The Kaiser plans Bronze 60 HDHP 5500/40%, Silver 70 2000/45, and Silver 60 HDHP 2700/15% are only available off-exchange. The Silver 73, 87, adn 94 plan are only available through Covered California. The Silver 70 Off Exchange plan virtually mirrors the Covered California Silver 70 plan but the rate does not include the Covered California Silver plan surcharge making it less expensive.
Effective Jan. 1, 2018, the Sutter Health Plus network in Alameda County and western Contra Costa County is expanding to include primary care physicians and specialists at University HealthCare Alliance and Affinity Medical Group IPA.
Individuals and families who are enrolled in a health plan that is being closed must actively enroll in another plan through Covered California. Those households will not be automatically renewed into a new plan. Without an enrollment selection, the family may have no health insurance at the beginning of 2018. Off-exchange members who have plans being closed will be migrated to a similar plan if the household has not changed their plan for 2018.
“The Graham-Cassidy plan takes resources away from California and from the majority of states, which means that far fewer Americans would have insurance or the existing protections from insurers,” said Peter V. Lee, executive director of Covered California. “The effect on California would be devastating, and lead not only to there being more uninsured people than there were before the Affordable Care Act, but would also cause huge negative impacts on the health care delivery system, the economy and on those with employer-based coverage.”
Western Health Advantage (WHA) has announced that the Department of Managed Health Care has approved their expansion for small group plans into the Bay Area. They also noted that they will not seek re-certification of their Covered California small group plans because of this expansion. WHA’s exit from the Covered California for Small Business plans does not affect their individual and family plan offerings through Covered California.
Next year, we will offer plans in three regions of Northern California only, which will include Redding, Santa Clara County, and Stockton/Modesto. The coverage options will include EPO plans available both on-exchange and off-exchange, and at all metal levels. Staying in these three key areas will help ensure Californians in those regions have access to health plans.
Covered California instructed health insurance companies to submit their rates assuming direct payment to fund the CSR subsidies would be continued, but to also submit a separate CSR surcharge to “load” any costs to fund this program onto Silver-tier plans for those who receive subsidies. As a result, Silver-tier consumers may see an additional “CSR surcharge” that averages 12.4 percent — ranging from 8 percent to 27 percent on the gross price of their premiums
The California Department of Insurance also conducted the first government-sponsored economic impact assessment in the United States related to transgender health insurance coverage. The assessment concluded removal of the discriminatory exclusions would have an insignificant and immaterial impact on premiums and that the benefits for transgender Californians were significant.
The Senate Republicans’ proposal to repeal the ACA has most of the same devastating consequences for Americans’ health care as the House bill, including provisions that would permit the elimination of coverage for essential health benefits and the caps on out-of-pocket costs that help prevent medical bankruptcy.
“This is yet another failing report card for the Exchanges. The American people have fewer insurance choices and in some counties no choice at all. CMS is working with state departments of insurance and issuers to find ways to provide relief and help restore access to healthcare plans, but our actions are by no means a long-term solution to the problems we’re seeing with the Insurance Exchanges,” said CMS Administrator Seema Verma.