CoveredCA deserves praise for keeping the weighted average rate increase to a reasonable 4%. However, what the media and CoveredCA themselves miss in their coverage is that the 2016 Standard Benefit Plan Design has changed from the 2015 offering, and not for the better. Copays and deductibles are up among many of the programs. A few choice changes:
Bronze-level deductibles are up $1,000 for an individual and $2,000 for a family, from $5,000/$10,000 to $6,000/$12,000
Bronze-level copays to see the primary care physician have increased from $60 to $70
Bonze-level copays to see a specialist have increased from $70 to $90
Silver-level deductibles are up from $2,000 to $2,250 for an individual and $4,000 to $4,500 for a family
Silver-level specialist visit copays are up from $65 to $70
CoveredCA has also changed the standard benefits for its Enhanced Silver program, which is offered only to the lowest income individuals and families that still qualify for CoveredCA- those with incomes between 138% and 250% of the federal poverty line. Programs that previously didn’t have a deductible now employ one and copays are up for many services. The increased to the Enhanced Silver programs directly hurt the lowest income members of CoveredCA. However, these plans have a standard actuarial value (the amount which the health plan will pay out compared to what the consumer will) that must be met and which CoveredCA insists will not change. It remains to be seen how CoveredCA will reconcile these benefit changes with that obligation to pay out a standard amount on each policy. The CoveredCA release is only a summary and the full Explanation of Benefits has not yet been published.
However, not all the changes are bad. CoveredCA has made the popular Bronze-level programs more flexible in that they allow more services before the deductible. For instance, last year a Bronze plan holder could only receive two different benefits without paying their deductible first- their PCP copay and their annual physical exam. In 2016, a Bronze plan holder can use both of those services plus urgent care, specialist visits, and lab tests before needing to meet their (increased) deductible.
Media outlets touting the relatively small rate increase for CoveredCa’s 2016 health insurance plans need to also point out these benefit changes if they want to be truly honest in their comparison of the value consumers will receive in 2016 as compared to 2015. Without the context of the plan changes the modest rate increase discussion is only half the story.