American Indians and Native Alaskans have access to special $0 cost share health plans that are available through Covered California. A recent enrollment by a member of a federally recognized Indian tribe was offered four different Anthem Blue Cross PPO $0 cost share plan where each one had a different premium rate. This is odd since regardless of the metal tier level of the $0 cost share American Indian-Native Alaskan (AI-NA) health plan, they all have the same exact benefits: zero dollar cost share for all services.
American Indian – Native Alaskan health plan confusion
The danger of the misleading premium rate information on the Covered California website is that a consumer enrolling in the Gold $0 cost share AI-NA would be paying more per month for a health plan with the exact same benefits as someone who chose the Bronze $0 cost share AI-NA plan. A call to Anthem Blue Cross confirmed that they only recommend consumers eligible for the AI-NA $0 cost plan only select the Bronze plan.
AI-AN $0 cost share health plans
A call to a Covered California service center representative elicited no additional information as to why the Anthem Blue Cross PPO AI-NA $0 cost plans would be priced according to a metal tier level when all the benefits were the same. Technically, the AI-AN $0 cost share plans offered by several different insurance companies don’t belong to any metal tier level. (A metal tier level Bronze 60, Silver 70, Gold 80, Platinum 90 where the number indicates the actuarial value of the health plan. A Bronze 60 plan is estimated to cover 60% of the average member’s health care costs for the year.)
Covered California health plan illustrations limited
Covered California doesn’t have a way to display or illustrate the unique nature of the AI-NA $0 cost share plans. If anything, they need Diamond plan category since members of these plans will have 100% of their health care expenses covered when using in-network providers. Instead of the $0 cost share plans being displayed as at least Platinum, Covered California has categorized them as Bronze or Silver plans. In the one instance I worked with in region 18, Orange County, only the Anthem Blue Cross PPO AI-AN $0 cost share plans were replicated in the Bronze, Silver, Gold and Platinum categories, each with a successfully higher premium rate. Screen shots of the Blue Cross metal tier AI-NA $0 cost share plan premiums and benefits below.
Different premiums for Anthem Blue Cross AI-NA PPO plans
There can be difference between the health plans as carriers offer different plan types such as PPO, HMO, HSP, and EPO. But the plan type illustrates the type of provider network, not the benefits of the health plan. For the Anthem Blue Cross PPO AI-NA $0 cost share plans they all use the Pathway X provider network just like their other California individual and family plans. While I couldn’t find a rate sheet specifically for the Anthem Blue Cross AI-AN $0 cost share plans, other carriers list just one premium rate by age for the AI-NA $0 cost share plan they offered. The conclusion is that either Anthem Blue Cross supplied erroneous rates for different non-existent $0 cost share metal tier levels to Covered California, or someone put in the wrong rates into the Covered California database for these plans.
Peter Lee, Executive Director of Covered California, wrote about this very sort of confusion in a letter to Secretary Burwell of the Department of Health and Human Services (HHS) this past December. Mr. Lee was commenting on proposed federal regulations for Web Based Entities (WBE), internet based websites that enroll consumers in health plans qualified for the premium assistance.
Covered California believes that having clear standards and expectations of WBEs’ choice architecture is of critical importance to ensuring consumers are well served. In the absence of clear standards, consumers may experience confusing displays of health plan options, make less optimal plan and product choices, be routed to off-exchange products, or not get appropriate in-person support when it is needed. Having poor or confusing plan choice display runs the risk of resulting in smaller enrollment and a worse risk pool. – CoverdCa_comments_9937-P_WBE_DirectEnrollment12-21-15.pdf
The confusing consumer information of the Anthem Blue Cross PPO AI-NA plans on the Covered California website is similar to what Mr. Lee was alluding to by the WBEs, Covered California seems to have committed. The Covered California illustration of various metal tier AI-AN $0 cost share plans with different premiums, yet with exactly the same benefits, is the ultimate in a consumer confusion scenario. The larger point is that attempting to consolidate all the health insurance plans and premiums for consumer comparison and analysis is a difficult task. I just hope that no one eligible for the $0 cost share AI-AN health plan enrolled in an Anthem Blue Cross Platinum version through Covered California because they are truly wasting their money.
|Date:||January 28, 2016|