PPO and EPO plans generally have a larger network of hospitals and medical groups. They will include popular providers such as Cedars Sinai, Hoag, Providence, Sutter, and UC hospitals and medical group. The members of PPO and EPO plans can travel great distances to see their favorite specialist.
Health Insurance Rates
Posts related to the rates or premiums charged by health insurance companies for their health plans.
Comparison of how community rated and attained age rated Medicare Supplement plans differ and discount to make them competitive.
Where households realize a dramatic increase in Blue Shield PPO Covered California premiums is when the SLCSP has a small increase or negative rate change. Consumers in regions 2, 3, 4, 6, 7, 15, 16 and 18, where the SLCSP rate increases were in the low single digits will see a smaller subsidy. In other words, the Blue Shield PPO plan rate increases in those areas was greater than the SLCSP that the subsidy is based upon. The subsidy did not keep pace with the Blue Shield PPO rate increase like they did in regions 1 and 10.
Covered California has taken some of the guesswork out of selecting a plan by allowing only standard benefit design health plans on the market place exchange. First, all plans must cover the same health care services from routine office visits, maternity, to mental health services. You will not find plans that are lower cost because they do not cover maternity or cap the benefits for cancer treatment.
Of course, if the annual premium for the second lowest cost Silver plan increases more than the other plans, it increases the subsidy for all consumers. In this example, the consumer would see monthly premiums for most plans below the 2022 levels. However, the second lowest cost Silver plan would have no increase from 2022 to 2023, even with the larger annual unsubsidized premium increase.
It is doubtful that in California individuals who remain unvaccinated would be slapped with a surcharge to cover the risk of future medical claims associated with treating a Covid-19 infection. That is not the way California approaches health insurance rates. However, the health plans can increase rates in regions that have demonstrated elevated health care costs and reasonably predict the higher cost trend to continue because of unvaccinated adults.
The ceremonial announcement of health insurance rate changes, usually a modest increase, is meant for the consumption of politicians, elected officials, regulators, special interest groups, and the media. You know, all those people who have group health insurance and are not subject to the vagaries of the ACA subsidy calculation. The reality of what most consumers pay for their health insurance through Covered California is far more complicated than a celebratory press briefing announcing a 1.8 weighted average percent increase.
The 56-year-old San Mateo County resident purchased health insurance through Covered California in 2020 and 2021. The estimated income was $45,000. In 2020, after the Covered California subsidy, the individual paid $109.98 per month for the Kaiser Silver 70 plan. In 2021, the Kaiser Silver plan jumped to $285.71, a 160 percent increase over the prior year.
The big unknown is how you will use health care services in the next year. If you historically visit a doctor for the occasional sports injury, allergies, or to have wax removed from your ears, even if you visit the doctor more than 3 times (the Bronze 60 limit), you may still be money ahead with the Bronze plan.
Therefore, I request that all health insurance and specialized health insurance companies provide their policyholders with a partial premium refund no later than December 31, 2020. These refunds should be reflected in the November or December 2020 premium statements sent to policyholder or certificate holders, if refunds have not already been issued.