The lead was certainly the 12.5% average rate increase for CoveredCA health plan holders, but the more shocking revelation from the CoveredCA press release this morning was the announcement that Anthem will withdraw from 16 of 19 regions in California. The 3 remaining regions are 1, 7 and 10, the counties belonging to which can be found here. Region 1 includes the northernmost area of the state- Mendocino county and above. Region 7 includes Santa Clara county and region 10 covers Merced, San Joaquin, and Stanislaus. 153,000 members will be terminated 12/31/2017 and forced to find new coverage during the 2017 Open Enrollment period, currently set to begin on November 1 and end December 15th.
During those 6 weeks, Anthem members will have to find a new carrier to suit their needs, but may have trouble doing so. With their withdrawal, there are precious few carriers writing non- HMO products in 2018. Blue Shield of CA is set to continue offering their PPO product (for now) which makes them the only carrier to offer a non-HMO in the majority of the state. Oscar Health will offer their EPO product in some regions while Health Net will offer their Health Service Plan as well.
This is a major blow to consumer choice both in plans and more importantly in doctors. In addition to forcing a patient to use a single Primary Care Physician to manage their care, CoveredCA HMO plans generally carry much smaller networks than their EPO/PPO brethren. To put numbers to a point, take America’s most famous ZIP code as an example. Anthem’s EPO currently offers 701 doctors within 5 miles of 90210, while their HMO offers a relatively paltry 52. Using those same parameters, Blue Shield’s PPO offers 1,110 physicians, and only SEVENTEEN in their HMO.
Anthem members will have to wait until November to execute any changes to their plan, but can prepare by taking the following steps:
- Prepare a list of their physicians, facilities, and hospitals that they frequent so that your broker can find the plan that closest mirrors your outgoing one that still allows you to see a majority of your physicians
- Be prepared for this search to yield imperfect results- if you have multiple physicians and hospitals you frequent, it’s unlikely 100% of them will be covered by any program.
- Collect your most recent tax return to see if you may be eligible for a subsidy to pay for health coverage
- Pre-register with your insurance broker to be among the first to know when the new plans and prices become available.
Unfortunately, this is an evolving story and we won’t have the full picture until October or November when specific rates are released for quoting. In the meantime, if you’re interested in further reading you can parse the full rate guide here or contact us at firstname.lastname@example.org