Covered California™ announced 13 diverse health insurance plans that will offer in 2014 affordable, quality health care coverage to millions of Californians. The plans reflect a mix of large non-profit and commercial plan leaders, along with well-known Medi-Cal and regional plans.
The tentative selection of health plans is subject to a rate review by state regulators. It is impossible to make a direct comparison of these rates to existing premiums in the commercial market because in 2014, there will be new standard benefit designs under the Affordable Care Act and the actual change in an individual’s premium will depend on the person’s current insurance coverage. However, Covered California believes that a valuable frame of reference for its premiums is comparing them to the small employer market in California. Both the small employer market and Covered California are competitive markets and offer guaranteed issue- you cannot be denied for pre-existing condition.
The rates submitted to Covered California for the 2014 individual market ranged from two percent above to 29 percent below the 2013 average premium for small employer plans in California’s most populous regions. This is impressive since the 2014 products include doctor visits, prescriptions, hospital stays and more essential benefits; protecting consumers from the “gimmicks and gotchas” of many insurance policies.
Additionally, there is financial protection like a maximum out-of-pocket cost of $6,350 which will dramatically reduce the chance of someone going bankrupt because of medical bills not covered by insurance.
Covered California’s rigorous review and selection process resulted in a portfolio of plans that achieve three objectives: a robust choice of offerings throughout the state, affordable prices and access to doctors and hospitals. The terms of Covered California’s relationship with its partnering health plans means they will collaboratively work to promote care improvements, foster prevention, and seek to reduce costs by promoting better care.
Once plan rates are approved by state regulators, Covered California looks forward to signing final contracts and begin the work of enrolling millions of Californians in the following health plans:
• Alameda Alliance for Health
• L.A. Care Health Plan
• Anthem Blue Cross of California
• Molina Healthcare
• Blue Shield of California
• Sharp HealthCare
• Chinese Community Health Plan
• Valley Health Plan
• Contra Costa Health Services
• Ventura County Health Care Plan
• Health Net
• Western Health Advantage
• Kaiser Permanente
To get prices at such competitive points, winning health plans built their bids around the expectation of high enrollment, not high profit. Plans reduced profit margins down to two and three percent embraced Affordable Care Act programs such as Accountable Care Organizations and Patient-Centered Medical Homes, that seek to improve care while lowering costs, found common ground with doctors, medical groups and hospitals on lower reimbursement rates to make care affordable.
Virtually every health plan designed a custom network for Covered California. Negotiations included a detailed review of each plan’s rates, their mix of hospitals, physicians and other providers, and their contingency plans for expanding networks in the event more consumers sign up than expected.
The current list of insurers is for individual policies only. Covered California will announce its options for small businesses to buy health insurance in June.
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