health insurance

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Report: California State Employees Get Relatively Generous Health Insurance

(Getty Images)

(Getty Images)

SACRAMENTO, Calif. (AP) — Health insurance plans offered to state employees in California and elsewhere are relatively generous, with government picking up a large share of deductibles and co-pays, according to a report released Tuesday.

The report by The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation was a first-of-its kind survey of state government health insurance plans nationwide. It found that state plans paid on average 92 percent of a typical enrollee’s health care costs, which is equivalent to the best offerings — “platinum” plans — that the public can purchase on one of the new health insurance exchanges.

In California, Pew found that figure was 95 percent and that 68 percent of plan members had no annual deductible.

Putting the report into a broader context that can make the data easily understood is difficult. Continue reading

On California Exchange, Only Kaiser’s Rates Will Go Down in 2015

Kaiser Permanente's lower rates on the California health exchange for 2015 may be meant to attract customers. (Ted Eytan/Flickr)

Kaiser Permanente’s lower rates on the California health exchange for 2015 may be meant to attract customers. (Ted Eytan/Flickr)

As all the other health insurers on California’s Obamacare exchange raise their rates for next year, Kaiser Permanente plans to lower them.

The Los Angeles Times reports that a new analysis by Citigroup shows Kaiser’s premiums dropping by 1.4 percent in 2015.

At the same time, the average premium across all plans on the Covered California exchange will rise 4.2 percent.

Citigroup health care analyst Carl McDonald told the Times he thinks Kaiser’s move is meant to draw customers: Continue reading

State Reconsiders Letting Catholic Universities Limit Abortion Coverage

Santa Clara University's employee health insurance will stop covering 'elective' abortions next year unless state officials change their minds. (Michael Zimmer/Flickr)

Santa Clara University’s employee health insurance will stop covering ‘elective’ abortions next year unless state officials change their minds. (Michael Zimmer/Flickr)

By Grace Rubenstein and Mina Kim

State officials are reviewing whether they made the right call when they approved health plans that limit abortion coverage.

California law has strongly protected abortion rights for decades. But in recent years, the state’s Department of Managed Health Care — which oversees health insurance — has approved a handful of plans that exclude coverage for “elective” abortions. That is, abortions that aren’t necessary to protect the health of the mother.

Those insurance-plan approvals occurred quietly, with little public attention. Until last year, when officials at two Catholic universities, Santa Clara University and Loyola Marymount in Los Angeles, told faculty and staff that the schools would now only cover abortions that are “medically necessary” for the mother’s health. State officials had approved those insurance plans.

The decision surprised and angered hundreds of Santa Clara faculty members, who tried and failed earlier this year to get the school’s Board of Trustees to reverse the decision. And it also appeared to reverse decades of legal precedent in California. Now, officials from the Department of Managed Health Care say they’re going back and reviewing the policy.
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Explaining the Health Insurance ‘Explanation of Benefits’

By Lynne Shallcross

We are wrapping up the first phase of our PriceCheck project. The goal is to shine a light on costs of common health care procedures in California. We’re starting with screening mammograms, and already we’ve found that the cash price (for people who are uninsured or have gone out of network) varies from a low of $60 at the H. Claude Hudson Comprehensive Health Center in Los Angeles, a county-run clinic, to $801 at U.C. San Francisco on the high end.

Together with KPCC in Los Angeles and ClearHealthCosts.com, we’re also asking you, the members of our community, to share what you’ve been charged — and what your provider has been paid — for common health procedures.

In order to do that, you need to get familiar with your insurance company’s “explanation of benefits” or EOB. That’s the form your insurer sends to explain what was paid, to whom, at what level and why.

Here’s a typical EOB, that we’ve marked with some explanations below:

An explanation of benefits from Anthem Blue Cross.

An explanation of benefits from Anthem Blue Cross.

Continue reading

Covered California Questions Health Insurance Initiative

Covered California executive director Peter Lee, seen here at a November, 2013, press conference. (Max Whittaker/Getty Images)

Covered California executive director Peter Lee, seen here at a November, 2013, press conference. (Max Whittaker/Getty Images)

UPDATE: June 20

KQED’s April Dembosky attended the Covered California board meeting Thursday afternoon where the board expressed concern that a voter initiative on the upcoming November ballot could compromise its authority. The initiative would give the state’s insurance commissioner the authority to reject excessive rate increases in health insurance premiums.  But Covered California already negotiates rates with insurance plans. How would the initiative, if passed, affect Covered California?

Covered California board member Susan Kennedy called on agency staff to conduct an intensive analysis of the initiative’s potential impact Covered California’s ability to operate — and to get it done soon.
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Insurance Commissioner Defends Health Insurance Initiative

Dave Jones leads the California Department of Insurance. (Courtesy: Department of Insurance)

Dave Jones leads the California Department of Insurance. (Courtesy: Department of Insurance)

In this lull between the end of the first open enrollment for Covered California and the release of rates for next year — expected to be made public in July — San Francisco’s Commonwealth Club invited the state’s Commissioner of Insurance Dave Jones to talk about the state of the health care overhaul in California.

