Anthem Blue Cross, the largest player in the Obamacare insurance marketplace in the Northern San Joaquin Valley, will still serve those customers in the region while pulling out of most of California.
Anthem’s decision to remain in Covered California’s Central Valley pricing region, including Stanislaus, San Joaquin, Merced, Mariposa and Tulare counties, averted the kind of upheaval that fueled Republican efforts to repeal and replace the Affordable Care Act this year.
Almost 70 percent of Covered California customers in the five-county region have Anthem health coverage and those residents – about 45,000 of them – will need to make changes for next year.
Anthem said Tuesday it will discontinue the current plans for its Central Valley members at year’s end. The affected members will need to shop for new health plans, during an enrollment period starting Nov. 1, and the new Anthem plans will cost 15 percent to 48 percent more than the current ones.
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Anthem will offer “exclusive provider organization” plans for its remaining Covered California customers. It promised to outline the changes and options in notices to affected members. The changes don’t affect Anthem insurance plans for employers, Medicare Advantage or supplement plans, Medi-Cal manged-care and grandfathered individual market plans purchased before March 23, 2010. The insurer still will offer individual dental and vision plans in California.
In announcing new rates for 2018, Covered California said its marketplace remains stable despite the national repeal-and-replace drama of the past several months.
Stanislaus and the four other counties will see the second highest rate increases for Covered California health plans next year, averaging 24 percent, which is double the statewide average increase of 12.5 percent.
Residents at low- to moderate-income levels who qualify for federal subsidies should still find affordable insurance options on the exchange, Covered California said.
Along with the Central Valley region, Anthem will participate in Covered California in Santa Clara County and the Redding area and northern counties. It has a total of 108,000 customers in those regions.
The insurer said that instability in the marketplace and changes in federal rules and guidance regarding the Affordable Care Act led to its decision to leave the other regions in California, a decision that affects 153,000 of the 1.4 million customers on the Covered California exchange.
Peter Lee, executive director of Covered California, said in a press call Tuesday the exchange played a role in convincing Anthem to stay in the Central Valley and the two other regions, which represent 40 percent of Anthem’s Obamacare enrollment.
Anthem’s cheaper rates have made it the choice of 67 percent of the Covered California customers in the Modesto-Stockton-Merced area. Kaiser Permanente has 27 percent of customers in the pricing region, 5 percent are with Blue Shield and a few are with HealthNet.
Anthem’s largest rate increase next year (48 percent) will apply to its EPO platinum tier plan.
More than 90 percent of people enrolled in the region use federal subsidies to lower their monthly premiums and the tax credits should insulate them against most of the rate increases coming next year, said Lizelda Lopez said, a Covered California spokeswoman.
Lopez cited a lack of competition and coordination of care among health care providers as the reason why insurance costs are higher for residents in the Modesto-Stockton-Merced area.
Anthem’s new plans, called exclusive provider organizations, are like preferred provider organizations or “PPOs”, but will cover none of the bill for patients who use an out-of-network health care provider, said Sean Crisp, a Modesto insurance broker. PPOs usually cover a percentage of the costs for out-of-network services.
Crisp suggested that Anthem customers who need to change plans should review their options with an insurance broker.
In the local pricing region, the rates for Kaiser plans are expected to increase between 3 percent and 7 percent next year. Blue Shield customers will see a 9 percent to 22 percent jump, while HealthNet will raise its rates 14 percent.
An enrollment window for making changes for 2018 opens Nov. 1. Those who change their insurance coverage may have to see other doctors.
Ken Carlson: 209-578-2321, @KenCarlson16