California Health Care

Find latest news, legislation and regulations related to the California health care system. Medical coverage services in the golden state are offered through the following options:

  • Covered California: The Health Exchange Marketplace
  • Insurance Carriers: providing off-exchange medical benefits
  • Veterans Administration (VA) Health Care Coverage
  • Medi-Cal
  • Prison Health Care for California

Health care in California has gone through radical changes since the passage of the Patient Protection Affordable Care Act (PPACA) in 2010 and the implementation of Health Care Reform in 2013. Obamacare plans in California are sold through the state health insurance exchange, Covered California.

Individuals, families and businesses can enroll on a health care plan through Covered California, through Medi-Cal, through a health insurance broker, or by contacting a health insurance carrier directly. Popular carriers offering health insurance in California include Anthem Blue Cross, Blue Shield of California, Kaiser Permanente, Health Net, Molina and United Healthcare. For rates and benefits, click California Health Insurance Quotes. Open Enrollment 2017 is from November 1, 2016 to January 31, 2017. Outside of that window, you may apply during the Special Enrollment Period as long as you have a qualifying life event.

Government agencies that regulate health care in California include the California Department of Insurance, the California Department of Health Care Services, the Department of Managed Health Care (DMHC) and Ombudsman. The DMHC and Ombudsman offer protections and legal assistance for the consumers of health care in California.

 

by Wendy Barnett

Covered California Silver Plan’s May Receive a Rate Increase for 2018

Be on the watch for Covered California announcements in October or November 2017 regarding rate changes on the Silver Plans, or more specifically the “cost-sharing-reduction (CSR) surcharge.” Covered California already announced their proposed rates for 2018 which will have a weighted average increase of 12.5%. However, in addition to this rate increase, there may be a surcharge on all Silver Plans. This has to do with whether or not the federal government will make an annual commitment to funding CSR plans as was done since the Affordable Care Act (ACA) was passed. (more...)

Posted: September 29th, 2017 under Covered California Insurance

by John Hansen

Anthem’s EPO Gives Blue Shield the Winning Edge

Blue Shield of CA Maintains the PPO and thus the Image of Being the Carrier Who Offers “Choice”

What’s an EPO? That was the big question for many consumers during the 2017 Open Enrollment Period in California. It made consumers uneasy, and it caused many to switch from Anthem Blue Cross Covered California to Blue Shield Covered California.

Anthem Dropped Out-of-Network Coverage

Yes, there is a difference. Anthem stopped offering out-of-network coverage. And, for many Californian’s who want choice, they felt they would be limited by this.

Whether you go with Anthem or Blue Shield, it most often makes the most sense to stay in network. Your out-of-pocket costs remain so much lower when you stay in-network.

Anthem was losing money on their out-of-network coverage offered by their PPO’s so they made a gutsy move to switch all their individual and family plans over to EPO’s and stop offering out-of-network coverage. But they may have made a mistake. (more...)

Posted: August 18th, 2017 under Anthem Blue Cross California , Health Plans in California

by John Hansen

How to Solve the Problem of Rising Insurance Rates

The Affordable Care Act (ACA) was intended to be just that…affordable. However, many are arguing that Obamacare has really just caused rates to rise. For some who are receiving the benefits of expanded Medicaid or large subsidies through the exchanges, health insurance has become attainable and/or has become more affordable. However, for many Americans prices went up.

How can we make health insurance premiums more affordable in the United States?

Here are a few possible solutions:

  • Put more people on ACO/HMO Managed Care Plans
  • Repeal the Affordable Care Act
  • Allow Health Plans to deny for pre-existing conditions
  • Get rid of Minimum Essential Benefits
  • Move more people onto Major Medical Plans

(more...)

Posted: August 11th, 2017 under Covered California Insurance

by John Hansen

Sick People Affecting Covered CA Risk Pool

The Question of Health Care Centers around Risk Management and Maintaining Healthy Pools of Members

If people didn’t get sick, health care would be cheap, but it would also be unnecessary. As legislators are trying to deal with the issues surrounding health care in America, one of the key issues is how to deal with the incredibly high costs of servicing people with serious health conditions.

This is the primary concern of health insurance carriers. They need a healthy pool of members in order to stay in the black. (more...)

Posted: August 4th, 2017 under Covered California Insurance

by John HansenCost Sharing Reduction on the Chopping Block

If consumers have are under 200% of the Federal Poverty Level (FPL), they qualify for Cost Sharing Reduction (CSR), which means better benefits at the same cost if you enroll on a Silver Plan through Covered California, the California Health Exchange. However, these benefits are being threatened by Republican leaders in Washington DC as they consider the future of health care in America.

If CSR payments from the federal government are stopped, that would mean a decrease of $400-$600 million from Washington coming to California insurers. Top leaders at Blue Shield of California say that this alone could lead to a rate increase of 5%-10%.

Covered California Executive Director, Peter Lee, warned the GOP in Washington that cutting off Cost Sharing Reduction could lead to rate increases of 25%-40%. (more...)

Posted: July 26th, 2017 under Covered California Insurance