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Covered California Executive Director Answers Questions About Open Enrollment

Nov 8, 2016

November marks the start of Covered California’s insurance open enrollment. 2016 will be the fourth year that residents in the Central Valley can shop online for private, federally-subsidized health insurance.

Valley Public Radio spoke with Executive Director Peter about changes going on in the exchange that both people with insurance and the uninsured need to be aware of.

First, Lee says it all begins with knowing if you are eligible to sign up or change your current plan:

Even though this is the fourth year, many people still don’t know what this thing ‘open enrollment’ is. Under the Affordable Care Act, once a year from November 1st to January 31st, that’s the time when health plans have to take everybody regardless of their health condition. And that is the one time a year, if your circumstances haven’t changed, you can find out of you are eligible for financial help. In the Central Valley we have tens and tens of thousands of people, actually hundreds of thousands, that have either signed up for Medi-Cal or are getting financial help through Cover California to pick a private plan that works for them. And this is a time to do some shopping and see if you are eligible for financial help. But irrespective of being eligible for subsidizes, this is the time when plans can’t turn you away and you can switch plans based on what is right for you.

What this is for is for people who don’t have employer-based insurance that are in what is called as the individual market. We still have, across California, over a million people who are uninsured. Anyone who is uninsured should be knocking on our door at coveredca.com and seeing what they are eligible for.

Lee says rates are increasing in the valley but at a pace slower than the national average. However, he says there is more to the story:

The first thing, when you hear about premium increases they are always averages. And in the end, averages are kind of meaningless. Because the average increase in a Fresno, Kings, Madera County is 11%. But for the lowest cost bronze plans, which many people pick, it is only 4%. But that average means that there are some people in Fresno who will see basically no rate increase and others who might see an increase of 16-17%. So it really is incumbent on everyone in the Central Valley that that individual insurance to go to coveredca.com, put in their current income because what they actually pay depends on what their income is. So they really need to shop and roll up their sleeves to make sure they have the right plan for 2017.

Lee also addressed United Healthcare announcing that they will no longer sell in California:

California has turned a lot of plans away. We have a lot of competition. Even in the Fresno area there are four different plans. These are name brand plans: Anthem, Blue Shield, Health Net, and Kaiser. And with all due respect to United, they didn’t have a good offering. They were really expensive. There were only about 1,200 people statewide that signed up. So their leaving, really for most consumers, doesn’t mean anything.

For people who don’t enroll but could afford insurance, there is a tax penalty. Lee says, in the long run, it doesn’t make economic sense to pay the fee:

Last year, over 500,000 Californians paid a penalty. I want to be clear that paying money to the IRS for not having insurance is like throwing money out the window. It is crazy math to say ‘oh, the penalty is a little bit less than what it would cost to have insurance. So I will just pay the penalty.’ Why is it crazy math? Throwing money out the window buys you nothing. Buying insurance gives you piece of mind. Access to preventive care. Access to care when you need it. That’s a good buy.