Finally, some folks are considering just enrolling in Medi-Cal because they are eligible. They have very little or no income to report on their taxes because they are living off of savings, interest, and dividends. Here again, Medi-Cal would be used as a containment strategy to an unexpected accident or illness. Medi-Cal is typically a HMO plan which requires a Primary Care Physician to make referrals to specialists, order tests, or imaging.
A review of health insurance rates in Northern and Southern California shows rates for young adults will increase between 30% to over 40%. Instead of the 6% to 16% increase in rates for adults only, families could experience a 20% increase in health insurance rates in 2018.
What has not been explained was if the increased Silver plan rates were based on existing Silver plan enrollments or projected enrollments. For those individuals and families who receive very little or no APTC the off-exchange Silver 70 plans will be 8.3% to 27% less expensive. People will naturally enroll in off-exchange Silver plans to save money. There will also be people who downgrade their plans from Silver to Bronze to save money, or, enroll in a Gold or Platinum plan for more benefits at an equal or lower cost of a Silver plan through Covered California. Either way, people will exit Covered California Silver plans in 2018. And since only the Covered California Silver plans have the increased rates, will that generate enough money to subsidize those people left in the enhanced Silver plans?
The Petersen has plans with lower deductible amounts than IHC. Petersen also has an optional hazardous sports or activities rider. Optional Hazardous Sports or Activities Rider – Hazardous Sports or Activities are the following list of activities which are considered to be more than a standard risk. This optional rider will provide up to $250,000 for eligible expenses incurred by participation in the following:
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.
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.
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.
For years I have been at odds over how the San Juan Water District (SJWD) set their daily and metered rates for water in the Granite Bay area. Finally, SJWD is proposing a five-year rate structure that addresses the long term capital improvement needs of the district. The unfortunate 8% and 9% increase in the rates is a reflection of past Board decisions not to implement a stable rate structure for future maintenance, operations, and system upgrades.
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.
The one aspect of health insurance that the Affordable Care Act did not address is the cost of health care services. Without a governor on the prices that doctors and hospitals can charge, the health insurance companies must constantly increase their rates to cover the cost of health care expenses that seem to rise faster than the national average for inflation. One way to reign in the ever increasing costs of health care is by providing consumer information on the cost of health care services through price transparency. The Health Care Transparency Project has started an online petition to request the Trump administration implement price transparency for consumers.