Covered California health and dental plan changes for 2017

Covered California hosted a webinar where they went over the numerous changes to the health plans for 2017. This included the expansion of some health plans into more counties, the conversion of PPO plans to EPO for one carrier, and the addition of a HMO plan for another carrier. They also reviewed the minor and major cost sharing changes to their metal tier level plans offered by all the carriers.

Health Plan Product and Network Changes

1. Anthem Blue Cross is converting their Tiered PPO plans to EPO plans. Tier 1 hospitals will remain in-network. Tier 2 hospitals will not be covered in 2017.
2. Blue Shield will offer a HMO plan in many regions of California.
3. Kaiser is adding a Gold coinsurance plan and expanding its service into Santa Cruz County.
4. Molina is expanding into Orange County
5. Oscar is expanding into San Francisco, San Mateo, and Santa Clara counties in Northern California.

Health Plan Benefit Changes

1. Some Platinum Copayment plans copayments have been reduced.
2. Platinum Coinsurance plan eliminates the 10% physician for Emergency Room services.
3. Gold Copayment plans will have some copayment reductions and increases along with increase in the Maximum Out-of-Pocket amount from $6,200 to $6,750.
4. Gold Coinsurance plan will also have some reductions and increases to copayments while the 20% Physician Emergency Room services will be eliminated.
5. Silver 70 Copayment plans will have some reductions and increases to different health care services. The $50 Physician Fee for Emergency Room services was eliminated. The medical deductible will increase to $2,500 from $2,250. The Maximum Out-of-Pocket was increased from $6,250 to $6,800.
6. Silver 73 Copayment plan will have similar changes to copayments as Silver 70. The medical deductible will increase from $1,900 to $2,200. The Maximum Out-of-Pocket amount increase from $5,450 to $5,700.
7. Silver 87 Copayment plan will similar changes to copayments of the Silver 70. The medical deductible will increase to $650 from $550. The Maximum Out-of-Pocket will increase from $2,250 to $2,350.
8. Silver 94 Copayment plans will have a lower Urgent Care copayment, no Emergency Room Physician fee, but an increase of the ER facility fee from $30 to $50. The Maximum Out-of-Pocket will increase from $2,250 to $2,350.
9. Similar changes are occurring to Covered California for Small Business Silver 70 small group metal tier plans. While some copayments are decreasing, most benefits will have an increase in copayments. Medical deductibles and Maximum Out-of-Pocket amounts will also increase.
10. Health Savings Account (H.S.A.) plans will now be labeled as HDHP (High Deductible Health Plan) plans.
11. For Bronze plans, most all minimal copayments will increase. The medical deductible will increase to $6,300 from $6,000. The Maximum Out-of-Pocket amount will increase from $6,500 to $6,800.
12. Bronze HDHP (formerly H.S.A.) will have the medical deductible increase to $4,800 from $4,500. The Maximum Out-of-Pocket will increase to $6,550 from $6,500.

Dental Plans

1. Liberty Dental and California Dental Network will be added to the family adult dental offering.
2. Children’s medically necessary orthodontia will have one copayment which will apply to the entire course of treatment beyond one benefit year.
3. Adult exclusions include tooth whitening, orthodontia, and implants.
4. Fully standardized pediatric and adult copay schedules for Dental HMO plans.
5. Dental PPO plans will include 10% Out-of-Network charge for diagnostic and preventive services. 30% Out-of-Network coinsurance for basic services. Periodontal maintenance will now be included as a basic service in 2017 plans.

Primary Care Physicians Matching

1. Health Plans will assign a PCP to each member within 60 days of enrollment. It does not apply to Covered California for Small Business plans.
2. PCP does not have to be a doctor, could be a Physician’s Assistant.
3. Different household members can have different PCPs
4. PPO plan members can still see any doctor in their network without a referral from the PCP.

Download the complete slide deck presentation which includes more details on copayment and coinsurance changes.

View the video of the presentation at https://youtu.be/qTq2ioLwL-s