[quote=joec]In CA, I think United Healthcare has the smallest share of customers out of all the exchange insurance companies…
If they left, maybe they lose 1% of customers? It could also be a cost cutting move since they aren’t really playing in the state anyways…
That said, I think Blue Shield made the most in 2014 from a latimes article I read…so some companies were able to make money, of course, Blue Shield and Blue Cross/Anthem are bad IMO.[/quote]Yes, joec, Blue Shield has the most planholders out of all carriers who offer plans on Covered CA. That is likely because they offer the only PPO on the California exchange and people (like me) who lost coverage due to the ACA wanted to keep their doctors and most of the good ones only take PPOs. Blue Shield of CA has between 20% and 30% market share of the exchange customers who selected a plan (those not on Medi-Cal), depending on region. (SD County is the last region of 19 or “Region 19”). BSoC’s PPO also has nationwide coverage through the nationwide BCBS provider roster.
IIRC, United Health just reappeared back in the CA individual (exchange) market in October 2015 stating that they were going to offer coverage (not sure what type – HMO, EPO or PPO) starting 1/1/16 on Covered CA in about 3-4 NorCal regions or “test-markets.” However, in November 2015, they backed out, citing “unprofitability in the CA market.”
I feel that the probable reason for United Health backing out of offering plans on CC for 2016 was that Hispanics have a high rate of diabetes and high blood pressure as do members of Native American tribes and CA has the biggest population of any state in the nation of both of these races/Nationalities.
However, United Health won a 5-year contract to administer the Federal government’s Tricare Standard and Prime programs for the Triwest Region (incl CA) beginning 10/1/12. Millions of CA residents are eligible for and currently using Tricare in CA.
On 12/31/13, CA lost six major healthplan carriers from its individual market. Those were Aetna, Wellpoint, Humana, Pacificare, United Health and Cigna. All of the people with individual healthplans from these carriers were dumped onto Covered CA because by the end of 2013, the only individual plans offered in SD County were through Covered CA except possibly a few Bronze Plans (2-3) and “Cadillac” plans still offered through the open market. Those particular (non-ACA compliant) Bronze plans were all canceled at the end of 2014, dumping the planholders back on the exchange. In November of 2015, Cigna came back to SD County, offering two Bronze plans on the open market (one an HSA plan). I’m waiting to see what new carriers (if any) will offer plans on the CA individual market this fall.
I understand that SK resides in AZ and he was able to buy a suitable off-exchange plan for 2016 there. But CA is a completely different animal. Covered CA (and their partner in crime, Medi-Cal) run the exchange and all the planholders on it (as well as all the Medi-Cal recipients) as if we’re in the wild west. They have their OWN interpretation of the ACA. The bottom line is, you sign up on Covered CA for a non-MediCal plan and accept a subsidy to help pay the premiums (no matter how small), there are a whole lotta of strings attached to that. In short, CC owns your a$$. Not only MUST you file your tax returns on time and NOT file any extensions (as with ALL healthplan exchanges across the country) but your plan’s carrier has absolutely NO SAY whatsoever in whether they get to keep you as a customer the entire 12 months … or not. Paying your premium on time has nothing to do with it. If CC orders your carrier to drop your coverage on the 5th of the month (AFTER they rec’d your portion of their monthly premium thru automatic payment as well as received your subsidy from the Federal Govm’t to pay the rest of your monthly premium), they most certainly can and will drop your coverage. Neither they, nor CC have to tell you first that they are doing this, and usually do not. This could happen multiple times per year without your knowledge, folks. CC also follows orders from Medi-Cal, who wants as many people on Medi-Cal as possible as soon as possible. County Medi-Cal offices are under the gun to get the HUGE group of CC enrollees over the age of 55 enrolled in Medi-Cal (due to a large percentage of them now out of the workforce and thus no longer have access to employer-provided coverage) for the express purpose of placing of a “placeholder lien” on any real property they own for ALL Medi-Cal managed care premiums paid on their behalf for each month they are placed on Medi-Cal between the ages of 55 and 65. Since the inception of the ACA, there is no longer any “asset test” to qualify for Medi-Cal so many, many “asset rich” boomers are now prime targets for forced placement into Medi-Cal!
SB 1124 was introduced in 2014 to eliminate the incentive for CC/Medi-Cal to “target” their over-55 enrollees for forced-placement into Medi-Cal for estate recovery purposes. The CA Legislature DID pass the bill last year but Gov Brown refused to sign it, stating that he wanted to see significant improvement in CA’s general fund before agreeing to it.
▪ Health policy debate will continue in budget hearings and on bills to cover California’s remaining uninsured regardless of immigration status (SB 10 by Sen. Lara), and to limit Medi-Cal estate recovery (SB 33 by Sen. Hernandez), which discourages patients from enrollment and potentially risking losing family home.
The whole CC/Medi-Cal debacle (practical interpretation of the ACA by CA’s PTB) is greatly exacerbated by the dearth of plans now offered on CA’s open market. In essence, what has happened in CA is that we HAD a lot of choice as to healthplans and carriers on the open market, prior to when the ACA became law but now there really isn’t any choice at all. If one can’t obtain an employer based plan, has Tricare or VA eligibility or is offered an “affordable” plan through their union or retirement association, then they are essentially “stuck” with the plans CC offers.
In reality, CC does not exist to place individuals and families in plans they like (or can live with) who are willing to pay the monthly premium for. CC does not care if it signed up 1M enrollees into “marketplace plans” or just 200K. CC exists solely to gather financial information from its unsuspecting enrollees to be culled and re-culled from month to month and year to year for possible forced Medi-Cal placement. It traps a “captive audience” into the “CALHEERS/Medi-Cal system with the lure of “subsidies” to assist with monthly premiums (which are 2-3 times higher than the vast majority of the monthly premiums of pre-ACA plans and rise 6-20% per year). The “subsidies” are to “cushion the shock” of the massive increase from the enrollee’s old (pre-ACA) healthplan premium to CC’s current premiums so they “don’t feel it as much.” Once trapped into the “system,” CC enrollees’ financial info is manipulated and used against them for possible Medi-Cal forced placement, knowing that the vast majority of them have no other choice in healthplans.
The only reason that “obamacare” is called a “success” by its “supporters” is because far more people were placed on Medicaid/Medi-Cal than in actual “marketplace healthplans.” Obamacare’s proponents are using those Medicaid/Medi-Cal enrollee numbers to state that so many more millions are people are now “covered.” That doesn’t mean there are actually any providers willing to care for all these extra Medicaid/Medi-Cal enrollees in their respective regions. All it means is that these millions of new (willing and unwilling) Medicaid/Medi-Cal enrollees are now used by “obamacare proponents” for “statistical purposes” to tout how successful the ACA has been in getting the “uninsured” covered. The dirty little secrets of how the ACA really works on the ground are never mentioned, including the fact that a large portion of those signing up on exchange plans WERE previously covered prior to the ACA but their plans dropped them (even if they were “grandfathered”) in the wake of “obamacare.”
