Yesterday marked the official start of Covered CA open enrollment, which will run through January 31, 2016. For coverage effective January 1, people must enroll by December 31, 2015. As always, Medi-Cal enrollment is open year-round and individuals experiencing any life transitions (losing a job or moving, among many qualifying events for Special Enrollment) may enroll anytime, even after January 31, 2016.
For health care advocates and other consumer groups, it’s worth clicking around the much improved Covered CA website to explore the various tools available to maximize enrollment and target those eligible but not yet enrolled. Here are a few highlights:
- The Shop and Compare Tool is more useful than ever—showing options for plans by county with estimates of consumer out-of-pocket spending for each along with summary information about plan quality.
- A Preview Plans tool helps applicants pick the right plan based on what is important to them, for example how often they think they will visit the doctor or how many prescription drugs they will need. Once you input your personal information and preferences, you will see the plan options with links to provider directories for each plan. Those shopping for a better plan are encouraged to visit their plan’s website to look up whether their preferred provider is still in network. Knowing that timely access and network adequacy are works in progress, Health Access encourages consumer advocates and navigators to check out these tools with an eye on their accuracy as policy improvements are made.
- Find Local Help: Folks can get free help with the enrollment process by phone (and the many languages spoken at the call center) or from a navigator or certified application counselor in their area. This is important because we know that the remaining uninsured and long-term uninsured will likely need more help with information and guidance in picking a plan and understanding the value and details of health insurance. The navigators and enrollment assisters are specifically trained to help these consumers sort through these important issues.
- All Covered CA pages are translated in Spanish and other threshold languages. See these links at the top right of each page.
- Pay first month’s premium online to “close the deal.” After going through the application process and selecting the right plan, it’s nice to be able to finish the process by paying the first month’s premium online. More insurers than ever are making this possible this year. This “effectuates” (fancy talk for making it real) enrollment, setting the on-boarding process in motion.
- Using your plan: This year Covered CA is rightly focusing on helping consumers make the most of their health insurance to live healthier lives. Tools and information to make the most of your plan.
Framing the Opportunity and the Message for Open Enrollment 2015-16
- Subsidies are available to make coverage affordable! In terms of messaging, we want to echo and elaborate on Covered CA’s own emphasis on publicizing the availability of subsidies—not just for the premiums but also or cost sharing assistance. Recent surveys show that people actually know more about the tax penalty for not having coverage, than about the tax subsidies available to help families afford coverage in the first place. Organizations should use the open enrollment period to educate Californians about the many positive benefits that are available to low- and moderate-income families. To this end, Health Access would welcome stories illustrating how the subsidies have helped individual consumers afford and keep coverage or how this coverage has helped them take charge of their health and enjoy financial security and peace of mind.
- Coverage is not an end in itself, but a tool for keeping healthy or managing any chronic conditions. Getting enrolled is a critical first step—but that is only the beginning. Across the nation, insurance marketplaces are rightly focusing on how consumers can best use their coverage to stay well.
In this vein, it crucial to know your rights and the importance of using complaint processes (among other examples) for situations where the promise of what coverage is supposed to deliver falls short. Here are a few examples:
- Is the drug formulary (list of approved drugs in a given plan) restrictive or does it place specialty drugs on the highest cost tiers of the plan? A few months back Covered CA effectively barred this practice—but for some consumers the out-of-pocket expenses for high cost medications may still be too high. We want to hear about these situations so that we can continue adjusting the policy as needed.
- Is the provider directory accurate? With passage of SB 137 (E. Hernandez) Accurate Provider Directories in the 2015 legislative session, these expectations will be higher. But it will take time to fully implement this new law. In the meantime, Health Access wants details about any difficulties with provider directories (share a story here).
- To appeal enrollment determinations, Covered CA has a complaint page. And for complaints against Covered CA itself (nobody’s perfect), people should complete the Covered CA complaint form.
The Bottom Line On Covered CA Open Enrollment
Covered California continues to offer four transformative benefits to consumers:
- No denials for pre-existing conditions
- Financial help to better afford coverage and limit out-of-pocket obligations
- Standardizing benefits for easy comparison and security in coverage
- The bargaining power of a big group rather than an individual all alone at the mercy of the market. As an “active purchaser” exchange, California has been able to keep premiums low from one year to the next.
And there are more reasons to make the most of Covered CA open enrollment 2015-2016. By the most recent census, California showed the fifth-largest drop in the percentage of uninsured–but our state is still above average in our uninsured rate. Despite the significant progress made, we need this third open enrollment period to bring more Californians the benefit of coverage—starting with financial security and timely access to care.VIEW THE FILE Insurers