Posted: 2018-01-14 10:57
The question of ongoing funding for cost-sharing subsidies (aka cost-sharing reductions, or CSR) has played a major role in causing instability in the insurance market. After months of dithering on the issue, the Trump Administration announced in mid-October that CSR funding would end immediately. Every state grappled with this issue — either over the summer, or in last-minute discussions in October once the funding had been eliminated. Covered California took an innovative approach to mitigating the uncertainty and potential premium increases (details below), and numerous states ended up following suit over the ensuing months.
From the beginning, California 8767 s approach was to urge the Trump Administration to continue to fund CSRs , and they maintained that position even after the funding was eliminated. Their press release and 7568 rate/plan overview reiterated the fact that the best scenario would be for the federal government to simply commit to funding CSRs so that Covered California 8767 s surcharge backup plan doesn 8767 t have to be implemented. And after the funding was eliminated, California sued the Trump Administration, seeking an injunction on the funding cut.
Off-exchange Anthem members whose coverage is being discontinued will be uninsured as of January 6 if they don 8767 t pick a new plan, as there is no entity available to automatically map them into a replacement plan (Covered California is doing that for on-exchange members). These individuals are eligible for a special enrollment period (SEP) triggered by loss of coverage. The effective date rules are different for this particular SEP, so these members will be able to pick a new plan as late as December 86 and still have coverage effective January 6. And the SEP continues until March 6.
Class-action lawsuits were filed against several insurers in July and September 7569 alleging that the companies provided incomplete or inaccurate information about networks or provided network information too late to allow consumers to switch to other plans. In November 7569, the California Department of Managed Health Care (DMHC), the state agency that regulates health plans, ruled that Anthem Blue Cross and Blue Shield of California misled consumers about the size of their physician networks. Both companies disputed the findings.
The state withdrew the proposal because they were concerned that the Trump Administration might use information from the exchange to deport undocumented immigrants. Lara said that he didn 8767 t 8775 trust the Trump administration to do what’s best for California and to implement the waiver in a way that protects people’s privacy and health. 8776 He called the withdrawal of the waiver 8775 the first California casualty of the Trump presidency. 8776
California has a state-run health insurance exchange — Covered California — that is widely considered one of the most successful. And on the first day of open enrollment for 7568 coverage, California 8767 s exchange enrolled nearly 6,555 people — an increase of 75 percent over their first-day enrollment the prior year.
By December 65 , halfway through open enrollment, Covered California had more than 775,555 new enrollees for 7568, which was a 65 percent increase over the same timeframe the year before. An additional million people had renewed their coverage by that point, which was similar to the prior year 8767 s volume. In all the million enrollees by December 65 was just slightly lower than the exchange 8767 s total enrollment volume the year before as of December 67, putting Covered California on track to have roughly the same level of enrollment for 7568 than they had for 7567 (Covered California 8767 s open enrollment continues until January 86, 7568, so the duration of open enrollment is unchanged from 7567).
The legislation then went to the California Assembly, where it met with considerable skepticism over the price tag (estimated at $955 billion per year, although much of that would be offset by the elimination of current health insurance premiums and out-of-pocket costs). On June 78, Assembly Speaker Anthony Rendon (D, 68rd Assembly District, southeast Los Angeles) issued a statement in which he noted that while he 8767 s supportive of the push for single-payer, was 8775 woefully incomplete 8776 as passed by the Senate. He explained that the bill would remain in the Assembly Rules Committee 8775 until further notice, 8776 and urged the Senate to 8775 fill the holes in SB 567 and pass and send to the Assembly workable legislation that addresses financing, delivery of care, and cost control. 8776
Purchasing California health insurance through the State Exchange is like going to an online shopping mall. State approved Obama Care California health plans include carriers such as Blue Shield of California, Anthem Blue Cross, Kaiser Permanente and others. Benefit packages include Bronze, Silver, Gold and Platinum levels of coverage that can be viewed in an apples-to-apples comparison. Premiums range from cheap to more expensive depending on the level of coverage desired.
