Covered California Q & A

[pahealthquotes]

Dont know if this is a re-post but some really good info here.


Covered California Q&A

this sounds juicy for those selling in Cali

Question: How big could the individual health insurance market be, say by 2016?

Answer: No one really knows exactly what the size of the California individual market is going to be, but it is certainly going to be much larger than it is today, which is about 1.5 million people. About 500,000 of those currently self-insured in the individual market will qualify for premium subsidies and move to the Exchange. About 3 million currently uninsured are expected to enroll in individual market through the Exchange. Non-Exchange individual business could add another 1 million people. So, the 2014-2015 individual insurance market in California should be about 5 million lives. Also, it remains to be seen how many employers - especially those under 50 (employees) - will decide to drop coverage and point their employees to the Exchange. California could have anywhere between 5 million and 8 million people in individual health plans by 2016.

 

[Yagents]

PA, Lots of nuggets/answers in that link you provided. It may be specific to CA, but it will have lots of crossover into other other states.

Moderators, this should be moved to the reform forum for future reference.

Others: Here are some answers to recent questions we've been discussing in other threads:

Question: In my conversation with my carrier rep, I was told that they anticipate the exchange individual plans to be more expensive than their plans outside of the exchange. Why?
Answer: That is incorrect. The Exchange is very aware that adverse selection is one of the greatest threat its success. To the extent that rules (including premiums) are different outside the Exchange versus inside, there is room for market manipulation. In fact, the ACA addresses this issue definitely. "A qualified health plan means, among other things, a plan offered by a health insurance issuer that agrees to charge the same premium rate for each qualified health plan it offers without regard to whether the plan is offered through an Exchange or whether the plan is offered directly from the issuer or through an agent. (See ACA § 1301(a)(1)(C)(iii), 42 USC §18021(a)(1)(C)(iii))



Question: Will the essential benefits package apply to plans outside the Exchange as well as inside?
Answer: The essential health benefits package is aimed at ensuring that health plans in individual and small group markets offer a minimum of coverage, both inside and outside of health benefit exchanges, scheduled to take effect in 2014. Care must be taken to ensure that identical rules apply to health insurance benefits regardless of where they are sold to avoid adverse selection. Comparable benefit packages must be offered both in or out of the Exchange, otherwise, sicker patients will gravitate toward the market where more comprehensive coverage is sold. To the extent the rules are different outside the Exchange versus inside, there is room for market manipulation. California will need to consider how strongly to link rating rules inside and outside.
Question: Will individual health insurance plans still exist outside of the exchanges?
Answer: Individual health plans will be offered outside of Covered California. Individuals who do not qualify for premium subsidies based on their income are free to purchase their health insurance coverage directly from their favorite health insurance company. However, the plans available outside the exchange will mirror those offered in the Exchange.

Question: The 2014 monthly premium used in the subsidy illustration on your website is $1,187 for a family. Can you explain why it's so high?
Answer: Yes. The "unsubsidized" premiums used in the premium subsidy illustrations are unrealistically high for California residents. Here's some reasons of the top of my head:

1. In 2010, the GSO had to predict what the "average premium" would be in 2016. It was an educated guess based on predicting the rate of medical inflation over a 6 year period. They had no hope to begin with and, as it turns out, premium inflation dropped in the last 2 years, making their prediction high.
2. The number is a 2016 projection, so in 2014, it's over-inflated by two years.
3. The number is a national-average. California health insurance rates are below the national average.

 

[AllenChicago]

California has the highest number of (uninsured?) Illegal Aliens,
Ref: Illegal Immigrants in California
and some of the highest medical costs in the country.
Ref: Which states rank highest in health care costs? - Jan Norman on Small Business : The Orange County Register

What causes California Medical Premiums to be BELOW the national average? I've always believed it to be the opposite.

BTW, thanks for providing that link to Covered California, YAgents. It has good insights into what we can expect nationwide. Sure doesn't appear to me that California is teetering on the edge of bankruptcy as Rush Limbaugh says all the time.
-ac

 

[GreenSky]

What causes California Medical Premiums to be BELOW the national average? I've always believed it to be the opposite.

It's because we all eat properly, exercise and don't freeze our fingers and toes.

Actually (and this is a WAG), we have so much managed care that the prices can be kept lower by not paying the doctors much.

Or (WAG #2), so many people are insured compared to the national average that prices are kept low.

Or - I haven't an idea but I want to bump up my post count.

Rick

 

[AllenChicago]

OK Rick.. I'll buy into those answers. Sounds as reasonable as any!

One thing I just realized that's pretty startling is that the "Cover California" website contains a huge banner across the top for visitors to get permanent, or temporary health insurance to tide them over to 2014. The agency, "California Health Benefits Advisors" sure hit pay-dirt when they worked out this arrangement with the state!
-ac

 

[Yagents]

OK Rick.. I'll buy into those answers. Sounds as reasonable as any!

One thing I just realized that's pretty startling is that the "Cover California" website contains a huge banner across the top for visitors to get permanent, or temporary health insurance to tide them over to 2014. The agency, "California Health Benefits Advisors" sure hit pay-dirt when they worked out this arrangement with the state!
-ac

They didnt. no special arrangement. Just smart mktg. They used to b top ranked for exchange search

 

[AllenChicago]

YAgents, thanks for the clarification. I wrongfully thought that it was an official State of California website constructed to explain "Cover California" to the public. Now I see that the entire site is owned/operated by the CABA company.. Looks like it links to healthcareshopper.com and Quoteit for producing health quotes.

 

[pcbinsurance]

http://www.healthexchange.ca.gov/Pages/Default.aspx

 

[insurehound]

Here's a link to the recent Anthem Exchange presentation if anyone is interested.

Event Console#

 

[pahealthquotes]

Here's a link to the recent Anthem Exchange presentation if anyone is interested.

Event Console#

thanks for posting, some very good info there