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Stanislaus County residents will pay far more for Covered CA than others in state

Peter Lee, second left, the executive director of Covered California, poses with enrollees in the state-run health insurance exchange, in front of Los Angeles City Hall, Nov. 14, 2014.
Peter Lee, second left, the executive director of Covered California, poses with enrollees in the state-run health insurance exchange, in front of Los Angeles City Hall, Nov. 14, 2014. NYT

For a single adult, who has just turned 40 and is now more at risk of a whopping medical bill, the cost for the most popular Covered California health insurance plan next year will be $462 a month in a pricing region that includes in Stanislaus, San Joaquin and Merced counties.

That preliminary estimate is for a man or woman who is not eligible for a federal subsidy through the Affordable Care Act, which survived a gauntlet of Republican repeal measures this year.

The California Health Care Foundation, a research and education institute, released a breakdown on the 2018 rates for individual market insurance plans offered on the Covered California exchange, which carves the state into 19 pricing regions.

The costs for the coverage varies based on what it costs insurers to cover consumers in each region. The insurance rates are the lowest in Southern California and will range from $289 to $350 a month for Silver coverage next year. The majority of consumers choose Silver coverage, which has a 70 percent coverage level, $2,500 annual deductible and $7,000 out-of-pocket maximum.

The Silver plan premiums will be $100 higher in Stanislaus, San Joaquin and Merced counties than in other counties in the San Joaquin Valley, such as Fresno and Madera.

That may be vexing for residents in this part of the Valley. But Covered California explains that a lack of competition and coordination of care in the rural counties of Stanislaus, San Joaquin and Merced translates into higher health care costs and more costly insurance premiums.

The exchange gives the same explanation for why health insurance costs in general are more expensive in Northern California than in Southern California, where there is more competition among hospitals and health care providers.

The recent breakdown provided by the California Health Care Foundation did not include the preliminary rates for family coverage. On average, families who rely on coverage through Covered California are expected to see 24 percent rate increases in Stanislaus and nearby counties next year, double the statewide average increase of 12.5 percent.

The three counties will see some of the highest premium increases in the state for Obamacare coverage. About 18,000 residents in Stanislaus County have insurance through the exchange.

Federal subsidies remain in place to help reduce premiums for eligible county residents. A 40-year-old earning $18,090 a year will pay $61 a month for the Silver plan. That person would be eligible for an enhanced Silver plan with a $75 deductible and $1,000 out-of-pocket maximum.

Premium assistance is available for people with incomes between 139 percent and 400 percent of poverty level. A person earning slightly less than $25,000 a year will pay $127 a month for Silver coverage. A 40-year-old earning more than $48,240 a year (400 percent of poverty level) will pay the full $462 a month.

The actual premiums will vary for the different insurance plans offered in the region by Blue Shield of California, Anthem Blue Cross, Kaiser Permanente and Health Net. Covered California insurance plans have Bronze, Silver, Gold and Platinum benefit designs with coverage levels ranging from 60 to 90 percent.

Covered California plans to hold a three-month enrollment period for 2018 coverage from Nov. 1 to Jan. 31.

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