State health care exchange unveils cost estimates

6:49 PM, Feb 13, 2013   |    comments
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Physician assistant Jaime Lopez

California has been the most aggressive state in implementing the 2010 federal health care law, and now is again first at laying out some of the ground rules for insurance companies... and some of the costs for consumers.

"We're starting to educate Californians about the new health insurance world we'll all be facing," said Peter Lee, executive director of Covered California, the state health insurance exchange created under the federal law.

Estimates are that 8.8 million Californians will be eligible to buy insurance using the exchange, which acts as a kind of official insurance broker -- and one that drives a hard bargain.  On Wednesday, officials rolled out on the first information on annual out-of-pocket costs, and announced that insurers will be required to offer easy-to-compare standardized plans at four different cost levels, from generous benefits for those that want to pay more... down to a plan that would be considered catastrophic-only coverage.

"All Californians will benefit from having a standard benefit design," said Lee.  "Come January 1, 2014, they can make apples to apples decisions about choosing between health plans."

State officials also unveiled an online calculator (see it here) for consumers who will use the exchange to get a sense of what their health care costs will be under the federal mandates that kick in next year.

Not all Californians will be eligible to use the exchange, and officials make clear that no one will be required to use it.  Those eligible include those who get insurance through a small business, those whose income qualifies them for a federal subsidy, and those currently -- for whatever reason -- uninsured.

The subsidies are not just for the working poor.  Officials say that a family of four whose adjusted income is 400 percent of the federal poverty level -- $94,200 a year -- would receive a permanent monthly insurance subsidy.  Those who earn much less will receive the most affordable insurance coverage.

"For a low-income Californian," says Covered California's Lee, "that might mean that they can see a four dollar [doctor's] office visit, less than a bus ride."

More information about the cost of premiums is expected in June. And the competition for affordable coverage with transparent pricing could drive health care for more than just those who use the exchange.  The California program would comprise one of the largest pools of health care patients in the nation, and officials say 33 insurance companies have signed up to vie for one of the spots in the program.


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