‘A huge blessing’: Covered California is removing residents’ barriers to health care [The Sacramento Bee]

Elk Grove resident Carol Dyer used to pay $853 a month in premiums for her health insurance and a co-pay of $80 each time she visited her primary care doctor.

When she signed up for 2024 coverage with Covered California, however, her agent told her that her monthly premium would be $168. She expects her primary care co-pays to be $5 a visit.

“I kind of feel guilty because it’s so affordable,” Dyer said. “It’s crazy.”

Two-thirds of Covered California enrollees — nearly 1.1 million people — qualify for comprehensive health plans with premiums of $10 or less each month.

Cost should never be a barrier to accessing health care, particularly primary care, Covered California Executive Director Jessica Altman said. That’s why state leaders have opted to focus on reducing deductibles, co-pays and other out-of-pocket expenses.

“Studies show that lowering out of pocket costs increases utilization of critical health care services like primary care visits, screenings, and adherence to medications for chronic conditions like diabetes,” Altman said, “and it has reduced the need for potentially avoidable specialty care and ER visits.”

By the end of last year more than 90% of Covered California enrollees — 1.57 million state residents — had renewed their policies for 2024. There was an 18% jump in enrollment of Californians who hadn’t gotten their health insurance through the state-based marketplace last year, which Covered California officials say was the biggest gain in new policyholders in four years.

“The robust enrollment we have seen so far highlights how much Californians value affordable health care coverage,” Altman said. “California has strived to make health insurance more affordable for more people, and it is vital for the remaining uninsured in the state to look into their options.”

The open enrollment period ends Jan. 31, and those who sign up this month will be able to use their policies on Feb. 1.

A series of unfortunate accidents

Dyer, a cosmetologist, initially switched to a Covered California health plan during the COVID-19 pandemic. Her skin care business was deemed non-essential, meaning she couldn’t open for business during the mandatory stay-home order.

If Dyer had let her health insurance lapse because of this financial setback, she said, she would now be saddled with tens of thousands of dollars in medical debt.

In both 2021 and 2023, she suffered life-altering injuries. Ironically, they occurred while Dyer was doing some low-impact exercising to improve her health.

“I am a walker, and I was walking an alternate path because the path that I normally walk ... had construction,” Dyer said. “I tripped on an uneven sidewalk and I shattered my humerus, and it’s not humorous, not at all.”

After an emergency room visit, shoulder replacement surgery and physical therapy, Dyer still has not recovered full range of motion in that left arm. That injury occurred in October 2021.

Then, in February 2023, Dyer was taking a gentle boot-camp class at a senior center. She was walking past a row of chairs, holding a large exercise ball that obstructed her view. Dyer tripped over her instructor who was seated and broke her right arm when she landed.

“I didn’t realize how disabled my left arm ... was until I broke my right arm,” Dyer said. “I had an ambulance ride, and I had to go to the hospital and emergency. So again, those bills, if I hadn’t had the insurance I have, I probably would have had to take a loan out for those.”

Ensuring protection ahead of mishap

Covered California leaders have stressed time and again that no one can predict when they’ll need health insurance, and Dyer’s accidents show that serious injuries can occur even as people go about the routine aspects of daily life.

The UCLA Center for Health Policy Research estimates that there are 1.3 million Californians who are uninsured but qualify for subsidies with Covered California or would be eligible for Medi-Cal.

Quality affordable health insurance plays a critical role in improving the overall health and well-being of families and communities, Altman said. Consumers can get a premium quote on Covered California’s online home page, coveredca.com.

Altman said the state agency is offering more financial help during this open enrollment period than before. In addition to federal financial assistance, the Covered California board negotiated deals with insurers that have slashed out-of-pocket expenses for hundreds of thousands of Californians.

Deductibles have been eliminated, co-pays cut and generic drug prices dropped for households earning up to 250% of the federal poverty level.

If you are single and earn $33,975 or less, you would qualify, the agency said, and so would families of four if their household income does not exceed $69,375. These added savings apply to cost-sharing plans in Covered California’s popular silver tier.

There are four metal tiers — platinum, gold, silver and bronze — and as the value of the metals increase, so does the consumer share of costs. Health plans cover 90% at the platinum level, 80% at gold, 70% at silver and 60% at bronze. The policy holder covers the remainder of costs in each tier.

By eliminating some of those out-of-pocket costs, Altman said in an interview last year with The Bee, the Covered California board hopes to remove expenses that keep many low- and middle-income Californians from actually accessing the care they are paying to receive.

Dyer said she doesn’t know what she would have done without her Covered California plan: “It’s such a huge blessing.”