Local ‘Covered California’ patients have just one choice in 2019

By Giana Magnoli

Noozhawk Managing Editor

Residents planning to sign up for health insurance through the Covered California exchange have few choices for 2019, as Blue Shield continues to be the only company offering plans in Santa Barbara County.

The period of open enrollment for the state-run exchange ends Jan. 15 for 2019 coverage.

While the Central Coast region is served by three types of plans — Blue Shield PPO, Blue Shield HMO and Kaiser Permanente plans — Santa Barbara County only has Blue Shield PPO plans available for purchase through Covered California.

Anthem Blue Cross pulled out of Santa Barbara County and most California markets for the 2018 year, and now only serves 5 percent of state exchange consumers. Blue Shield enrollment makes up 32 percent of statewide enrollment and Kaiser, which covers parts of Ventura County, serves 33 percent.

Most plans through the exchange will have net premiums rise an average of 6 percent in 2019 from 2018 prices, according to Covered California, and the increase reportedly is partly due to eliminating the individual mandate penalty and concerns about decreasing enrollment.

Insurance companies increased rates 2.5 to 6 percent “due to concerns that the removal of the penalty will lead to a less-healthy and costlier consumer pool,” according to the state.

However, the rates were expected to increase an average of 5 percent next year anyway, according to Covered California.

Unsubsidized customers buying Covered California plans will see the largest increases, since subsidized consumers will be shielded with higher tax credits to offset the hikes, at least partially, according to the state.

There are only 4,550 enrollees in Covered California health insurance plans in 2018, as of February, with most people choosing bronze and silver plans, which have lower premiums and are designed for lower use.

Sansum Clinic providers will be in-network for Blue Shield Covered California plans next year, spokeswoman Jill Fonte said.

When the Affordable Care Act went into effect in 2014, Sansum Clinic’s 23 primary, specialty and urgent care clinics on the South Coast only accepted Anthem Blue Cross Covered California plans, not Blue Shield.

The organization negotiated an agreement last November to accept Blue Shield after Anthem pulled out of the market for the 2018 year.

There are many ways for residents to get help signing up for insurance, through certified enrollment counselors and insurance agents, and local resources can be found online here.

The Covered California website has a provider directory to help enrollees find in-network providers and hospitals, though it is worth noting that, generally, physicians are not directly employed by hospitals and may bill patients separately.

Cottage Health has its own team of enrollment counselors who can also answer questions about which providers are in-network for insurance plans, spokeswoman Maria Zate said.

The counselors can be reached at 805-569-7410 Monday through Friday, 8:30 a.m. to 6 p.m., and on Saturdays from 8 a.m. to 6 p.m., she said.

Residents with questions about patient billing at the Lompoc Valley Medical Center can call the main line at 805-737-3300, spokeswoman Nora Wallace said.

Marian Regional Medical Center in Santa Maria, a Dignity Health facility, has a billing information page at www.dignityhealth.org.

Most local residents get their health insurance through their employers, or through Medi-Cal, the California branch of the federal Medicaid system for low-income residents.

CenCal Health administers Medi-Cal for Santa Barbara and San Luis Obispo Counties, and as of Sept. 30, had 176,852 people enrolled, CEO Bob Freeman said.

“We expect Medi-Cal enrollment to be essentially flat with a slight trend downward,” he said of 2019 rates. “This is likely because of the currently robust economy.”

The Medi-Cal program was expanded in 2014 under the Affordable Care Act, and covers low-income adults, families with children, seniors, people with disabilities, pregnant women, children in foster care and former foster youth up to age 26, who are citizens or legal residents, according to CenCal.

Enrollment for Medi-Cal is year-round but a Covered California application during open enrollment will also check a person’s eligibility for Medi-Cal.

Medi-Cal applications are available online at www.mybenefitscalwin.org or by visiting Santa Barbara County Department of Social Services offices.

A 2016 survey for Cottage Health’s Community Health Needs Assessment found 88.7 percent of Santa Barbara County residents had health insurance, compared to 85.2 percent of Californians.

“The chart shows that people without health insurance are more likely than others in Santa Barbara to report only fair or poor health, to report binge drinking, and to experience both housing and food insecurity,” the assessment summary says.

“A notably smaller percentage of people with the lowest level of educational attainment (less than a high school degree) and in the lowest income category had no health insurance, possibly because they work in jobs that do not provide it or cannot afford the employee contribution to the premium, if they are working at all.”

Another 2016 survey, for the county Public Health Department’s Community Health Assessment, found 59 percent of its 2,927 respondents had employer-based health insurance, 15 percent had Medi-Cal, 8 percent had Medicare, 6 percent had private insurance, 3 percent had Covered California plans, 7 percent had no insurance, and some people had more than one type of insurance.

 

Noozhawk managing editor Giana Magnoli can be reached at gmagnoli@noozhawk.com.