One of the BIG DEAL changes to health insurance that starts 1/1/14 is that health insurance companies need to accept everyone — regardless of health history or status — and they cannot charge differently based on health status. This means that many who have been denied coverage or priced out of coverage will now have guaranteed coverage. It also means that the millions who have employer-based coverage (which is not changed) now know that they will be able to get coverage in the future if they leave their job.
On the cost-sharing levels:
A very “savvy question” — most people do not understand the difference of “metal levels” which will take effect in January 2014…starting then, ALL plans in the individual and small group market (both inside and out of the CoveredCA marketplace) must offer benefits that reflect a standard mix of what a plan pays versus what the consumer pays out of pocket. A Silver Plan means the plan pays 70% of the health cost and the consumer 30% in out-of-pocket…the richest plan (Platinum) means 90% of health costs are covered by the plan. VERY roughly the premium difference will go up about 10% for each level — but it could be different and we won’t know until final rates come in. The silver level is important for the 2.6 millions Californians who get subsidies, since the subsidy amount is based on the “second lowest” Silver Plan available to them. The consumer can then take that subsidy and buy a richer plan (and pay more of the premium) or buy a Bronze Plan and pay less. Also, lower income Californians will also get support to make their out-of-pocket costs lower.
On health costs:
The Affordable Care Act and Covered California do a range of things to help us lower health care costs. The biggest thing that CoveredCA does is that by getting everyone insured we can turn our attention to getting care delivered right — making sure consumers/patients get the right care, from the right provider in the right setting. We have huge waste now because too much care is provided in Emergency Rooms and by not investing in prevention. Covered California is building into our contracts with health plans a range of ways to promote better care. For the real wonks out there, you can go to our Exchange website (hbex.ca.gov) and look at our stakeholder page to see the draft of our contract with health plans (see the Attachments, Section 7). Take a look yourself…
Health Access California promotes quality, affordable health care for all Californians.