Health & Fitness

Covered CA enrollment expected to drop as penalty ends

Consumers can still find low-cost options for health insurance on the Covered California exchange.
Consumers can still find low-cost options for health insurance on the Covered California exchange. The Sacramento Bee

Covered California’s fall enrollment period will show whether peace of mind is a motivation for people to keep their health insurance next year.

Last year, Congress passed legislation that in 2019 erases the federal tax penalty for people without coverage.

Without the threat of a penalty, Covered California, the state’s health exchange, estimates that 12 percent of its customers, or 162,000 residents, will leave the program and an additional 100,000 who purchase insurance from brokers in the state will discontinue coverage.

Affordable Care Act supporters believe there are sound reasons for the 1.4 million consumers in the program to stay insured — to protect themselves against crushing medical bills at rates subsidized by the federal government.

Almost 70,000 residents in a five-county pricing region, including Stanislaus, San Joaquin, Merced, Mariposa and Tulare counties, are covered on the exchange and 95 percent of them receive help with monthly premiums. About 18,000 are covered in Stanislaus County.

“Certainly it’s possible some will roll the dice and decide to go without coverage,” James Scullary, a Covered California spokesman, said Friday. “People generally want health insurance. They want to have that peace of mind of coverage in case of an injury or illness.”

The anticipated departure of some consumers from the pool accounts for part of an 8.7 percent average rate increase next year for Obamacare plans offered by 11 insurers in California. On average, those insurers tacked an extra 3.5 percent onto next year’s rates due to projected costs of serving a smaller, less healthy customer base when the tax penalty ends.

Individuals and families whose premiums are subsidized will see small increases because higher premiums are triggers for larger federal tax credits. It will serve to pass $250 million in additional costs to the federal government. Individuals earning between $16,754 and $48,560 a year are eligible for subsidized rates and the same applies to a family of four with income between $34,638 and $100,400 a year.

Those not eligible for subsidies will be stung by the rate increases, projected at almost 7 percent in the five-county region. A state bill to help middle-income households buy costly insurance on the individual market failed to pass this year.

The enrollment period for 2019 opened last week and runs through Jan. 15. The enrollment deadline is Dec. 15 for coverage to take effect Jan. 1.

A 40-year-old adult earning $35,000 a year can purchase a standard Silver plan for monthly costs ranging from $187 to $376, according to Covered California’s “shop and compare” online tool. Anthem Blue Cross, Kaiser Permanente, Blue Shield of California and HealthNet are the four insurance carriers offering the metal tier plans (Bronze to Platinum) in this region.

For a family of four with annual income of $62,500, monthly costs for Silver coverage will range from $254 to $625, depending on what plan is chosen. In that scenario, the two children may be eligible for free or low-cost care through the Medi-Cal program and the parents could receive extra help for co-payments.

Some residents not eligible for subsidies settle for the skimpy Bronze coverage through Covered California. A 55-year-old with $60,000 annual income will pay from $535 to $821 a month for Bronze plans next year. The cheapest Bronze HMO requires 40 percent co-pays for primary care visits and generic drugs; the annual out-of-pocket maximum is $6,000.

Citing data from Covered California’s consumer pool, Scullary said that 1.2 million customers have needed some health care and 153,000 have been protected from claims ranging from $5,000 to $50,000. Scullary said 15,000 consumers were shielded from health care costs over $50,000 and 42 people had claims in excess of $1 million.

The state exchange will promote enrollment this fall through an advertising campaign and a bus tour beginning after the November election, the spokesman said. The agency has local partners and certified brokers across the state to assist consumers with choosing suitable plans.

Covered California has a Monday-to-Saturday customer service line at 800-300-1506. Enrollment information is available at