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Posted by on Sep 10, 2013 in California | 0 comments

California will see narrow network options in health insurance marketplace

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What is the online health insurance marketplace in California?

After the enactment of the healthcare reform law, California was the first state in the nation to pass legislation creating a health benefit exchange. The California Health Benefit Exchange is responsible for ensuring that Californians have access to affordable, high quality care. The official state health insurance marketplace is Covered California; this is the website consumers will use to determine if they are eligible for health programs like Medi-Cal (California’s Medicaid health care program), compare health insurance options, apply for federal subsidies, and enroll in coverage.

Will assistance will be available to help find coverage?

Consumers will be able to receive assistance as they work through the process of finding health insurance from Navigators, Certified Application Counselors, and Agents and Brokers.

Navigators will help consumers enroll in coverage through the online marketplace, including aiding in electronic and paper application preparation in order to establish eligibility and enroll in coverage and helping consumers find out if they qualify for federal financial assistance. They will also provide education and outreach efforts to raise awareness about the online Marketplace.

Certified Application Counselors will also help educate consumers and aid in the application process.

Agents and Brokers will help consumers apply for tax credits and cost-sharing reductions, compare plans, and enroll in coverage.

The Centers for Medicare & Medicaid Services, CMS, offers more details about the types of assistance available on their website.

In a Covered California Board Meeting on August 22, 2013; it was established that California’s Navigator Program will be delayed. The Navigator program in California will not be ready to serve consumers until June 2014, in time for the 2014 open enrollment period. For now, the state will rely on approximately 16,000 certified application counselors and 9,000 to 15,000 certified insurance agents.

What has California done to ensure consumers have a variety of health insurance options?

California requires carriers to offer at least one choice at each of the four metal levels, regardless of whether or not they participate in the exchange.

Products offered within the exchange must also be offered outside of the exchange marketplace, with the exception of catastrophic plans, which will only be available through the exchange.

Will coverage and premiums be the same statewide?

Health insurance companies are not required to offer coverage statewide; in fact, many companies in California will only be offering coverage in a limited area.

California is broken up into 19 geographic rating areas, which are used to help determine insurance premiums. Insurance companies can charge different premiums in each of the 19 regions. Here is a look at how the rating areas break down:

AREA COUNTIES
1 Alpine, Del Norte, Siskiyou, Modoc, Lassen, Shasta, Trinity, Humboldt, Tehama, Plumas, Nevada, Sierra, Mendocino, Lake, Butte, Glenn, Sutter, Yuba, Colusa, Amador, Calaveras, Tuolumne
2 Napa, Sonoma, Solano, Marin
3 Sacramento, Placer, El Dorado, Yolo
4 San Francisco
5 Contra Costa
6 Alameda
7 Santa Clara
8 San Mateo
9 Santa Cruz, Monterey, San Benito
10 San Joaquin, Stanislaus, Merced, Mariposa, Tulare
11 Fresno, Kings, Madera
12 San Luis Obispo, Ventura, Santa Barbara
13 Mono, Inyo, Imperial
14 Kern
15 Los Angeles (partial) (east) ZIP: 906, 907, 908, 910, 911, 912, 915, 917, 918, 935
16 Los Angeles (partial) (west) ZIP: 900, 902, 903, 904, 905, 913, 914, 916, 923, 928, 932
17 San Bernardino, Riverside
18 Orange
19 San Diego

CA_Rating_Areas

What will the health care options available through Covered California look like?

On August 7, 2013, Covered California announced that insurance companies had signed contracts to participate in the health benefit exchange, including twelve companies that will offer individual medical coverage, with five of those companies offering plans through SHOP as well. Five companies also have intentions to participate in the exchange by providing individual pediatric or children’s dental coverage.

Alameda Alliance for Health will be offering individual HMO plans in region six at the platinum, gold, silver, and bronze, as well as the catastrophic levels for qualified individuals.

Anthem Blue Cross of California initially applied to participate in both the individual and small group marketplaces. In June of 2013, Insurance Commissioner Dave Jones recommended Covered California exclude Anthem from participating in the Small Business Health Options Program Exchange. On July 22, 2013, Anthem withdrew from the small group exchange; choosing to offer plans only in the individual marketplace.

