Improved Access, Glitch Fix Helps California Health Insurance Customers – OCRegister | CarTailz

Unexpected illnesses and skyrocketing medical bills are behind a staggering number of bankruptcies in the US — from 40% to more than 66%, researchers have found — and that’s an electric nudge some people are using to encourage health insurance for the great unknowns of the year 2023 to complete.

Flu, RSV, new variants of COVID-19…without health insurance, a broken leg can cost about $7,500 to repair, a torn rotator cuff can cost more than $50,000, and cancer treatment can cost many times that, says Covered California.

Covered California’s 10th annual open enrollment period begins Tuesday, November 1 for coverage effective with the New Year. With the economy slowing, inflation and interest rates rising, subsidies still available for many people who need them, and penalties looming for people who don’t get coverage, many are saying the time is near.

“I was in my early 20s, a college student, young and invincible, and I didn’t have health insurance,” said Jezabel Urbina, director of strategy and services at LA Care Health Plan. “People that age think they’ll never get sick. Lo and behold, I had appendicitis – and was in the hospital for three days.”

It cost thousands of dollars. She recovered from appendicitis much faster than her finances recovered from the unexpected hit.

Covered California aims to help people avoid this kind of thing. Here Californians can find affordable insurance coverage from private brand insurers. Individuals who qualify may also receive financial assistance to reduce monthly premiums and may qualify for California’s low-cost or no-cost Medi-Cal program based on income.

According to data, about 1.7 million Californians have health insurance through Covered California, including about 500,000 in Los Angeles County, 160,000 in Orange County, and 163,000 in Riverside and San Bernardino counties. Hundreds of thousands more are expected to come into question.

A few things are new and noteworthy this year: The problematic “Family Bug” is fixed; the state’s public health emergency ends February 28, which may deter some people from Medi-Cal; Federal subsidies will continue through 2025; and surprisingly, interest rates rise by about 6%.

Covered California calculated a median “bronze” award for 2023 to be $276 in Los Angeles County, $287 in Orange County, and $277 in Riverside and San Bernardino counties.

Covered California selected 13 health and five dental insurance companies to provide coverage in 2023, including Kaiser Permanente, Anthem Blue Cross, Blue Shield of California, Aetna/CVS Health, and LA Care Health Plan.

There is competition in the ranks. Kaiser proudly points out that it has received the highest rating in the state, 5 stars, for overall quality from Covered California for each of the past four years. The LA Care Health Plan bills itself as the nation’s largest publicly operated health plan and the only public plan on the California Stock Exchange. The LA Care Covered product has some of the lowest rates in Los Angeles County, and nearly half of its members have premiums as low as $0 per month thanks to government subsidies. About 93% of LA Care Covered members qualify for some type of subsidy, officials said.

Thousands of workers who are offered insurance through their workplace may benefit from the ‘Family Fault’ changes. This is when workers can afford to buy their own employer-based health insurance, but cannot afford to add their family members – family members who were not eligible for financial assistance under the Affordable Care Act. The solution means around 400,000 Californians should be able to use open registration through the California Marketplace.

And more middle-class people will be eligible for premium subsidies in the coming year, Urbina said.

The pandemic made health insurance a matter of unique urgency, and the American Rescue Plan Act of 2021 expanded premium subsidies through the end of 2022. The recently passed Inflation Reduction Act ensures these subsidies will continue uninterrupted for another three years through 2025, according to the Kaiser Family Foundation.

A recent analysis by the Kaiser Family Foundation found that the average premium for a “silver” health plan — an increase over the aforementioned “bronze” — was $456 per month nationwide. California’s average was lower at $432, ranking 33rd out of 51 states and territories, with 1 being the worst (Vermont, $841) and #51 being the best (New Hampshire, $323).

Covered California is a child of the federal Affordable Care Act, or Obamacare, where states were allowed to set up their own health insurance exchanges. People must sign up for and maintain minimum insurance or face penalties when filing state income taxes.

A recent review by Covered California calls for immediate action regarding the eligibility determination, which “poses a significant risk of not only failing to comply with federal regulations but also using public funds to subsidize ineligible consumers.” Officials say they are working on it.

Consumer data shows that for insured individuals, insurance companies pay 90 to 95 percent of the bill for emergency care and hospitalization, Covered California says in its “Why Buy” materials. “Nobody plans to get into a car accident while driving to the supermarket, but life happens. Just as you cover your vehicle with auto insurance, it is important to cover yourself with health insurance.”

Open enrollment ends at the end of January.

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