Covered California Premiums Projected To Rise 15.8 Percent In County

Published on

In an increase that a watchdog contends could push people to drop health insurance, next year's premiums in the Covered California marketplace are expected to rise an average of 15.8 percent in Ventura County.

The weighted rate increase, which also affects Santa Barbara and San Luis Obispo counties, rises above the projected average hike of 13.2 percent across the statewide exchange. It ranks as the third largest increase among 19 Covered California pricing regions.

Covered California is the exchange created by the Affordable Care Act to provide coverage, often with government subsidies, to people who were once uninsured.

About 67,000 people in Ventura, Santa Barbara and San Luis Obispo counties are covered in plans purchased through the exchange.

Open enrollment for 2017, the exchange's fourth year of operation, begins Nov. 1. The projected double-digit increase statewide dwarfs the about 4 percent average rate increase experienced each of the last two years.

Exchange officials blame the statewide weighted rate increase in part on the rising price of specialty drugs, expiring provisions in the Affordable Care Act designed to minimize rate increases and high care costs attributed to people who enroll in insurance after they become sick.

The projected increase is steeper in the pricing region that encompasses Ventura, Santa Barbara and San Luis Obispo counties because there appears to be less medical competition, said Covered California spokesman James Scullary.

"Generally speaking health care has traditionally been more expensive in this region and one reason is that there are not as many hospitals and providers," he said. "This has always been a challenge."

Three insurers are set to sell 2017 plans in the region: Anthem, Blue Shield and Kaiser Permanente. Anthem's PPO premiums are projected to rise a weighted average of 13.8 percent. Blue Shield's PPO premiums are expected to rise an average of 20 percent.

Kaiser Permanente's HMO premiums are expected to increase an average of 5.5 percent.

But people can avoid much of the 15.8 percent average increase by considering all their options in Covered California and possibly switching to a different plan in the exchange, Scullary said.

Consumers who purchase the lowest-price silver plan are expected to pay only about 1 percent more than people paying premiums in the lowest-priced plan this year.

"Shopping is more important this year than ever before," he said, also citing Blue Shield's plan to introduce a relatively inexpensive HMO in parts of Ventura County.

About 90 percent of the people in the Central Coast region receive financial assistance. That aid is expected to increase, helping offset rising premiums, Scullary said.

But the premium increase is likely to have jarring impact, said Carmen Balber, executive director of Consumer Watchdog. She noted that people who change plans may have to switch to different doctors.

"I don't think the option of just shopping around is an option that is going to make consumers … feel any better," she said, suggesting some people may reject all of the plans.

"I think any time we're talking about double digit rate increase some consumers are going to drop out," she said.

Balber said the rising premiums in the Central Coast could be linked to the lack of competition not only among hospitals but also insurers.

"The only options in the region are Anthem, Blue Shield and Kaiser," she said. "That reduces competition."

According to Covered California, 89 percent of the people in the exchange in Ventura, Santa Barbara and San Luis Obispo counties are covered by Anthem or Blue Shield. A fourth insurer, UnitedHealthcare, has announced its plans to drop out of the market at year's end.

Representatives for Blue Shield said their pharmacy costs in Covered California and the rate at which people used insurance was higher than expected.

Provisions in the Affordable Care Act that provided payments to help insurers offset some costs and losses are expiring. The lost money forced Blue Shield to raise its rates nearly 5 percent, said spokeswoman Mia Campitelli.

The impact of the higher premiums will become more clear when open enrollment begins.

"I'm going to be interested to see what happens. I think cost is always an issue," said Catherine Pedrosa, a United Way of Ventura County employee and an outreach education specialist for Covered California. "Some folks don't have a choice. They are in need of health care."

About Tom Kisken

Tom Kisken is a health care and general assignment reporter.

Latest Videos

Latest Releases

In The News

Latest Report

Support Consumer Watchdog

Subscribe to our newsletter

To be updated with all the latest news, press releases and special reports.

More Releases