Anthem will be offering plans statewide; though not all plans will be offered in all regions. DirectAccess individual products will use the PPO Select and EPO Tiered networks. Plans will be offered at the platinum, gold, silver, bronze, and catastrophic metal levels Guided Access individual products will use the HMO Select network and will be offered at the platinum, gold, and silver metal levels.

Anthem will also be offering individual dental DPPO plans statewide through the online marketplace.

Contra Costa Health Plan will be offering individual HMO plans in region 5 at the platinum, gold, silver, bronze, and catastrophic metal levels.

Local Initiative Health Authority for Los Angeles County, dba L.A. Care Health Plan will be offering individual HMO standard plans at the platinum, gold, silver, bronze, and catastrophic metal levels in regions 15 and 16, which make up Los Angeles. Health insurance products will be using a new, narrower network, developed from the company’s current Medi-Cal network.

Molina Healthcare will be offering individual coverage in regions 15, 16, 17, and 19. Molina Marketplace HMO plans will be offered at the platinum, gold, silver, bronze, and catastrophic metal levels. Molina products will be using a narrowed subset of the Medi-Cal network.

Valley Health Plan will offer individual HMO plans in region 7 at the platinum, gold, silver, bronze, and catastrophic metal levels.

California Physician’s Service, dba Blue Shield of California (Blue Shield) will be offering individual PPO and EPO plans at the platinum, gold, silver, bronze, and catastrophic metal levels. The EPO products will be available in only regions 1, 2, 6, 9 with the PPO option available in all other regions of the state. Blue Shield will be using a narrower network to help reduce costs and offer lower priced premiums. Small group PPO and HMO plans will also be available statewide. Blue Shield of California will also have individual DHMO and DPPO products available statewide.

Chinese Community Health Plan will offer standard individual and small group HMO plans in regions 4 and 8 at the platinum, gold, silver, and bronze metal levels, as well as a catastrophic options for qualified individuals.

Health Net will offer Individual PPO products in regions 2, 4, 5, 7, 8, 9, 10, 14, 15, 16, 17, 18, and 19 at the platinum, gold, silver, bronze, and catastrophic metal levels. Individual Community Care HMO plans will be offered in regions 15, 16, 17, 18, and 19 at the platinum, gold, and silver metal levels. These HMO plans will use a new tailored-network built around local providers. Small group standard PPO plans will be offered statewide at the platinum, gold, silver, and bronze metal levels.

Kaiser Permanente will be offering individual and small group HMO plans. Individual plans will be available statewide, except for region 9, at the platinum, gold, silver, bronze, and catastrophic metal levels. Small group plans will be available statewide.

Sharp Health Plan will have individual and small group plans available only in region 19. Exchange plans use four networks; from most narrow to most broad they are Premier, Performance, Gold Value, and Blue Choice. Individual plans using the Premier Network will be available at the platinum, gold, silver, bronze, and catastrophic metal levels.  Individual plans using the Performance Network will be available at the platinum, gold, and silver metal levels. Small group plans will use all four networks and be offered at the platinum, gold, silver, and bronze metal levels.

Western Health Advantage will be offering individual and small group HMO plans in regions 2 and 3. Advantage individual products will be offered at the platinum, gold, silver, bronze, and catastrophic metal levels. Capital small group products will be offered at the platinum, gold, silver, and bronze metal levels.

Delta Dental of California will offer individual DHMO and DPPO dental products statewide.

LIBERTY Dental Plan will offer individual DHMO and DEPO dental products statewide.

Premier Access Dental will offer individual DHMO and DPPO products statewide.

Ventura County Health Care Plan, was initially going to participate in the online health insurance marketplace in California; however, the company has chosen not to participate in 2014.

 

New information is being released every day. Follow this blog to receive updates as new information is released in California.

Jillian Carlile
Research Analyst & Health Exchange know-it-all
Strenuus
jcarlile@strenuus.com

About Strenuus

Strenuus® is the industry leader in delivering network competitive intelligence services. We are the largest collector of managed care data in the country. With a singular focus on the managed care industry, we provide services to support payors, brokers, consultants and healthcare IT companies. Whether you represent employer-based coverage, Medicare, Medicaid, dental, work comp or specialty networks, we have the data and insights you need.

Learn more at www.strenuus.com.

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  1. Narrow Network Plans: lower premiums for less provider choice | Strenuus Insights - […] will trade provider choice and access for lower premiums, especially the young and healthy. California will see many narrow network…

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