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Now that the core benefits are standardized by the ACA law, it really comes down to pricing and carrier.
For example, a Bronze plan is a Bronze plan regardless of carrier so how do we then compare the carriers?
We'll give you the ground rules and carrier basics here but we created an entire article on what see day in and day out when dealing with the carriers.
This is the type of information you REALLY need.
You can find that full comparison here but let's get the broad strokes so we know what choices we have.
Carriers Participating in Covered Ca for Individuals and Family
Group Health Exchange (SHOP)
1. Pricing drives decisions now.
In fact, as medical costs have skyrocketed over the past decade, cost is now the driving factor and it's only going to get worse.
This has led to a wholesale moves down the benefit scale to offset rate increases and the carrier which dominates this price point, will be our focus.
2. Large HMO and PPO networks of doctors and hospitals.
The networks of the different major California carriers are similar but not exact.
90% of the doctors and hospitals will be similar from carrier to carrier but there will be differences and ultimately, what really matters is that your doctor and hospital participate.
It's hard to choose a carrier and plan for an entire company up front but you can request doctor/hospital choices from your family members or company employees to check against the provider online search for the plan that meets item #1 above.
Again, most likely, any of the major carriers will address most of their needs.
3. Plan and benefit flexibility.
We want it all.
We want the option to choose from lots of plans be it HMO, PPO, HSA, and we want to be able to offer all these plans to our family members and/or employees.
That's all we want!
The good news is that we can have that now.
Most of the major carriers offer an ability to do this now and they have dozens of plans available from catastrophic plans to very rich HMO and PPO options with little cost sharing.
4. We want our interaction with a carrier to be easy.
You're busy either running a family or a company.
The last thing you need is chasing around claims or membership issues.
As your licensed broker, we can help you with these issues but we can attest to the definite need to deal with a California carrier who is easy to deal with. From dealing with them all on a daily basis, there are definitely differences on this front.
5. Rate stability going forward.
Premiums on the California health insurance market just keeps climbing.
Although we can switch health plans annually, it's never pleasant so ideally, we want a carrier that is stable in terms of pricing.
This is function of plan design, financial strength, management, and of course pricing strategy.
Anthem is one of the strongest, nationwide carriers...probably in the top three.
1. Plan Pricing - their pricing is generally in the top 1-2 carriers for the California health market.
2. Network - Anthem has one of the largest PPO networks in the State and the allow participation in the Blue Card network for family members or employees in other States.
3. Flexibility - They were the first to offer a true cafeteria-like flexibility called Employee Elect where you could offer all their plans (or almost all) to each employee. They extended this to their dental options as well. On the individual side, they consistently bring out new plans on the PPO and HSA side.
4. Ease of Use - Traditionally they have been the easiest to deal with. They were the first to bring out online applications, the ability to email membership requests, and credit card for initial month premiums. Online tools are available on the Group side to streamline changes, additions, and questions.
5. Pricing Stability - Their increases have been low to middle depending on the market segment with HMO's being less competitive than PPO and HSA plans.
Blue Shield of California a very strong carrier in California which has become even more aggressive on the market in the recent few years. Blue Shield is one of the few non-profits on the market and it has always been an advocate of consumers in the market. Blue Shield offers a good PPO comparison to Anthem and Health Net and it is very competitive on the market currently.
1. Plan Pricing - they are consistently priced in the top 1-3 for comparable plans.
2. Network - For PPO plans, they compare well with Anthem in most counties. They do allow access to the Blue Card network for employees or dependents in other States. Their HMO is comparable to Cross but neither is thought to be the strongest carrier for HMO plans.
3. Flexibility - They offer plans in the HMO, PPO, HSA, and HRA segments across individual and group with multiple deductibles, copays, and price points.
4. Ease of Use - This is where Blue Shield has made so much progress. Over the last few years, Blue Shield has made great gains in terms of how easy they are to deal with on a day to day basis. It's been a huge improvement.
5. Pricing Stability - Their pricing is extremely competitive on the Small Group market. On the individual side, their newer plans are priced higher but are richer in benefits.
Health Net of California was originally Blue Cross' HMO many years ago.
Traditionally, they were a strong HMO carrier but they have aggressively moved into the PPO market as the future of HMO's and its cost structure dimmed. Health Net has become very strong on Small Group market and they have come out with a very aggressively priced individual family market.
1. Plan Pricing - Today, Health Net's individual plans are probably the lowest priced on the market. Their group plan pricing tends to be in the top 1-3 on the market with a strong HMO pricing model.
2. Network - Health Net has a strong HMO network as that has been their bread and butter long before the PPO came along for them. The PPO network is solid although likely smaller than Anthem or Shield with their focus on PPO.
3. Flexibility - Health Net allows a cafeteria type Small Group offering where you can offer many plans to carriers. On the indvidual market, they have narrow range of plans but they are priced very well.
4. Ease of Use - Health Net tends to be pretty reasonable both in terms of enrollment (underwriting) and membership. They have catched up with Cross and Shield in terms of online capabilities and systems.
5. Pricing Stability - The group pricing has been relatively stable and we have new individual plans that are the lowest on the market.
Kaiser of California is likely the largest carrier in the State. It's very different from the other carriers in that the doctors/hospitals belong to the carrier. You must stay within their network in most cases.
1. Plan Pricing - Kaiser has always been hard to beat in terms of pricing and that will likely continue.
2. Network - This is what literally makes Kaiser a separate model of health care altogether. Kaiser employs the doctors and owns the hospitals. You must stay within the Kaiser network for most situations. The availability of Kaiser really depends on where you live. On average, they will have more facilities in denser areas and less in rural area. There are areas where there is no Kaiser network.
3. Flexibility - Kaiser has tried to expand their plan options albeit within their facility network. Kaiser offers some pro's in terms of flexibility such as electronic records and facilitated processing but poses other concerns such as greater medical service management.
4. Ease of Use - This is another facet of the Kaiser model which is very different. In general, the day to day with Kaiser can be pretty nice...kind of like a one stop shop. Where we hear negatively from our clients is if you have a more serious situation or want a wider breadth (say a specialist) of providers. Kaiser is pretty solid when it comes to information technology and the general administration with such things as electronic records. Of course, there can be a significant amount of "management" when it comes to medical services but that's inherent in any HMO.
5. Pricing Stability - Pricing has always been advantage with Kaiser and if pricing is your only concern and HMO is fine...Kaiser will be hard to beat.
We focused on Anthem Blue Cross, Blue Shield of California, Health Net of California, and Kaiser since they are some of the strongest California health insurance carriers.
There are many other options on the market, but from our experience, they usually are not advisable against one of the above mentioned four. Many large California carriers have opted out of the Exchange on the IFP market (Aetna, United, and others).
Call 800-320-6269 to go over any questions you may have on the carriers in the State.
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