could deny coverage to people with pre-existing conditions.

But that positive effect may be wearing off as people get sick over time or leave the individual market for coverage elsewhere, experts say.

The expansion of coverage under the Affordable Care Act has driven the percentage of uninsured Californians to a record low.

The share of Californians lacking health insurance was 8.1 percent at the end of last year, down from 17 percent in 2013, federal data show.

The expansion of Medi-Cal, the state’s Medicaid program for lower-income residents, accounts for a significant part of that reduction. Since January 2014, nearly 5 million people have joined the Medi-Cal rolls, bringing total enrollment to 13.4 million — about one-third of the state’s population.

Anna Gorman contributed to this report.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

This story will be updated.

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Viewpoints: Trump, Ryan And The GOP Health Policy Platform; Growing Debate Over Medical Errors

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State Highlights: Lobbying Picks Up Over Calif. Tobacco Tax Ballot Measure; Okla., Colo. And Pa. Recieve Grants To Train Rural Doctors

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If Placebos Have No Pharmaceutical Effect, Why Do They Still Deliver Health Benefits?

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Number Of Incurable Prostate Cancer Cases On The Rise: Report

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U.N. Chief: Progress Against AIDS ‘Inadequate – And Fragile’

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Benefits Of Electroshock For Some Depression Patients Outweigh Risks: FDA

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