The commissioner closed his remarks by pitching for the rate review ballot initiative coming up in November. As moderator of the discussion following, I fielded several questions from the audience about the upcoming initiative. To recap the basics: If passed, the initiative would give the insurance commissioner the authority to reject excessive health insurance rate increases.

The insurance commissioner already has that authority over auto, homeowner, property and casualty insurance — via voter-passed Proposition 103 back in 1988. Many voters are surprised, Jones said, to find out he cannot also reject health insurance premium increases.  He called this lack of explicit authority a “major missing piece of the Affordable Care Act.” Continue reading

Why Are Nearly All Covered California Enrollees in Just Four Plans?

Certified specialist helps a consumer apply to Covered California at a free enrollment fair at Pasadena City College. (David McNew/Getty Images)

Certified specialist helps a consumer apply to Covered California at a free enrollment fair at Pasadena City College in November. (David McNew/Getty Images)

By Dan Diamond, California Healthline

Anthem Blue Cross had 1,591 people use Covered California to get subsidies and sign up for its health plans in October.

Valley Health Plan had five.

That data point’s taken from a Covered California release that offers some of the first insight into the makeup of early enrollees through the exchange and which plans they’re picking. And while it’s hardly fair to directly compare the two issuers — Anthem has a presence in all 19 of Covered California’s regions, whereas Valley is only offering plans in Santa Clara County — the contrast is eye-catching.

It’s also telling. The biggest players, so far, are getting enormous market share from Covered California’s customers. The smaller plans are seeing a trickle.

So Far, Exchange Strengthens Market Position of Large Plans Continue reading

Thousands Of Consumers Get Insurance Cancellation Notices Due To Health Law Changes

Insurers say some of their policies do not meet the standards required by the Affordable Care Act and must be dropped. (Getty Images)

Insurers say some of their policies do not meet the standards required by the Affordable Care Act and must be dropped. (Getty Images)

By Anna Gorman and Julie Appleby, Kaiser Health News

The main reason insurers offer is that the policies fall short of what the Affordable Care Act requires starting Jan. 1. Most are ending policies sold after the law passed in March 2010.  At least a few are cancelling plans sold to people with pre-existing medical conditions.

By all accounts, the new policies will offer consumers better coverage, in some cases, for comparable cost — especially after the inclusion of federal subsidies for those who qualify. The law requires policies sold in the individual market to cover 10 “essential” benefits, such as prescription drugs, mental health treatment and maternity care. In addition, insurers cannot reject people with medical problems or charge them higher prices. The policies must also cap consumers’ annual expenses at levels lower than many plans sold before the new rules.

“I don’t feel like I need to change, but I have to.”

But the cancellation notices, which began arriving in August, have shocked many consumers in light of President Barack Obama’s promise that people could keep their plans if they liked them.

“I don’t feel like I need to change, but I have to,” said Jeff Learned, a television editor in Los Angeles, who must find a new plan for his teenage daughter, who has a health condition that has required multiple surgeries.

An estimated 14 million people — 2 million of them in California — purchase their own coverage because they don’t get it through their jobs. Calls to insurers in several states showed that many have sent notices. Continue reading

For Legal Immigrants, Obamacare Has Options for Aging Parents

A view of the the Statue of Liberty. (Timothy Clary/AFP/Getty Images)

A view of the the Statue of Liberty. (Timothy Clary/AFP/Getty Images)

Mohan Iyer has been in a bind. He’s lived in the U.S. since he came here for college from India in 1980. He ultimately got a job, a green card and became a citizen in 1994. Most of his siblings live here now, too.

After his father passed away two years ago, Iyer and his siblings have wanted their mother to move here. But there’s one big problem: she is effectively barred from any kind of reliable health insurance.

“Health care has been a big issue,” said Iyer, who is 50 and lives in Menlo Park.

New immigrants of any age can purchase health insurance on Covered California
That’s because new immigrants over age 65 are not eligible for Medicare. For legal immigrants like Iyer, who are people of working age, the impossibility of obtaining health insurance for their parents has been a barrier in their hopes of moving aging parents or grandparents to the U.S.

Americans over 65 tend not to worry much about health insurance, because of Medicare, the government insurance program for the elderly and the disabled. But while Medicare is available to virtually all citizens, starting at age 65, immigrants legally present in the U.S. for less than five years are not eligible.

And because of the very existence of Medicare, private insurance companies generally do not offer health insurance plans for those over 65. “There are health insurance options,” Iyer said, “but these are usually catastrophic traveler’s insurance. They usually have a very high deductible and they’re expensive.”

They also tend to exclude pre-existing conditions, he said. Continue reading