Covered California Offers More Choices, Slight Hike In Premiums

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Ventura County residents buying health insurance in the Covered California marketplace will have more choices but could pay slightly more in premiums while also facing, in some instances, rising out-of-pocket costs.

Since Covered California started selling insurance in late 2013, only three insurance plans sold coverage through the marketplace in Ventura County, triggering concerns about lack of choice.

A fourth insurer, UnitedHealthcare, will offer coverage in the county for 2016, Covered California officials announced last week. The company will compete with Anthem, Blue Shield and in most of the county, except for Ojai and an area east of the Santa Barbara County line, Kaiser Permanente.

"That's a very good thing," said Cynthia Gabriela Aguilar, a Santa Paula insurance agent, noting that the market was dominated by Blue Shield and Anthem. "We need more competition."

At the end of open enrollment this year, 67,000 people in Ventura, Santa Barbara and San Luis Obispo counties were covered with plans purchased through Covered California. The exchange offers subsidies to people who meet income standards and was created through the Affordable Care Act.

Preliminary pricing figures for 2016 show that premiums in plans sold through Covered California in the three counties will increase a weighted average of 4.4 percent. That's slightly higher than the statewide average increase of about 4 percent.

The lowest-priced bronze plan in Santa Barbara, San Luis Obispo and Ventura counties could jump nearly 7 percent in premiums, according to estimates. The lowest-priced sliver plan could fall almost 4 percent.

A 40-year-old single person in the three counties who makes $23,450 a year and qualifies for subsidies would likely pay an average of $45 in monthly premiums in the lowest-tiered, or bronze, plan, in 2016. He or she would pay $114 for a silver plan.

If the person didn't qualify for a subsidy, he or she could pay an average of $280 for a bronze plan and $349 for a silver plan.

About 52 percent of the people in Covered California plans in Ventura, Santa Barbara and San Luis Obispo counties are covered through Anthem.

If they stay in the plans, they could pay a weighted average of 9 percent more in 2016 than in the current year, according to the preliminary estimates.

Blue Shield covers about 37 percent of the Covered California clients in the three counties.

People who stay in the plans could see their premiums drop in price an average of 2.4 percent.

People who stay in Kaiser plans bought in Covered California could see weighted increases of 5.5 percent.

The 40-year-old making $23,450 and receiving subsidies would pay the lowest premiums in Blue Shield plans at $89 a month, followed by Kaiser at $124.

Anthem and United would charge $142 a month.

Though premiums will rise on average, Covered California officials said people who pick the lowest-priced plan in a particular tier may be able to save money over their current premiums.

Some observers note a 4.4 percent increase is relatively small in the world of health insurance.

"You're certainly happier than the regions that go up 8 or 9 percent," said Beth Capell of the Health Access California advocacy group. "You're not as happy as Los Angeles and Riverside/ San Bernardino."

In northeast Los Angeles County, premiums could decrease an average of 0.2 percent in 2016, according to Covered California. In San Bernardino and Riverside counties premiums could increase an average of 1 percent.

The premium price doesn't tell the whole story, said Carmen Balber, executive director of the Consumer Watchdog advocacy group. Deductibles in bronze-level plans will increase to $6,000 for an individual in 2016, up $1,000, she said.
Some co-pays increase as well.

Out-of-pocket prices could also be pushed by limited networks of doctors insome plans, she said.

"At the end of the day, the sticker price is not the bottom line for the consumer," she said.

Covered California officials note the shop-and-compare calculator that allows people to estimate the price of plans should be available for 2016 plans Monday.
Covered California enrollment for 2016 coverage begins Nov. 1 and continues to Jan. 31.

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