Covered California addresses 2018 open enrollment confusion

Oct. 30--The calls from Bay Area consumers worried about their 2018 Obamacare health care plans keep filling up Kelley Filice Jensen's voicemail.

"People are very confused,'' the San Jose health insurance agent said. "They want to know if their plans are being canceled, or if their coverage will go away any minute and they'll be stuck without any insurance.''

In Oakland, insurance agent Jonathan Greer also is hearing from bewildered clients, including enrollees in Obamacare plans who stand to lose their Anthem Blue Cross policies next year.

"People are calling me saying, "I need answers. What am I going to do?''' Greer said.

Their fears are understandable. The repeated, unsuccessful attempts by President Donald Trump and the Republican Congress to repeal and replace the Affordable Care Act have taken a toll. Rattled by the uncertainty, Anthem Blue Cross and other insurers have backed out of many Obamacare insurance exchanges around the country.

And adding to the turmoil, Trump earlier this month halted Obamacare "cost-sharing reduction" payments to insurers that enable about 7 million low-income Americans to reduce their out-of-pocket health costs.

But for many of the 1.4 million Californians now enrolled in Obamacare plans, the prospects of obtaining affordable health care aren't as dire. That's because Covered California -- the state's health care exchange created under the Affordable Care Act -- months ago began putting together backup plans.

Covered California's executive director, Peter Lee, goes as far as saying that the insurance marketplace for 2018 is "rock solid."

Health care experts say a chief reason behind the exchange's relative success is that it has a pool of healthier enrollees compared with the 42 states that depend on the federal Obamacare marketplace.

"It means that premiums in California are 20 percent lower than they would have been without that risk mix," Lee said.

Rates in 2018 are expected to jump 12.3 percent statewide, but consumers in most Bay Area counties will see much smaller increases -- ranging from about 4 to 8 percent -- according to data Covered California released last summer. In comparison, rates in some states are jumping more than 30 percent.

In addition, Covered California devised a nifty way to work around Trump's decision to kill the cost-sharing subsidies.

For 2018, the exchange has allowed health insurance companies to artificially inflate their popular "Silver" plan rates by 12.4 percent to cover the loss of the cost-sharing benefits.

Subsidized consumers enrolled in those moderately priced Silver plans should not be adversely impacted because their monthly subsidy -- paid by the federal government -- will increase by roughly the same amount, Lee said.

"It was mind-boggling to me that so many other state insurance commissioners were caught flat-footed when we knew eight months ago that this was a major question mark,'' Lee said.

About 40 states are now implementing work-around plans.

Lee estimates that 78 percent of the Covered California enrollees whose premiums will be affected by the surcharge will pay the same as -- or less than -- this year.

Pittsburg resident Gliceria Magat is among them.

The 56-year-old owner of a home health care business said her $145 monthly premium will drop to $140 a month.

"I'm happy about that,'' said Magat, though she admitted she was still a bit confused about the reason behind the reduction.

Meanwhile, Anthem Blue Cross in 2018 will offer Obamacare plans only in Santa Clara County, five counties in the Central Valley and 22 Northern California counties. That means about 153,000 Covered California customers who had Anthem policies in other counties need to find a new insurer.

But Lee said that 84 percent of doctors who contract with Anthem are available in other health plans offered through the exchange.

A new provider directory was created by Covered California this year to help Anthem customers like Berkeley-based real estate agent Michael Ertem, who with his wife and two children has relied on an Anthem plan for several years and wants to keep his family's current doctors.

The family should be able to do that if they select a plan with Blue Shield of California. His other option is Kaiser Permanente.

"Some of my friends are very happy with Kaiser, but I want to be able to choose our doctors," Ertem said. So his family is going with Blue Shield.

Obamacare's subsidies that often dramatically reduce insurance premiums will still be available to any legal California resident earning less than 400 percent of the federal poverty level. That translates to $98,400 for a family of four.

Lee is urging exchange enrollees with unsubsidized Silver plans -- about 65,000 of 300,000 people, who will be slammed with the 12.4 percent surcharge -- to avoid that fate by purchasing a bronze, gold or platinum plan, or even buy a Silver plan outside the exchange.

Robert Laszewski, a Virginia-based health policy expert and a frequent critic of both Lee and Obamacare, applauded Covered California's foresight.

"The states that enabled carriers to efficiently respond to the cuts did the right thing,'' said Laszewski, who has blogged that Trump's decision to end the cost-sharing reduction subsidies will, ironically, cause the rates of Americans with unsubsidized plans -- many of whom voted for Trump -- to go up even higher.

Added Laszewski: "I'm glad Peter Lee is finally paying attention to the 40 percent of the market that aren't eligible for subsidies and have had to deal with the burden of the high rates and deductibles the past four years.''

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NAVIGATING OBAMACARE

Covered California's 2018 open enrollment begins Wednesday and, unlike the Dec. 15 deadline imposed by Healthcare.gov, the federal Obamacare marketplace, California's exchange will extend the sign-up period until Jan. 31.

If you want your plan to kick in Jan. 1, you must purchase a plan by Dec. 15. For a Feb. 1 start date, you must buy a plan by Jan. 15. Any plan purchased after that date will become effective March 1.

If you don't choose a plan by mid-November, insurers will re-enroll current policyholders in their current plan. But you can change it before the end of open enrollment.

SOME TIPS FROM THE PROS

Insurance agents Kelley Filice Jensen and Jonathan Greer offer these tips:

Shop early. Don't wait until the last minute because the whole process can take longer than you think.

Check your mailbox. Your health insurance company may be sending you updates and notices that you should consider before enrolling in your plan.

Ask yourself: How much money did you spend on medical care this year? If you didn't spend a lot, you might consider a Bronze-level plan, which has the lowest premium but charges the highest out-of-pocket costs for health care.

To save money, shop and compare different plans on the exchange -- either a different metal tier or another insurer.

If you're changing plans but want to ensure you keep your doctors, call your physicians' billing offices -- not the front office -- to confirm if your new plan will be accepted.

Seek free help from certified health insurance agents or enrollment "navigators."

For more information, go to: www.coveredca.com

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