Reality Check

Reality Check

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Reality Check: Obamacare Options - Do You Know What's Available?

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    NEWSLETTERS

    In this edition of Reality Check, Sam Brock looks into the number of insurance companies available to you when Obamacare takes effect in October. (Published Tuesday, Sep 17, 2013)

    Within California’s health care exchange universe, known simply as ‘Covered California,’ shapes and objects are still forming and pieces moving into place.

    We’re getting a clearer picture of what will be available to consumers in 2014, however, as both the state and country prepare for Obamacare’s individual mandate to take effect on January 1st.

    In California, the state’s insurance marketplace opens for business in a mere matter of days, on October 1st.

    Do you know what options are available to you?

    “We’re working hard with Covered California to make sure it goes off with as few hitches as possible,” said Charles Bacchi, executive vice president for the California Association of Health Plans, an organization representing all health plans in California.

    “People need to understand that they can only buy coverage in California between October [of 2013] and March of next year for 2014,” he said. “Otherwise, they won’t be able to purchase coverage until 2015.”

    Bacchi explained that there are currently 12 different health insurance companies approved to sell products on Covered California for 2014.

    Those companies are: Alameda Alliance for Health, Anthem Blue Cross of California, Blue Shield of California, Chinese Community Health Plan, Contra Costa Health Plan, Health Net, Kaiser Permanente, L.A. Care Health Plan, Molina Healthcare, Sharp Health Plan, Valley Health Plan and Western Health Advantage.

    Just because there are 12 companies represented on the exchange, however, does not mean that there will be 12 plans available to you.

    In fact, the reality is quite the contrary.

    In most regions of California, there will be between three and five companies selling their product. In some cases, one company might offer a couple different options, such as a PPO (preferred provider organization) and HMO (health maintenance organization).

    Without getting into too many details, those plans differ in their structure, particular providers such as doctors and hospitals, and how much they cost.

    “One of the things that enrollees need to do is when they buy coverage, especially if they currently have coverage, they want to look and see which providers are contracted with which plans,” Bacchi said.

    Dana Howard, spokesperson for Covered California, told NBC Bay Area that consumers will be able to check which providers are linked to which plans when the web site launches on October 1st.

    Covered California’s web site is www.coveredca.com.
    Howard stressed that regardless of which plan you select, the benefits by law have to be the same.

    “One company cannot charge $45 for an office visit copay, and the next company charge $75,” Howard said. Those days are *over with. All the benefits are the same, regardless of which metal level you are at.”

    All of the health insurance plans available on Covered California come in four different ‘tiers’: Platinum, Gold, Silver and Bronze.

    As Howard explains it, the tiers are simply a way for consumers to figure out what cost structure and level of risk works best for their lifestyle.

    “It allows customers to make what we call an apples-to-apples comparison,” Howard said. “So now, no longer are they trying to figure out what benefits they’re getting. Now they only have to figure out, ‘what’s it going to cost, and are my hospital and doctor within that plan?"

    If you select a plan and choose the Platinum version, for example, the coverage plan will cover roughly 90 percent of your medical costs.

    The downside, however, is that your monthly premiums will be higher than the other options.

    On the other end of the spectrum, if you choose the Bronze tier you will only be covered for around 60 percent of medical costs, but your premiums will be substantially lower.

    “You’re really just choosing what price point as a consumer makes you feel comfortable,” Bacchi added, “and then which plan it is that you want to receive your care from.”

    Continue to check with NBC Bay Area and the Reality Check franchise for details on how Covered California will work, who will be impacted and what the best way is to take advantage of subsidies.