Don't get confused — Covered California still exists

Nov 2, 2017

As open enrollment for Covered California begins, President Trump’s recent attempts to dismantle the Affordable Care Act have caused a lot of confusion. KALW’s Health Reporter Marissa Ortega-Welch gave some pointers for navigating the chaos.

During open enrollment period for Covered California — the state’s health insurance market under the Affordable Care Act — Californians can sign up for insurance, shop and compare premiums, and make changes to their insurance plans. 

CROSSCURRENTS: Trump recently got rid of some subsidies for the Affordable Care Act (aka “Obamacare”). How does this affect Californians who get their insurance through the Covered California state exchange?

MARISSA ORTEGA-WELCH: The first thing to note: what Trump got rid of is the cost-sharing subsidies that insurers get from the feds. That’s not the same thing as tax credits.  The tax credits are NOT going away. As long as you’re still eligible for a tax credit, you’ll get it. If you buy a plan under Covered California, the tax credits are what reduces what you pay monthly out of pocket. When you go online, it shows you the total premium cost and how much you’d pay based on your income. The difference is covered by that tax credit.

Why are people concerned about Trump doing away with cost-sharing reductions, if it’s not going to affect the tax credits they get?

Cost-sharing subsidies are still helpful. If you buy your plan through Covered California, you know that there are these different tiers of coverage — bronze, silver, gold, platinum — and you might obsess over which plan you choose. The silver plan premiums are more expensive than bronze, but so far they have been the best deal, when you factor in your out-of-pocket and co-pay expenses. They have been the "best bang for your buck" and that's because they were the plans subsided by these cost-sharing reductions from the federal government. As a consumer, you may not have realized you were getting this discount, but if you had a silver plan, it’s possible you were benefiting from the cost-sharing subsidies without even knowing it. 

What will happen to premiums now that Trump repealed this cost-sharing reductions? Will they go up?  

Yes, and nationally you’re hearing a lot of states freaking out. They set their premiums for 2018 months ago, thinking they’d get these subsides, and then Trump comes around and tells them they no longer will get the subsidies and it’s chaos. Here in California, though, the state insurance exchange anticipated Trump’s move. They’ve had warning! They knew Trump could take away this federal funding, so they prepared by tacking on a surcharge to the silver plans ahead of time when they set premiums. Depending on your income, a silver plan may not be the best deal anymore. That’s why it’s really important to log into Covered California, shop around, and find the best plan for you.

Rates are also going up because they do every year — it’s just a typical annual increase. The rates will increase 12 percent on average in California and 4 to 8 percent in the Bay Area. This is due to rising medical costs, a new tax on insurers, and the uncertainty of the market this year.

Even though premium prices are going up, tax credits are going up too, so your premium might stay the same or even decrease! 

Peter Lee, the Executive Director of Covered California, said 78 percent of Covered California enrollees will either see their premiums stay the same or possibly even go down. Again, it's really important to log into Covered California, update your income and other information, and see what plan makes the most sense for you. 

How does the Bay Area compare to the rest of California and the country?

A lot of the news you hear right now about rates jumping and markets spiraling because of Trump’s actions — it’s not happening in the Bay Area. So far, from the perspective of consumers, our region and the state is faring fairly well. California is still affected by the loss of cost-sharing subsidies though. You may not feel it as a Covered California customer but it’s affecting you as a taxpayer and it’s affecting our state budget. That’s why California and 17 other states sued the Trump administration over cost-sharing subsidies. Their argument is that this jeopardizes families’ access to healthcare and undermines state budgets.

We’ve also heard in the news that a lot of insurance companies are pulling out of this market because it’s so unstable. Is that happening here?

Anthem Blue Cross is pulling its Covered California plans in a lot of counties. They say the federal changes make the insurance market unstable, and therefore unprofitable for them to do business in many parts of the state. In the Bay Area, Anthem is only offering a Covered California plan in Santa Clara County this year. This does not affect people who have Anthem Blue Cross through their employer or people who are on Medi-Cal or Medicare.

For Anthem Blue Cross customers, you will need to log in and shop around for a new plan. If you’re worried that switching plans means you’ll have to switch doctors, there is a new “provider directory” on the Covered California website that helps you locate which plans include your current doctor. There is also a new state law signed into effect this year that allows you to stay with your insurance provider if you are seriously ill and in the middle of treatment.

We’ve also heard in the news that the open enrollment period will be shorter this year than in previous years.

Yes, sort of, but don’t get confused! The open enrollment for the federal Obamacare marketplace ends on December 15th but the Covered California enrollment period opened November 1st and will stay open until January 31st. If you already have Covered California, your current plan will automatically renew unless you choose a new plan. Your plan might get renewed at a higher cost but you might be eligible for a cheaper plan. That is why it’s important to login, shop around, and find the best plan for you.

You want to be sure and update your income and other information, compare plans, and see what you’re eligible for. Also, check your mailbox! You might be receiving a letter from Covered California updating you about your plan and premiums.

You can enroll, update your information, and get help at coveredca.com or by calling 1-800-300-1506

Let KALW’s Health Reporter Marissa Ortega-Welch know if your premium is going up or down. Email her at health@kalw.org.