Covered California announces Stanislaus County health plans

kcarlson@modbee.comMay 23, 2013 

DN Kaiser 24

Exterior shots of Kaiser Modesto Medical Center on Dale Road, September 17, 2008. (Debbie Noda/The Modesto Bee)

DEBBIE NODA — Modesto Bee

    alternate textKen Carlson
    Title: Staff writer
    Coverage areas: County government, health and medicine, air quality, the environment and public pension systems
    Bio: Ken Carlson has worked 13 years for The Bee, covering local government agencies in Stanislaus and San Joaquin counties. His in-depth reporting has focused on access to health care and public employee pensions.
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— The Covered California health exchange reported Thursday that it will offer 13 insurance plans this fall in the effort to extend coverage to millions of residents.

The participating insurers include industry leaders such as Anthem Blue Cross, Kaiser Permanente and Health Net, as well as smaller regional plans. Officials said the insurance will cover doctor visits, prescriptions, hospital stays and other medical services to meet the standards of the Affordable Care Act.

Officials estimate 5.3 million Californians who are uninsured or poorly insured will be eligible to buy health plans through the exchange in October and 2.6 million may qualify for tax credits to lower the premiums.

The Affordable Care Act will require people to have insurance or pay a penalty starting next year. Covered California unveiled the health plans and proposed premiums for 19 different regions of the state. Residents of Stanislaus, San Joaquin, Merced and Mariposa counties will have four choices: Anthem, Blue Shield, Kaiser Permanente and Health Net.

A quick assessment showed the plans in Stanislaus and other Northern California counties were substantially more costly than those in Southern California. For example, the average premiums for the top plans in Stanislaus were $449 per month, compared with $367 per month in San Bernardino and Riverside counties, or a 22 percent difference. The Affordable Care Act imposed rate-setting restrictions on insurers but does allow them to use geographic regions as factors for charging premiums.

In Stanislaus County, the top — or platinum — plans covering 90 percent of medical bills will cost from $416 a month for the Anthem plan to $508 monthly for the Health Net plan for a 40-year-old adult. That same person could receive a tax credit lowering the premium to $127 if his or her income is $22,900 a year or less. (To see the range of possible rates for a 40-year-old adult, click this link.)

The four insurers will offer plans at different coverage levels labeled bronze, silver, gold and platinum. The bronze (priced at $223-$348 a month) has the highest co-payments and will cover 60 percent of bills while the consumer pays 40 percent. Gold coverage ($358-$451 a month) has lower co-pays and covers 80 percent of costs.

Covered California also will target young adults who often don't make health insurance a priority. In Stanislaus County, a 25-year-old will be able to buy catastrophic coverage for as little as $150 a month or a more comprehensive plan for $175 to $274 a month, and might qualify for a subsidy depending on income.

The rates still require approval from regulators.

The health exchange did not release proposed rates for family plans. It previously estimated that subsidized premiums will range from $90 to $745 a month for four-member families earning $32,500 to $94,200 annually.

The 13 insurers are among 33 that expressed interest in working with the exchange four months ago. Peter Lee, executive director of Covered California, said some ultimately decided not to participate and others quoted rates that were too high. Officials acknowledged that insurers could try to increase the introductory rates, but they won't know until proposals are submitted for 2015.

Nick Bavaro, a benefit adviser in Modesto, said he had expected a larger choice of plans for Stanislaus County but noted the four insurers have strong statewide networks with an abundance of doctors, specialists and hospitals.

He predicted that many county residents will opt for coverage, especially those previously denied insurance because of health conditions.

"People who have pre-existing conditions such as diabetes will be able to get insurance," Bavaro said. "People on COBRA who are paying large premiums will have other options now. Those are good things."

Kaiser Permanente has a hospital and array of clinics in Modesto for those signing up for its plan. Other health care providers were noncommittal when asked if they will accept patients covered by the exchange's health plans.

"We don't have much information other than to say we hope our doctors and hospitals will be included in products available through Covered California," wrote Craig Baize, a spokesman for Sutter Health's Central Valley region.

A Blue Shield executive said Thursday that Sutter Health will be included in its plans offered through the exchange. Sutter is aligned with Memorial Medical Center of Modesto and physicians in the Sutter Gould Medical Foundation.

Carin Sarkis, spokeswoman for Doctors Medical Center of Modesto, said hospital officials were "researching the health plans and whether we are participating in the networks of those plans."

Health Net spokesman Brad Kieffer said the company plans to use its preferred provider network for its Covered California plan in this county. That allows its customers to use Doctors, Memorial, Emanuel Medical Center in Turlock and Stanislaus Surgical Hospital in Modesto, he said.

The California Medical Association released a statement challenging claims that the newly insured will have access to 80 percent of practicing physicians in the state. The group said a loophole in the federal law could leave doctors with unpaid claims when patients fail to pay their premiums.

The association representing 37,000 physicians cited a history of poorly monitoring the adequacy of health plan networks and suggested many physicians will be hesitant to contract with plans offered through the exchange.

"Access to coverage doesn't equal access to care," said Dr. Paul Phinney, CMA president.

On the Net:

Bee staff writer Ken Carlson can be reached at or (209) 578-2321.

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