Kevin Knauss: Health, History, Travel, Insurance
Posts related to the Covered California application, consumer account, estimating income, household size, monthly subsidies, health plans, Medi-Cal, and terminations.
If Bribes are a legitimate source of income for Medi-Cal why not for Covered California I thought? When I checked the 2016 Covered California Countable Sources of Income table, Bribes was suspiciously missing from the list. Why is Covered California hiding this significant source of income for many politicians from their consumers?
If you review the 2018 Covered California rate booklet, which doesn’t actually have any rates in it, you notice that many of the carriers are having modest rate increases. Most of the rate increases are around 10% or less. Some carriers such as Blue Shield, Health Net, and Oscar are dropping rates in some regions. What jumped out at me was Molina which was identified as having rate increases at a minimum of 16% and up to 51% in the regions they offer health plans.
If a consumer was in a market where the only choices were Blue Cross and Blue Shield, and Blue Cross was the SLCSP (Blue Shield necessarily being the least expensive Silver plan offered) then these consumers may see their relative tax credit subsidy decrease. This will hold true if the Blue Shield plan, and now the only plan available, continues to have a rate lower than what Blue Cross would have had in 2018.
After sifting through all the reports and data, I’m not sure if either agency is accurately reporting voter registration inquiries through Covered California. While the online registration numbers look comparable between the Secretary of State and Covered California, it is unclear if the data is a measurement of a click to open an online registration web page or an actual complete voter registration action. The voter registration card requests from Covered California seem wildly inflated compared to what the counties are reporting to the Secretary of State. However the Secretary of States figures may also be corrupt by potentially erroneously high requests posted by San Bernardino County and the lack of requests from huge counties such as Los Angeles.
If you reside in any of the above counties you will be able to keep your EPO plan. If you reside in any other county, and you have an Anthem Blue Cross EPO or HMO plan, through Covered California or off-exchange, you will need to select a new insurance carrier for 2018. The exit of Blue Cross from the individual and family market does not affect employer group health insurance plans or their Medicare Advantage plans.
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.
One of the first changes consumers and agents will notice is under the information for household members. For the question of Sex (which should be gender), in addition to Male and Female, the drop down box will include Transgender: Male to Female and Transgender: Female to Male. While selecting the Sex is required, the Covered California application does not alert the consumer to the fact that rates are not based on gender AND you cannot be denied health insurance or receive a higher rate because you are transgender.
But how does an enrolled individual in a standard Silver 70 plan, who is not eligible for the CSRs, feel about subsidizing lower income plan members? Could the argument be made that some individuals are paying an inflated premium, close to a Gold plan, but only receiving Silver plan level benefits? At a very minimum, the inflated Silver plan rates are a distortion of the health insurance market place. One of the goals of the ACA and the exchanges like Covered California was to bring more transparency and accountability to the health plan selection process for consumers. If the inflated Silver plan rates, along with artificially inflated subsidies, do become a reality, the market place for health insurance will take a step backwards as plan selection becomes more confusing for consumers.
In a certain sense, Covered California is no different than any other agent trying to enroll consumers and earn a monthly commission. I suppose there are other industries that must spend 1/3 of their forecasted revenue on marketing just to maintain their sales, but the percentage seems excessive on the face of it. You have to wonder how sustainable a business model is if spending 33% of the budget on marketing is necessary for survival. It also raises the question of if the exchange based model is the most efficient means of qualifying consumers for the Premium Tax Credit and distributing the subsidy.
A review of 50 randomly selected terminated Covered California agents, as of May 12, 2017, showed 36 agent licenses were still authorized to transact insurance through the California exchange when reviewed through a DOI license search. 10 of the agents showed no authorization for Covered California. 3 agents were listed as Inactive and 1 had their licensed revoked. Of the fifty agents, 5 resided outside of California; 4 from Florida and 1 from Arizona.