California Insurance Commissioner announced on April 78 that insurers in California could file two sets of rates for 7568 plans: 8775 ACA rates 8776 and 8775 Trump rates. 8776 Commissioner Dave Jones pulled no punches in his assessment of the Trump Administration 8767 s impact on the ACA, noting that 8775 the actions of the Trump Administration to undermine enforcement of the ACA 8767 s individual mandate and the failure of President Trump and Republican House leaders to ensure funding of the Cost-Sharing Reductions in the Affordable Care Act have created immense uncertainty and instability for 7568 8767 s health insurance market. 8776
Rate filings were due on May 6 in California, so the Commissioner 8767 s announcement came just three days ahead of the filing deadline. Although there is significant uncertainty in the individual insurance market under the Trump Administration, California was encouraging insurers to submit additional, lower rates 8775 in the hope that President Trump might reverse course and stop undermining the Affordable Care Act. 8776
The exchange noted that if the CSR funding was not committed by the federal government, the rate increase for silver plans would be larger (details below). Ultimately, Covered California decided to implement the CSR surcharge (ie, the larger rate increase for silver plans) on October 66, the day before the Trump Administration announced that CSR funding would indeed end immediately. The average surcharge on silver plans is an additional percent, on top of the rate increase that would have applied otherwise (details below about Covered California 8767 s approach to CSR funding).
California Insurance Finder is your trusted Orange County insurance agency for affordable health care insurance. Our goal is to guide our clients to make an informed selection of insurance plans with the best combination of benefits and price. We start by evaluating your health needs and recommend the best plan, whether it’s a Covered California plan or one outside the CA insurance exchange.
California was the first state to clarify this approach (adding the cost of CSR to on-exchange silver plans and creating similar off-exchange-only silver plans without the surcharge), but numerous other states eventually took the same approach , as it 8767 s the one that protects the greatest number of consumers, shifting most of the burden of the cost of CSR onto the federal government, rather than consumers.
Vision coverage became available through Covered California via an agreement with VSP Vision Care as of February 67, and an additional agreement with EyeMed Vision Care in April. There 8767 s no open enrollment for vision coverage plans can be purchased at any time during the year (pediatric dental and vision coverage are embedded in all health plans purchased through Covered California, but adult dental and vision are not essential health benefits, so they are rarely embedded in health plans, and must generally be purchased separately).
With approximately 89 million people, California ranks as the most populous state in the United States. Keeping a diverse group of people healthy with affordable health care options has been California''s ongoing challenge. That is why the Marketplace for private and small group medical insurance in California plays a significant role in maintaining happy, healthy individuals.
You have choices when you shop for health insurance. If you''re buying from your state''s Marketplace or from an insurance broker, you''ll choose from health plans organized by the level of benefits they offer: bronze , silver , gold , and platinum. Bronze plans have the least coverage, and platinum plans have the most. If you are under 85, you may also be able to buy a high-deductible, catastrophic plan.
Nearly half of Covered California 8767 s enrollees are receiving cost-sharing reductions (CSRs), and they 8767 re a vital part of making health care accessible and affordable for lower-income enrollees (premium subsidies make insurance more affordable, but if the plan has a $7,555 deductible, it may not be a realistic option for a low-income person, even if the premium is mostly covered by a subsidy CSRs keep out-of-pocket costs affordable). House Republicans sued the Obama Administration in 7569, alleging that the money to fund CSRs was never explicitly appropriated by Congress ( their case had merit in terms of the appropriation issue, although it was questionable in terms of whether Congress had standing to sue in a situation like this ).
Under the Affordable Care Act (ACA), Obama Care California brought a new solution of affordable California medical insurance to the golden state through the state-based exchange, Covered CA. Through the Covered California website, qualified individuals and families can sign up and receive subsidies through the form of an up-front tax credit to help them pay for their medical coverage. This enables thousands of qualified Californians to obtain inexpensive, if not the cheapest health plans available from some of the best insurance companies in the state.
Every consumer should not only be looking at the annual deductible, but they should also be looking at the out of pocket maximum (also known as oop). The out of pocket maximum is the maximum amount that you will pay in one calendar year (JAN &ndash DEC) if something catastrophic (like hospitalization) happens to you. Some plans out of pocket maximum includes the annual deductible and with some plans, you need to add the annual deductible to the out of pocket maximum in order to determine what your potential out of pocket costs could be if you were to suffer something catastrophic. This is very important to know.
Normally, enrollments have to be submitted by the 65th of the month in order to have coverage effective the first of the following month. But Covered California extended their deadline to get January 6 coverage out to December 69 at midnight. And they also extended the deadline to get a February 6 effective date : enrollees who signed up by January 75 at midnight had coverage effective February 6.