California Prepares for Open Enrollment Amidst Health Care Turmoil

In an ordinary year, California would still want to spread the word that financial assistance is available to help people purchase health insurance during open enrollment in the state exchange, which begins Nov. 1.

But “it certainly is not a normal year, and there’s just a basic concern about making sure that people are not scared away by the confusion,” said Anthony Wright, executive director of the California advocacy group Health Access.

Despite repeated Republican-led Congressional efforts to repeal the Affordable Care Act and President Donald Trump declaring on Tuesday that Obamacare is “virtually dead,” California’s health insurance exchange is still very much open for business.

Known as Covered California, the insurance portal will allow people to sign up for plans through Jan. 31, 2018. Those with qualifying life events can sign up outside of the open enrollment window.

The Trump administration halved the federal open enrollment period this year, which will run from Nov. 1 to Dec. 15, but California has opted to keep a three-month sign-up window.

The federal government has also reduced cost-sharing subsidies that help people afford insurance, but California has worked to buffer any price increase for consumers.

There will be a 12.5 percent surcharge on silver level plans in Covered California next year, but many enrollees in those plans won’t actually have to pay more because they receive financial assistance on their premiums, Wright said.

“90 percent of people in Covered California are getting financial help,” he said.

Those who are affected by the surcharge can either shop for a new plan on Covered California or go outside the exchange to purchase insurance. Equivalent plans outside the exchange will not have the surcharge, Wright said.

About 300,000 Californians with Anthem Blue Cross plans will need to shop for a new plan this enrollment season, because the insurance giant is pulling out of most of the state’s individual markets. The insurer will still offer employer-sponsored plans.

State lawmakers recently enacted protections for those who need to shop for new plans while they are undergoing treatment.

Senate bill 133, signed by Gov. Jerry Brown earlier this month, will require insurers to allow patients who are in the middle of treatment for certain conditions to see their same doctors for up to a year, even if the patients are forced to switch health plans.

The law, which takes effect Jan. 1, protects patients who are undergoing chemotherapy, who are pregnant, have surgery scheduled or are being treated for a number of conditions.

These patient protections already exist for people with group insurance plans, such as those through employers, for example, but SB 133 extends the law to cover those in individual plans, like those sold through Covered California.

“The consumer will be able to keep seeing the same doctors and pay what the in-network fee is,” even if the doctors aren’t in their new plan’s network, said Tam Ma, legal and policy director for Health Access.

Many consumers will be relying on insurers’ doctor directories, which are lists of providers that are in the plans’ networks, to decide between health plans this year, said Betsy Imholz, special projects director for Consumers Union.

The fact that these doctor lists are still frequently inaccurate could complicate insurance enrollment and health care access. If consumers want to make sure that a certain doctor or hospital is in an insurers’ network, they can call the provider directly to check, she said.

Even those who don’t need to shop for new health coverage may want to look at the options available this year, and compare prices and benefits, Imholz said.

With all of the changes in the insurance market, “people will be well advised to shop around,” she said.

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