+
Covered California:
10 Things You Need to Know about
Open Enrollment
Darin Latimore, MD, FACP
October 19, 2014
+
Darin Latimore, MD, FACP
Associate Dean
Office of Student and Resident Diversity
UC Davis School of Medicine
Dr. Latimore declares that in the past 12 months neither he nor any member of his
family have had a financial arrangement or affiliation with any corporate organization
offering financial support of grant moneys for this continuing education program.
This initiative is
supported by a
grant from
Covered
California.
+ This activity is sponsored by the California
Academy of Family Physicians.
This initiative is a partnership of the California Academy of Family
Physicians, California Academy of Physician Assistants, California Chapter
of the American College of Physicians and Osteopathic Physicians and
Surgeons of California.
+
Learning Objectives
At the end of the session, participants should be able to:
 Describe the
goals for the next Covered California open
enrollment period.
 Identify
the health plans available in 2015 through
Covered CA.
 Understand plan
network and access Issues.
 Describe to patients how
Covered California.
to explore their options with
+
Next Open Enrollment Period
November 15, 2014 to
February 15, 2015
+ Covered California 2015 Health
Plan Benefit Year
January 1, 2015 to
December 31, 2015
+
10 Things to Know
about Open Enrollment
Covered California is targeting two groups of Californians:
 Californians applying for first-time coverage
 Californians renewing
current policies
1
+
Outreach Campaign Goals
Covered California aims to:
 Increase enrollment from
1.2 million Californians to 1.7
million Californians;
 Fix problems consumers faced
during the first open
enrollment period; and
 Offer
a streamlined renewal process.
+
10 Things to Know
2
about Open Enrollment
Consumers should set up Covered California accounts NOW.
+
Covered California Accounts
 Consumers should
have an active Covered California
online account. (Having an online account is not required,
but it will allow consumers to access their Covered
California information without assistance and will make
the renewal process easier.)
 Consumers should
provide email addresses to get
important updates.
 Consumers can use
their accounts to update their
income, add or remove a member of their household and
change their communication preference.
+
10 Things to Know
3
about Open Enrollment
Consumers can choose from the same health plans…minus
one.
 Covered
California has selected 10 health insurance plans to
be in the state health exchange in 2015. All 10 health were in
the exchange for 2014.
 Only one
of the health plans from the 2014 Open Enrollment
Period is out: Alameda Alliance for Health.
+
Health Plans in 2015
 Anthem Blue Cross of
California
 Blue Shield
Care Health Plan
 Molina
of California
 Chinese Community

 LA
Healthcare
 Sharp Health
Plan
Health Plan
 Valley Health Plan
Health Net
 Western Health
 Kaiser Permanente
Advantage
+
10 Things to Know
4
about Open Enrollment
Having the same health plans DOES NOT mean the same
network of physicians.
Networks/Access remain a problem in 2015.
+
Health Net: PPO to Narrow Network
 Health Net
plans to transition from a PPO network to a
network with 54 percent fewer physicians and no
coverage for out-of-network care in certain regions.
 The
slimmed-down plan will cost up to 9 percent more
than the PPO coverage, however.
 HealthNet said
affordable.
New York Times
the change was necessary to keep rates
+
Blue Shield and Anthem
 Blue Shield
of California has proposed a physician
network for 2015 that will have up to four percent fewer
providers in certain areas
 Anthem Blue Cross plans to maintain its current physician
network.
New York Times
+
Networks/Access in 2015
Remember:
 Covered
California does not change how existing state
health care problems are administered.
 Covered
California does NOT regulate plan networks.
 Covered
California does not contract directly with
physicians, hospitals or other providers.
Health insurance plans contract directly with providers
and the terms of those contracts (financial and nonfinancial) are proprietary to each plan.
+
Regulator Investigating
 DMHC is
investigating the accuracy of Anthem Blue Cross
and Blue Shield of California’s provider directories. This
was prompted by consumer complaints about access
issues.
 Results of investigation/DMHC response
expected before
next open enrollment begins (November 15).
+
We’re Raising Your Concerns
+
10 Things to Know
about Open Enrollment
Confirm your network status now WITH HEALTH PLANS.
 There
is no Covered California Physician Directory
Planned for 2015.
 Confirm Contract Status with PLANs.
5
+
If Not Covered California,
Who Can Help Me with Contracts?
Health Insurance
Company
Anthem Blue
Cross of California
Network Development
Phone
email
Contact Name/Title
Number
Aldo de la Torre, Vice
President Provider
Engagement and Contracting 855- 238-0095 aldo.delatorre@wellpoint.com
Blue Shield of
California
Hugo Florez, Senior Director,
PPO and Specialty Networks
818-228-2607 Hugo.Florez@blueshieldca.com
Network Management
Health Net of
California
David Davidson, Director,
Contracts Administration &
david.s.davidson@healthnet.co
Provider Services/Operations 818-676-7331
m
+
10 Things to Know
about Open Enrollment
Consumers can expect minimal changes in premiums and
subsidies.
6
+
Health Plans in 2015: Premiums
Most Covered California consumers will see low premium
increases in 2015, and some consumers will see no
increase or even a decrease.
 The
statewide average increase = 4.2 percent.
 Some plans
offering an 8.5 percent decrease.
+
Subsidies in 2015
 90 percent of
consumers who purchased through
Covered California received federal subsidies to reduce
costs.
 For most consumers, that subsidy
will either increase or
remain very close to 2014 subsidy amounts.
 For many consumers, any
increase in premium will be
offset by an increase in subsidy.
+
10 Things to Know
about Open Enrollment
Plans AUTOMATICALLY will renew consumers unless they
(the consumers) make a change.
