The first comparison was of two individuals at a Sacramento company enrolled in a Sutter small group HMO Silver plan. The rate for the 60-year-old employee is $838 and $688 for the 56-year-old employee. An IFP Silver plan directly from Sutter Health Plus HMO is $1,115 for the 60-year-old and $958 for the 56-year-old. The IFP rate is 25% and 28% higher than the small group plan at the respective ages. The lowest IFP plan available to these employees in the Sacramento region is a Kaiser Silver HMO plan at $990 for age 60 and $851 for age 56.
The value of dental insurance is questionable in the minds of many consumers. And I don’t necessarily disagree with that evaluation. However, the importance of regular dental exams, cleanings, and hygiene cannot be disputed. If dental insurance keeps a person on track with good dental hygiene and habits, they will be spared the expense of expensive dental procedures in the future.
If you have to move out of your county because of the wildfires you may be entitled to a Special Enrollment Period. California is broken into 19 different rating regions. Los Angeles County is actually two regions, 15 and 16. If you move to a different region, you have a qualifying event for a Special Enrollment Period IF you already have health insurance.
This enforcement action is a result of 21 cases involving 63 consumer grievance violations that occurred during 2014 through 2017. In these cases, L.A. Care deprived enrollees of their rights to medical care. The plan has acknowledged its failure to comply with the law, and the Department has determined that an administrative penalty and Corrective Action Plan are warranted. The corrective actions include employee training and increased oversight of the grievance and appeals system.
The Health Net PPO, not to be confused with the EnhancedCare PPO offered through Covered California, is the only plan that will give plan members access to both the Stanford doctors and hospital. These plans are only sold off-exchange or directly from Health Net. Plan enrollment is limited to certain regions and counties within California.
You can’t assume that all hospitals part of a larger network are all in-network with the same carrier if one is in-network. In Butte County, Blue Shield contracts with all the Enloe associated hospitals. But Anthem Blue Cross only contacts with Enloe Medical Center – Esplanade. The converse is also true. Blue Cross doesn’t typically contract with Sutter hospitals for their individual and family plans. However, in Amador County, Sutter Amador is an in-network hospital for Blue Cross.
The goals of Prop 8 sound good: better patient care and lower costs. Basic economic theory suggests that artificially regulating prices lower leads to shortages. We cannot force the current dialysis clinics to become nonprofit organizations. Just like large retailers close under-performing brick and mortar stores, I would expect no less from the CEO of a dialysis company to close those locations whose primary insurance payer were on the lower end of the reimbursement scale such as Medi-Cal or Medicare.
Kaiser Permanente has seen their market share increase with the Affordable Care Act. Their percentage of Covered California enrollments has steadily increased from 24% in 2015 to 33% in 2018.They have also been very stable in their plan offerings on and off exchange. Kaiser rates increased 3% – 7% in Northern California and 6% – 10% in Southern California in 2018. In 2019, the average rate increase will be 9% throughout California.
Health Net is making it easier to add adult dental and vision to their off-exchange plans. They call the added dental and vision benefits the Plus package. For the EnhancedCare PPO, PureCare EPO, and PPO plans the Plus package of dental and vision benefits is $14.42 per adult. The maximum dental benefit per year is $1,000. Instead of a member cost-sharing percentage these plans have a fee schedule. For example, a filling on one tooth would be $22.
Why should your employment dictate whether your health insurance is worse or exponentially better than your neighbors? Shouldn’t all health plans be the same? The human condition does not change depending on who you work for. The individual who works for the State of California, a union, or a self-insured plan can have the same health conditions as a self-employed individual. People routinely move from large group plans to individual and family plans and their health conditions don’t change. But the price and member cost sharing is far higher under small group and individual and family plans than it is with some of the union plans. Is that fair?