LOS ANGELES - Californians can now view a list of health plans that are competing to provide policies to the millions of uninsured residents who need health care coverage to meet the Affordable Care Act's deadline, state officials announced last week.
Covered California, a five-member board appointed by Gov. Jerry Brown and legislators that operates the exchange, unveiled the 13 health insurers who have agreed to be part of the marketplace, including the state's largest health insurers such as Anthem Blue Cross, Blue Shield and Kaiser Permanente.
Consumers can go on to CoveredCA.com and compare plans under tiered policies that include Bronze, Silver, Gold and Platinum -- each providing different levels of out-of-pocket costs, based on income. The plans listed are for individual coverage. Small business owners will view different rates which will be available in June. All who qualify can begin purchasing insurance in October.
The rates, however, are still subject to review by the Department of Managed Health Care and other regulators, Covered California officials said.
"Californians should be proud of how not only health plans in this state, but doctors, medical groups and hospitals have stepped up, creating a market that will allow millions of consumers to enroll in affordable priced products " said Peter Lee, Executive Director of Covered California. "Because of that, we will be able
to deliver exceptional value, low rates, access to health care in every region of the state, and a solid platform to achieve the dream of providing quality health care for all Californians."
In addition, no patient can be turned away for pre-existing conditions and the maximum out-of-pocket cost comes to $6,350 annually, said Lee "which will dramatically reduce the chance of someone going bankrupt because of medical bills not covered by insurance."
At least 5.3 million Californians could be eligible for coverage under Covered California. Of those, at least 2.6 million may be eligible for tax subsidies to help pay for health care coverage. Those subsidies will be available for individuals earning up to $46,000 and for families with incomes of up to $94,200. Although consumers can purchase insurance directly from brokers, only those who go through the exchange are eligible for the subsidies.
In Los Angeles County, for example, an estimated 779,000 are eligible for subsidies through the exchange. In San Bernardino, at least 341,000 people qualify.
For those who don't qualify for subsidies, Covered California provides a rate chart so that those who live in Southern Los Angeles County, who are 40, for example, can consider a range of plans, offered by Health Net, Anthem, Molina Healthcare, L.A. Care, Blue Shield, and Kaiser Permanente.
At the platinum level, a consumer can pay a range from $311 to $429 a month. Under the bronze level, the range would be $204 to $301. The platinum level provides the lowest deductible and co-pays, but it comes with higher premiums. In contrast, the Bronze plan includes a higher deductible but a significantly lower premium. All plans cover the 10 basic health benefits, ambulatory care, hospitalization, prescription drugs, laboratory services and pediatric care.
While several state groups praised Covered California for releasing the information, some cautioned that the changes come with trade-offs and in some cases could impact physician availability.
The California Medical Association, for example, said a loophole within the Affordable Care Act, could leave those physicians who are contracted through the exchange to foot the bill for services provided to patients who have failed to pay their insurance premium.
"The law allows for a three-month 'grace period' for nonpayment of premiums, but only requires insurers to pay the claims through the first month of nonpayment," according to the association.
The contract drawn up for the exchange does include a provision that requires 15 days advance notice to physicians when a patient has entered the second month of the grace period, "but still leaves the burden of 60 days worth of unpaid claims on the physician and the patient."
"The notification requirement is certainly a step in the right direction," Dr. Paul R. Phinney, president of the CMA said in a statement. "That said, the remaining risk is still large enough that some physicians could be put out of business if left on the hook for tens or thousands of dollars. It is imperative for access to be more than an empty promise of an insurance card, that physicians are not deterred from participating in Covered California."
Patrick Johnston, president and CEO of the California Association of Health Plans also praised the group and participating insurers for releasing the charts on Thursday, but added that while many people are going to see a lower premium and help with subsidies, there will be some people who will see some increases, especially younger people who don't see a doctor. They offset the costs from older patients who need healthcare more.
"The Affordable Care Act is a balancing act, seeking to spread costs by enrolling the young and old, sick and healthy, lower and higher income earners," Johnston said in a statement. "The subsidies will also enable many Californians to pay less for more extensive coverage than they had before."
California is among seven states that received the go-ahead from the U.S. Department of Health and Human Services to operate its own health insurance exchange, one of the provisions under President Barack Obama's Affordable Care Act.
Those participating include:
--Alameda Alliance for Health
--Anthem Blue Cross of California
--Blue Shield of California
--Chinese Community Health Plan
--Contra Costa Health Services
--L.A. Care Health Plan
--Sharp Health Plan
--Valley Health Plan
--Ventura County Health Care Plan
--Western Health Advantage
Here are 5 common gaps qualified health plan issuers have to resolve before plans can be sold on an exchange.More:http://www.healthcaretownhall.com/?p=6715