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Affordable Care Act: Covered California will give access to over 80% of doctors and hospitals through 13 health plans

June 22, 2013

Sacramento – Affordable, quality health care coverage will be accessible through Covered California in 2014. Californians will be able to choose from 13 health insurance plans, both non-profit and commercial, along with 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 a pre-existing condition.

The rates submitted to Covered California for the 2014 individual market ranged from 2 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 plans 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 beginning 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

“Covered California plans include the largest current plans in the individual market, as well as new entrants, regional plans and local Medi-Cal plans that want to be part of making history,” said Peter V. Lee, executive director of Covered California. On average, there will be five plans from which to choose.

Even in rural areas where choice has been historically sparse, there will be two or three health plans. Throughout the state, consumers will have a choice of Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs) and Exclusive Provider Organizations (EPOs).

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 2 and 3 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.

For more information, visit www.CoveredCA.com/newsCovered California will give access to over 80% of doctors and hospitals through 13 health plans.

About Covered California

California was the first state to create a health benefit exchange following the passage of the federal health care law. Covered California is charged with creating a new insurance marketplace in which individuals and small businesses can get access to health insurance.

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. Small businesses will be able to purchase competitively priced health plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits.

Covered California is an independent part of state government whose job is to make the new market work for California’s consumers. It is overseen by a five-member board appointed by the governor and Legislature.

 

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