Increased access, glitch fix help health insurance customers in California [The Press-Enterprise]

Unexpected illness and exorbitant medical bills are behind a stunning number of U.S. bankruptcies — from 40% to more than 66%, researchers have found — and that’s an electric prod some are using to encourage folks to buy health insurance for the great unknowns of 2023.

Flu, RSV, new variations on COVID-19 … without health insurance, fixing a broken leg can cost some $7,500, a torn rotator cuff clocks in at more than $50,000, and cancer care can cost many, many times that, Covered California says.

Covered California’s 10th annual open enrollment period begins Tuesday, Nov. 1, for coverage that will take effect with the new year. With the economy slowing down, inflation and interest rates rising, subsidies still available for many folks who need them and penalties looming for folks who don’t get coverage, many say the time is nigh.

“I was in my early 20s, a college student, young and invincible, and I didn’t have health insurance,” said Jezabel Yrbina, strategy and services director with L.A. Care Health Plan. “People that age think they’ll never get sick. But lo and behold, I had appendicitis — and was hospitalized for three days.”

It cost thousands of dollars. She recovered from the appendicitis much more quickly than her finances recovered from the unexpected hit.

Covered California aims to help folks avoid that sort of thing. It’s where Californians can find affordable coverage from private, brand-name insurers. Folks who qualify can also get financial help to reduce monthly premiums and, depending on income, can qualify for California’s low-cost or no-cost Medi-Cal program.

Some 1.7 million Californians get health insurance through Covered California, including some 500,000 in Los Angeles County, 160,000 in Orange County and 163,000 in Riverside and San Bernardino counties, according to data. Hundreds of thousands more are expected to be eligible.

A few things are new and notable this year: The problematic “family glitch” is being mended; the state’s public health emergency ends on Feb. 28, which might boot some folks off Medi-Cal; federal subsidies will keep rolling through 2025; and, surprise, rates are going up some 6%.

Covered California calculated a median-level “bronze” premium for 2023 that’s slated to be $276 a month in Los Angeles County, $287 in Orange County and $277 in Riverside and San Bernardino counties.

Covered California has selected 13 health and five dental insurance companies to offer coverage during 2023, including Kaiser Permanente, Anthem Blue Cross, Blue Shield of California, Aetna/CVS Health and L.A. Care Health Plan.

There’s competition in the ranks. Kaiser proudly points out that it received the highest rating in the state, 5 stars, for overall quality by Covered California for each of the last four years. L.A. Care Health Plan touts itself as the largest publicly operated health plan in the nation, and the only public plan on the California exchange. Its L.A. Care Covered product has some of the most affordable rates in Los Angeles County and nearly half of its members have premiums as low as $0 per month, thanks to federal subsidies. About 93% of L.A. Care Covered members qualify for a subsidy of some sort, officials said.

Thousands of workers who are offered insurance through their workplaces stand to gain from the “family glitch” changes. That’s when workers can afford to buy their own employer-based health coverage, but can’t afford to add their family members — family members who were ineligible for financial help through the Affordable Care Act. The fix means some 400,000 Californians should be able to take advantage of open enrollment through California’s marketplace.

And more middle-class folks will be eligible for premium subsidies this coming year, Urbina said.

The pandemic made health insurance a matter of unique urgency, and 2021’s American Rescue Plan Act expanded premium subsidies through the end of 2022. The recently passed Inflation Reduction Act ensures that those subsidies continue without interruption for another three years, through 2025, according to the Kaiser Family Foundation.

A recent Kaiser Family Foundation analysis found that the average premium for a “silver” health plan — a step up from the aforementioned “bronze” — was $456 a month nationwide. California’s average was less, at $432, ranking it 33rd out of 51 states and territories, where 1 is the worst (Vermont, $841) and No. 51 is best (New Hampshire, $323).

Covered California is a child of the federal Affordable Care Act, or Obamacare, where states were allowed to create their own health insurance exchanges. Folks must enroll in and maintain minimum essential coverage or face penalties when they file state income taxes.

A recent audit of Covered California urges immediate action on eligibility determinations, which pose “significant risk of not only non-compliance with federal regulations, but the use of public funds for subsidies provided to ineligible consumers.” Officials say they’re working on it.

Consumer data shows that, for insured individuals, insurance picks up 90 to 95 percent of the bill for emergency care and hospitalizations, Covered California says in its why-buy materials. “No one plans to get into a car accident when they drive to the supermarket, but life happens. Just like you protect your vehicle with car insurance, it’s important to protect yourself with health insurance.”

Open enrollment closes at the end of January.

Updated 9.50 a.m. 11/1 with correct spelling on Yrbina, which was incorrect due to inaccurate information provided to SCNG