Dive Brief:
- The 1.2 million-plus consumers in Covered California, the state-run health insurance exchange, can expect modest price increases averaging 4.2% for 2015, exchange officials said July 31. Some plans are offering weighted average rates that are 8.5% lower than current pricing.
- Ten insurers will offer exchange plans to individuals through the exchange next year. Rates remain subject to final approval by state regulators. Open enrollment begins in November.
- Some consumers have reported having trouble in finding doctors and hospitals because of "narrow networks" in some plans participating in Covered California. Exchange officials said insurers are trying to resolve problems by expanding their 2015 networks.
Dive Insight:
According to Covered California's 2015 rate book, individuals buying exchange plans are "guaranteed appropriate provider networks in every region" of the state. Exchange officials said Covered California actively negotiated with insurers to keep premium hikes at a minimum and deliver networks of doctors and hospitals that meet consumers' needs and give them "meaningful choice."
But the Los Angeles Times said many consumers likely will continue to vent about narrow networks and other restrictions they often must accept in exchange for lower rates. The LA Times cited an ongoing state investigation into consumer complaints about lack of access to doctors and misleading provider lists that could prompt further changes to exchange plans.
For the most part, insurers haven't backed down from smaller networks for the exchange's second year, the LA Times said, though there have been some adjustments made in response to criticism from consumers and regulators. Anthem Blue Cross said it has added 6,300 doctors since January to its network for individual policyholders in and outside the exchange. And Blue Shield of California will give Bay Area members more flexibility to visit doctors and hospitals in neighboring counties.
An industry observer suggested it is too early to tell whether California exchange plans' premiums will stay low since insurers are heavily subsidized during the Affordable Care Act's first three years. California Insurance Commissioner Dave Jones described it as "merely a pause in the double-digit rate increases we've seen historically," prompted in part by a November ballot initiative that would give his office new authority to regulate health insurance rates.
Want to read more? You might enjoy this story about how the ultra-narrow New Hampshire network impacted excluded hospitals.