Limited information was recently released by the Covered California health exchange and our office will keep give you an overview of the information released to brokers and the public. You can also visit the Covered California site for additional news.
With coverage starting in 2014, Covered California will help individuals compare and choose a health plan that works best for their health needs and budget. Financial help will be available from the federal government to help lower costs for people who qualify on a sliding scale. Covered California is an independent part of the state government whose job is to make the new market work for California's consuemrs. It is overseen by a five-member board appointed by the Governor and Legislature.
How many people will be eligible for these plans? There are 5.3 million Californians who may be eligible for coverage through Covered California. More than 2.6 million of those individuals may be eligible for tax subsidies to help pay for health care coverage.
Which plans were selected? 13 plans were selected including some regional carriers. In alphabetical order:
1. Alameda Alliance for Health
2. Anthem Blue Cross of California
3. Blue Shield of California
4. Chinese Community Health Plans
5. Contra Costa Health Services
6. Health Net
7. Kaiser Permanente
8. L.A. Care Health Plan
9. Molina Healthcare
10. Share Health Plan
11. Valley Health Plan
12. Ventura County Health Care Plan
13. Western Health Advantage
These health plans meet all the state and federal requirements for plan as well as additional standards established by Covered California. They represent a mix of major insurers and smaller companies, regional and statewide providers, and for-profit and nonprofit plans. They deliver exceptional value and choice with affordable premiums, a wide choice of benefit levels, and good access to doctors and hospitals in all areas of the state.
What benefits are included in the Covered California Health Plans? The plans that will be offered through Covered California are guaranteed to provide basic levels of coverage and provide consumer protection set forth in the Affordable Care Act, including the ten Essential Health Benefits:
1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventative and wellness services and chronic disease management
10. Pediatric services
Standard Benefit Design
Not only must each plan cover the Essential Health Benefits, they must also follow Covered California's standard benefit designs. With standardized benefits, consumers can accurately compare health insurance plans because the benefits are the same for all plans offered in the Covered California marketplace. Additionally, standardized benefits assures that the selected health plans define the consumer's and limit the consumer's out of pocket costs by type of service.
What is the average premium rate rate for California consumers?
Rates vary by region, by metal level and age. However, the info below depicts a broad overview of average rates for Silver Plans offered across the state:
Statewide Average Premium Rates (for Silver Plans across all 19 Rating Regions)
Lowest Silver Plan $304.00
2nd Lowest Silver Plan $325.00
3rd Lowest Silver Plan $335.00
Average of the 3 plans $321.00
How did Covered California get these premium rates?
Health plans that were selected to offer coverage in the Covered California marketplace designed their provider networks with access, quality, and affordability in mind. In order to ahieve all three factors, some plans included in their provider netowrks an integrated delivery system, which focuses on efficiency and quality as the main drivers of affordability. Other plans focused on prevention, care coordination, early intervention, and the health management of high-risk enrollees to achieve affordable rates. Overall, the health plans all focused on managing their membership to ensure they are getting the right care at the right time.
How do these rates compare to small group rates?
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 benefits and the actual change in premium will depend on an individual's insurance they have today. The best frame of reference of how good these rats are is by looking at current rates available in the samll employer market in California. Each market is a competitive market with guaranteed issue.
What are the bronze, silver, gold and platinum plans?
Covered California health plans will be offered in a tiered format with a choice of plans in each tier. The "metal levels"-bronze, silver, gold and platinum-define the level of coverage you pay as a patient compared to what the plan pays. The metal levels are defined by the Affordable Care Act and they are:
Metal Tier Paid by health plan Paid by consumer
________________________________________________
Bronze 60% 40%
Silver 70% 30%
Gold 80% 20%
Platinum 90% 10%
How will Covered California health plans improve quality of care?
Covered California and each health plan selected are committed to ensuring high quality of care for all enrollees. Specifically, each plan must:
Ensure that each enrollee has had a preventive health and wellness visit during the first year of enrollment;
Identify and proactively manage all "at-risk' enrollees;
Determine enrollee's health status and proactively develop a plan to manage their individual health care needs;
Promote the use of best practice models for continuity of care and care coordination that are proven to improve quality of care;
Be transparent about plan performance at the point of enrollment, specifically regarding standard measures of preventions, access, and clinical effectiveness; and,
Be certified by the National Committee for Quality Assurance or URAC (formerly known as the Utilization Review Accreditation Commission) to meet quality standards.
