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Top Insurance Companies

by John Hansen

California has 11 major health insurance carriers. But the top health insurance companies in California for the past three to four years have been Anthem Blue Cross, Blue Shield, Oscar and Kaiser Permanente. In 2015 and the previous year, Anthem Blue Cross had the highest number of enrollments in the annual open enrollment program through Covered California.

In 2016, Blue Shield took over the top spot from Anthem. This was largely due to the expansion of their coverage to various parts of the state. Oscar and Kaiser Permanente also increased their membership. Here are details about the top health insurance companies California residents prefer.

How Blue Shield Beat Anthem Blue Cross in 2016 Open Enrollment

Anthem and Blue Shield have been strong competitors in the health insurance market in California, striving to outdo each other for network expansion and rates. In 2015, Blue Shield worked hard to expand its network while offering competitive prices. By 2016, their efforts paid off as they turned out to be the number-one California health insurance carrier for the 2016 open enrollment.

Major Reasons for Blue Shield’s Success

  • Network Expansion: When an insurance carrier has a larger network in a region, that area tends to do well. Most times, people ask their doctors about the health plans they accept. Then, they choose insurance coverage based on the type of health plan their doctor will accept. So, in most areas where Blue Shield is available, doctors recommended them to their patients.
  • Effective Negotiation: Most of the leading health insurers need to negotiate with medical networks for pricing. This means they may need to raise their rates in order to satisfy the requirements of the doctors in the network. But Blue Shield knew this and was able to negotiate for wider network coverage at fair rates.
  • Maintaining Low Rates: Maintaining competitive rates and covering a wide area can be a daunting task for smaller health insurance companies. In fact, doctors that work with smaller networks often offer lower rates. But, if you need to switch to a specialist doctor, you may need to opt for a health plan with a major carrier. Blue Shield was able to offer networks with specialist doctors at fair rates that’ll also be affordable to many consumers.

Who’ll Be the Top California Health Insurer in the Years to Come?

The rivalry between Anthem and Blue Shield is likely to continue. As they expand their networks, they’ll get into negotiations with top medical service providers and networks to reduce the rates for medical services. In any county where an insurance company is more successful at doing this, they’ll take the lion’s share of the market.

In many cases, medical service provider networks will only partner with one of the top California health insurance companies. They do this to avoid allowing the companies to compete for the same network, which could end up causing insurance rates to drop, reducing the amount of money medical networks can make.

Medical networks like to sign a contract with just one health plan because it allows them to remain in control. They will only partner with the company that offers them the greatest amount of money for the medical services they’re providing.

Kaiser Permanente Gets Set to Be the Leading Health Plan

While Anthem and Blue Shield are competing for the top spot on the health insurers chart in California, they need to be aware that other companies are catching up as well. Kaiser Permanente, one of California’s leading HMOs, is steadily raising their market share to beat the top players.

For some time now, Kaiser has been hiring the best brains coming out of medical school. They’re constructing more hospitals and providing more medical facilities. They also have a model that gives them an advantage over other carriers because they can offer high-quality affordable care at relatively low rates.

After the enrollment of 2016, Blue Shield had 31 percent of the market, Anthem had 25 percent and Kaiser Permanente had 24 percent. These three insurers still ruled the market in 2017. Kaiser Permanente had 28 percent, Blue Shield 25 percent and Anthem had 19 percent because their enrollees had to choose new coverage.

In 2017, Kaiser Permanente finally became the top insurer in terms of market share. Anthem pulled out of many areas in California, and several of their customers had to enroll in an alternative plan. Most of them opted for Kaiser Permanente.

Major Changes Occurred in Coverage Areas for Some Insurers

In 2018, almost all counties in the state of California have at least three insurers providing coverage. But major changes occurred due to the shrinking coverage of Anthem.

  • Anthem is still participating in Covered California but in a greatly reduced coverage area
  • Anthem is only present in three of the 16 rating areas in the state
  • Anthem decided to scale back their coverage in California
  • Former Anthem enrollees could switch to another plan during the annual open enrollment
  • Those who didn’t return to the exchange to choose another plan were automatically enrolled in a plan that had the lowest rates at their metal level
  • About 19 percent of enrollees on the Anthem plan had to select new health plans for 2018

Blue Shield Expands Coverage

As Anthem was shrinking their coverage, Blue Shield was increasing their reach. They expanded coverage into Contra Costa, Solano, Ventura and Alameda. This helped the company stay in the number-two spot, just behind Kaiser Permanente.

Get a Quote From the Top Insurance Companies

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