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The Metallic Plans Are Coming To California

Quick tips on the Anthem Blue Cross of California Clear Protection PPO Plan
Clear Protection Plans in California New Metallic Plans will be available Jan 1st with 4 levels (plus one catastrophic) detail below
Anthem Blue Cross Clear Protection 3300 Basis for plan is the Kaiser $30 no-deductible plan
Clear Protection 3300
Most non-grandfathered plans will be rolled onto one of 4 Metallic plans Jan 1st, 2014
Clear Protection 3300 Subsidies will dictate who buys in or out of Exchange for Metallic plans (detail below)


We're starting to gear up for the big Jan 1st 2014 transition to health reform plans on the California health insurance market.  We now have guidance on the baseline plan for which all individual and small group health insurance plans will be based on in California.  Let's look at what benefits we might see and how to get the best deal with options going forward.

Bring on the Metallic Plans

The health reform statute stated that there should be 4 metallic plans (platinum, gold, silver, and bronze) based on a given benefit level.  California based their metallic plans on the Kaiser $30 copay group HMO health plan which is pretty rich.  It has no deductible, unlimited $30 copays, generic and brand RX to name a few key points.  The Platinum must then be 90% of the actuarial value of the Kaiser HMO $30.  Okay, that just sounds like insurance jargon so what does it really mean?

Actuarial Value means what?

It's a tricky concept and not an exact science.  Think of it this way, if the Kaiser $30 benefits is the absolute best, the Platinum option should be about 90% of it.  That's not getting us much closer to understanding and in all honesty, each carrier will have slightly different takes on what this looks like.  Is it s $250 deductible?  Maybe higher deductible but lower percentage after (called coinsurance)?  We'll see soon enough.  The carriers are supposed to have their plans available mid-year 2013 since people can enroll October 1st for a Jan 1 effective date.  The Gold has an 80% actuarial value; Silver 70%; and Bronze 60%.  There's also a less-rich plan for young adults to help keep the rates down for them. 

The new Bronze Age of California health insurance

The bronze is really the plan to concentrate on.  Let's walk through how this will probably go down.  California health insurance will be guaranteed issue starting Jan 1st which means you cannot be declined due to health.  If you purchase in the exchange and make under 400% of the poverty level, you will receive a credit against your health plan selection along a sliding scale (at 133%, you'll get quite a bit more than at 400%).  The rates will likely increase quite a bit from where we are now due to the guaranteed issue result, adverse selection, mandates, etc so most healthy people will take the lowest priced plan available (bronze) and in all honesty, we're almost there now.   Any rebate will be partially offset by increasing rates overall so the same "lowest hanging fruit" shopping will happen especially for people who do not have coverage now.  Who would take the Platinum?  Someone with really big health issues since they want the richer coverage.  This will drive the cost of platinum (and to lesser extend gold and silver) up at a faster clip.  Unless you're getting 100% rebate, everyone will slowly be pushed to the Bronze plan. 

What will the likely health plan look like?

California just released the final version of Health Exchange plan benefits so we do not need to guess any longer.   Again, we should know around summertime 2013.  Maternity is covered on all plans effective July 1st, 2012.  Most likely, all plans will cover generic and brand RX as opposed to some plans that now cover generics only.  The max out of pocket might be $2K higher than the deductible which actually is equivalent to mid-level plans currently on the market.  We were concerned that the bronze would be too rich and therefore, too expensive but we would expect the above estimate to range 20-30% higher than current equivalent plans based on other health reform changes.  Next article, we'll tackle everything we know about the health insurance premium subsidies (based on income) which figures prominently in to the cost equation for people making 133% to 400% of poverty. 



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