California health insurance  -      Health Exchange in California  -    Participating Carriers

List of California Carriers Participating in the Exchange Released

The information on California health reform is gaining momentum and today was the first of two very important pieces of information to be released.  We received a notification of which carriers will participate in the Health Exchange in California starting Jan 1st, 2014.  There were few surprises but the list of carriers is smaller than we expected.  Let's look at what we can expect.

Four major California carriers plus 9 Regional Players

The big four that will participate in the Individual and Family market (Group health market called SHOP will be announced next month) will be Anthem Blue Cross of California, Blue Shield of California, Kaiser, and Health Net of California.  These carriers probably make up a good 90% of the individual and family market anyway but there are some notable exclusions.  Aetna, Cigna, and United Health have announced that they will not participate in the IFP (Individual and Family plans) for the year 2014.  They publicly stated that they will wait to see how the market settles out over the initial year and then re-evaluate.  There were also smaller regional California carriers which can find on the full State announcement here.

Different Plan Types by Area

There will be 19 different geographic areas in California and more interestingly, the carriers are offering different network types (PPO, HMO, and EPO) by area.  In some cases a carrier may offer a PPO in one region but offer an EPO in another region of the State.  A quick refresher on the three.  HMO's provide richer benefits but access to providers is more regulated (primary care physician, referrals, etc).  The PPO offers more flexibility in terms of providers available and access to those providers but requires more cost sharing on behalf of the member.  The EPO (or Exclusive Provider Organization) generally uses the PPO network but does not provide benefits outside the network in non-emergency situations. 

The California health exchange also provided initial plan pricing which was the big deal.  These rates may fluctuate as the State still needs to approve them but we have both average prices and the specific rates by area for a 40 year old.   The rates confirm what we expected.  We took an example of a person who was on a grandfathered $4000 deductible plan which is very comparable to the Bronze.  The family rate for two 42 year olds (plus 2 kids) is about $850 ($288 for two 40 year old adults each plus we're estimating about $150 for each child).  They're current rate is $550 or a $300/difference.    $300 is a pretty big jump from $550.  Granted, the Grandfathered plans are better priced than some of the currently available plans (depending on which one you have...the old Share plans are pretty high) but the real important piece is whether you can apply a health subsidy to this amount.

Health Subsidy calculation shown in rate grid

If the above family makes under 400% of the Federal Poverty Level, that roughly $850 premium will come down significantly depending on what percentage of the the FPL, the family makes.  Let's say that between 250-400% of the FPL (qualifies for subsidy) will probably break even.  They will pay about the same as they did before Health Reform.  If the famly makes between 138-250% of the FPL, that family will probably pay less than they before.  If they make below 138% of the FPL, they will be eligible for free Medi-Cal.  Over 400%?   They'll pay the full $850 and that's going to be tricky.  All of a sudden, the 4 times FPL becomes very very important! 

Related Articles:

The Bronze Health Plan in California
Why the Silver Plan Matters
Expected Rate Shock for health rates in California
Penalties for not purchasing California health insurance
Subsidies to help buy California health coverage
Introduction to the California health exchange

 

You can run your California Plan Quote here to view rates and plans side by side from the major carriers...Free.

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