7
+
Renewals: Important Dates
 Consumers can renew policies beginning
on October 1.
 Consumers who want to change
coverage must wait until
the start of Open Enrollment (November 15) to do so,
however.
 Exchange policies
automatically will be renewed if
enrollees do not specify that they want to change plans
by December 15.
+
10 Things to Know
about Open Enrollment
Health Plans will mail a series of renewal notices to
consumers in October, November and December.
8
+
Renewal Notices: Timeline
Early October: a letter letting consumers know it’s time to
renew their coverage (“NOD 12” code in lower left).
a. Instructions on how to renew coverage.
b. The member’s 2014 plan selection and 2014
premium assistance amount.
c. The name and contact information for the
Certified Enrollment Counselor or Certified
Insurance Agent who assisted the member last year.
+
Renewal Notices: Timeline
November 1: a co-branded renewal letter from the
consumer’s health insurance plan.
a. The member’s 2014 and 2015 premium amounts
and a description of the difference.
b. The member’s 2014 premium assistance amount.
c. Directions to go to the Shop and Compare Tool at
CoveredCA.com to see the full range of 2015 plans
and rates and to calculate their net premium.
+
Renewal Notices: Timeline
Mid-November: a 2015 welcome letter (“NOD 01” code in
lower left).
a. Confirmation of the member’s 2015 eligibility.
b. 2015 premium assistance amount.
+
Renewal Notices: Timeline
Mid-November: a 2015 “You’re almost done” letter (“NOD
08” code in lower left).
a. Confirmation of the health plan selected.
b. The member’s 2015 premium amount and 2015
net premium assistance amount.
c. Reminder to pay premium directly to the health
insurance company
+
Renewal Notices: Timeline
Late December: an invoice from the health insurance plan
the member selected.
a. The member’s 2015 monthly net premium.
b. Instructions for making the premium payments to
the health insurance plan, not Covered California.
+
10 Things to Know
about Open Enrollment
During Open Enrollment, consumers have multiple avenues
to purchase health insurance.
9
+
Reminder: How Patients Can Enroll
www.coveredca.com
CC Service Center 800-300-1505
Certified Enrollment Counselors
www.coveredca.com
is the ONLY official website!
Certified Insurance Agents
Mail or Fax
Local county human or social services office
+
Reminder:
Three Paths to Health Insurance
Path 1
Path 2
Path 3
At or below 138%
of the Federal
Poverty Level (FPL)
Medi-Cal
Between 139250% FPL
Eligible for a CC Health
Plan with premium
assistance and
improved benefits
Between 251400% FPL
Eligible for a CC Health
Plan with premium
assistance but not
improved benefits
Over 400% FPL
Eligible for a CC
Health Plan
+
10 Things to Know
about Open Enrollment
Encourage use of the New Shop and Compare Tool NOW.
Consumers should understand cost shifts and the
availability of providers.
10
+
New Shop and Compare Tool
Available NOW!
Consumers now can use the 2015 Shop and Compare Tool
on the Covered California website to look at plans and
products in their areas and get preliminary estimates of
costs and premium assistance.
https://www.coveredca.com/shopandcompare/#calculator
+
Shop and Compare Tool
+
Shop and Compare Tool
 Basic information needed:
 Number
of people in
household
 Age of each person
 Household income
 Zip Code
+
Shop and Compare Tool
Answers questions
about Covered
California and what
it can do for you and
your family.
Displays plan
options in each
region and provides
a breakdown on
monthly costs.
+
In 2014: Who Got Covered?
SUCCESS!
3.4 million or 58 percent of previously uninsured adult
Californians obtained health insurance in the first open
enrollment period.
 25 percent through
Medi-Cal
 12 percent through
an employer
 Nine
 Five
percent through Covered California
percent through other non-group coverage
Kaiser Family Foundation
+
Who Got Covered?
Medi-Cal
29%
25%
Covered California
Other non-group
Employer-Sponsored Insurance
13%
6%
Remaining Uninsured 42%
Kaiser Family Foundation
9%
5%
Somewhere else/unknown
Remaining Undocumented
Uninsured
12%
Remaining Eligible Uninsured
Newly Insured 58%
+
The Remaining Uninsured
Length of Time Uninsured
37% Never insured
45% 2 years +
12% 1-<2 years
6% 2 months-<1 year
Income/Eligibility
30% Undocumented
30% Medi-Cal target group
24% Exchange subsidized
target group
4% 400% FPL
4% Don’t know/Refused to
Answer
Race/Ethnicity
24% White
32% Eligible Hispanics
29% Undocumented
Hispanics
5% Blacks
Total
8% Other
Hispanics:
62%
Age
17%
25%
33%
24%
19-25
26-34
35-49
50-64
The Remaining Uninsured in their Own Words
Among California’s remaining
uninsured: What is the main
reason you have not gotten
health insurance this year?
34% -- Can’t afford it/Too
expensive.
I still cannot afford health insurance. It’s a total
rip-off, it’s extremely expensive. I don’t have
enough income.
Can’t apply for it because of my legal status. My
husband’s income is too high. Don’t think I
qualify.
15% -- Don’t qualify for
coverage/Financial help.
9% -- Haven’t tried/Too busy.
Working so much I haven’t had time. I’m limited
with my time and the applications are too long. I
don’t have time.
9% -- Lack of information/
Don’t know how to get it.
Kaiser Family Foundation
I find it too difficult to understand and there’s no
support from anybody to help me. Confused
about the system.
+
The Remaining Uninsured
An opportunity exists:
 57 percent of
the uninsured think they will enroll later
this year; only 31 percent think they will continue
without health insurance.
 36 percent of
the uninsured say they tried unsuccessfully
to get insurance in the first open enrollment period.
Thank you!
+
Questions?