Both DMHC and CDI make their rate review process as transparent as possible to the public. This is not the case for Covered California. The reason Covered California gets to negotiate rates in secret is because the health plans are considered contractors and the rates are considered bids. I learned this after I filed a Public Records Act request asking for the rates submitted to Covered California.
Since the beginning of health care reform under President Obama there has been intense speculation about how the health insurance companies will react when setting rates for the various health plans they offer. Health insurance is not a commodity like wheat, oil, or pork bellies where the market place of buyers and sellers agree upon a price. While competition does impact the rates to a certain degree, health insurance prices are largely determined by the health care services to be covered, the cost of health care services, and the expected claims for those services within a geographical location where the plan is being offered.
I would not have believed it had I not witnessed it with my own eyes. When I renewed the Covered California health plan for a client her monthly premium amount she will be responsible for will actually be lower in 2017. Even though the carrier had an overall rate increase and she was another year older, the Advance Premium Tax Credit monthly subsidy calculated by Covered California will be larger in 2017. The net result is she will be paying less than $5 per month for the same Silver health plan in 2017.
Many Californians have realized that when they report a change to their Covered California accounts during the year they are hit with higher health insurance premiums. This occurs when the change reported is after a consumer’s birthday. Any change within the Covered California CalHEERS online enrollment program automatically triggers the application for health insurance to be resubmitted for an eligibility determination. The new eligibility is calculated as of the individual’s age at the time of the reported change.
Whenever a health insurance company or health plan wants to change their health insurance rates in California they must submit a justification for the rate change in the monthly premium amounts to the Department of Managed Health Care or Department of Insurance. Regardless of which agency they must submit their rates to, the agencies just […]
California Department of Insurance Commission Dave Jones excoriated Aetna in a news release on December 18th over Aetna’s planned small group premium increases but he was noticeably silent when Health Net submitted a similar rate increase for individuals and families. The average increase for the 2015 Health Net IFP PPO plans is 10.8% while the Aetna small group […]
Children’s dental insurance options have now been added to the line of plans being offered through California’s health insurance exchange Covered California. Part of the ten Essential Health Benefits that must be offered through the new health insurance exchanges or Marketplaces is pediatric dental. The state exchanges can meet this requirement in various ways and Covered California has opted to offer stand alone plans.
While the filed rate increases of Anthem Blue Cross may be unreasonable that hardly justifies their being banned from the Covered California small employer group program. There is also the prospect that Anthem Blue Cross might be forecasting a sharp drop in membership of their small group plans as small businesses abandon the plans or employees leave to purchase subsidized health insurance through Covered California.
This latest premium increase must have created a greater exodus of members than they had anticipated.