Covered California announced on May 23 the 13 diverse health insurance plans that will offer millions of Californians affordable, quality health care coverage beginning in 2014. Thousands of doctors and more than 300 hospitals are part of the plans’ networks. The tentative selection of health plans is subject to state regulators’ rate review.
In Riverside and San Bernardino counties, seven plans will compete for customers (see the accompanying table). The plans reflect a mix of large nonprofit and commercial plans, along with well-known Medi-Cal and regional 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 Affordable Care Act defines the metal levels that specify how medical costs will be apportioned between the individual and the insurance provider:
The actual monthly premiums will depend on the individual’s age, income level, region and whether the family is included.
In 2014, the ACA requires nearly all citizens to have health insurance or pay a penalty.
Health officials say it’s impossible to make a direct comparison of the proposed rates to existing premiums in the commercial market. In 2014, new standard benefits will be designed under the Affordable Care Act. Also, 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. That market and Covered California are competitive and offer insurance for which a person cannot be denied because of a pre-existing condition.
The rates submitted to Covered California for the 2014 individual market ranged from 2 percent more to 29 percent less than the 2013 average premium for small employer plans in California’s most populous regions. The 2014 products include requirements not necessarily included in the 2013 plans, such as doctor visits, prescriptions, hospital stays and more essential benefits.
Also, financial protection is offered, such as the maximum out-of-pocket cost of $6,350 that will dramatically reduce the chance of someone going bankrupt because of medical bills not covered by insurance.
Once state regulators approve plan rates, Covered California looks forward to signing final contracts and beginning the work of enrolling millions of Californians in the following 13 health plans: Alameda Alliance for Health, Anthem Blue Cross of California, Blue Shield of California, Chinese Community Health Plan, Contra Costa Health Services, Health Net, Kaiser Permanente, L.A. Care Health Plan, Molina Healthcare, Sharp HealthCare, Valley Health Plan, Ventura County Health Care Plan and Western Health Advantage
Covered California is charged with creating a new insurance marketplace in which individuals and small businesses can get access to health insurance. 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 (to be announced in June) and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits.
The governor and Legislature appointed a five-member board to oversee Covered California.
Covered California coverage levels
|Metal level||Paid by health plan||Paid by consumer|
The seven health insurance plans Covered California will make available in Riverside and San Bernardino counties
- Anthem Health Maintenance Organization
- Anthem Preferred Provider Organization
- Blue Shield PPO
- Health Net HMO
- Health Net PPO
- Kaiser Permanente HMO
- Molina Healthcare HMO