By Here’s what the 1.5 million Californians with individual coverage can expect in 2021. In a nutshell: expect premium increases across the 11 Covered California insurers to average less than 1%.
With new regulatory rules in place, employers have more flexibility to reimburse employees with cash-for coverage, meaning they can reimburse their teams for individual marketplace health plans. This is great news!
Here are the details on the two latest HRAs.
- ICHRA- individual coverage HRAs are going to be a game-changer. They are a flexible, customizible, tax-free option. Employees choose any plan they want from the individual marketplace to qualify for participation.
- EBHRA- excepted benefits HRAs allow for higher levels of employer contributions than flexible spending arrangements (FSAs) and the unused funds can rollover year to year. These can be used to cover the cost of copays, deductibles, or other costs not covered by the plan.
- QSEHRA- no longer the new kid on the block, this HRA has steadily grown in popularity.
Short term plans are also a new option, as of last year.
These short term, limited duration plans (STLDs) come with more restrictions, such as limits on preexisting conditions, and offer less coverage (i.e., good bye well-visits and maternity coverage), but their lower price point can be attractive to those that are relatively healthy and looking for more affordability.
Some things haven’t changed:
Doctor networks continue to stay small: An ongoing trend since the start of Obamacare, many plans will cover an increasingly smaller percentage of doctors in a given area. That leaves the consumer with fewer choices and a greater chance of having to go out of network to get the care they need. This is a strategy used by carriers to keep costs down, but it leaves consumers financially vulnerable for shouldering those scary and sky-high out-of-network costs. It’s always smart to check every year if your doctor will remain on your network.
Premiums are still really expensive: While premiums decreased by 4% across the board, according to CMS, they are still too expensive for those who don’t qualify for premium tax credits to off-set the costs. We see markets stabilizing and more and more options designed to help individuals afford health insurance. Here are a few things to keep in mind that are new to 2021 or in the past year.
When to enroll: Open enrollment for 2021 coverage will run from October 15, 2020 to January 15, 2021. Remember: California has permanently adopted this three-month schedule.
California is lucky to have one of the largest number of carriers in the individual market. California is divided into 19 pricing regions, each with different pricing and health insurance options. Nearly all Covered California consumers have at least three health insurance companies to choose from in their region, and in some regions as many as seven.
If you’re looking for a faster way to pull up the plan options in your zip code use Take Command Health’s plan search tool. Our online tool will help you search plans that include your favorite doctors in network!
Know your alternatives: who’s available in California in 2021
Anthem Blue Cross will expand its health insurance offerings in the Central Valley and return to the Central Coast, Los Angeles County and the Inland Empire, (returning to several areas of the state after exiting them at the end of 2017)
Blue Shield of California
Expanding into parts of Kings, Fresno, Tulare, and Riverside counties
Chinese Community Health Plan
Expanding to cover all of San Mateo County
Health Net
Health Net offers HMO, PPO, EPO, and HSP (Healthcare Service Plans) through Covered Calfornia. Plan availablility varies by region. Approximately 13% of CA state insurance exchange enrollees are covered through HealthNet.
Kaiser Permanente
One of the top 3 insurance options in the state exchange- over 24% of Covered California enrollees choose Kaiser Permanente. Kaiser HMO plans are available throughout California.
L.A. Care Health Plan
L.A. Care Health Plan covers the Northeast and Southwest Los Angeles regions with their HMO plans.
Molina
Molina offers HMO plans to 6 regions of California: Eastern region, L.A. county- northeast and southwest, the Inland Empire, and San Diego county. Molina has a history of competitive pricing which makes them a desirable option for consumers.
Oscar Health Plan of California
Joined the exchange in 2016; Oscar offers EPO plans to the regions encompassing San Francisco county, L.A. county (southeast and northwest) and Orange county.
Sharp Health Plan
Sharp Health Plan covers San Diego and the Southern Riverside areas with their HMO plans. Enrollees have two options with Sharp: Premier Network (copay plan) or Performance Network-Network 2 (coinsurance plan).
Sutter Health Plus
Valley Health Plan
Valley Health Plan offers HMO plans to Santa Clara County.
Western Health Advantage
Western Health Plan offers HMO and Health Savings HMO plans to individuals in Sacramento, Yolo, Solano, El Dorado, Placer, Marin, Napa, and Sonoma counties.
Affordable Alternatives You Should Know About
An increasing number of our customers are opting for alternatives to traditional insurance. Here’s a couple of our top picks. They might not be for everyone, but they are worth checking out and comparing to major medical plans on our platform.
Pivot short term plans: Pivot provides short term medical insurance solutions until a qualified major medical health plan is chosen, helping reduce your financial risk. Pivot plans are renewable 90 day plans which in most states can be automatically renewed 4 times without additional medical screening to provide up to 12 months of continuous coverage.
Faith-based: Faith-based Medi-Share has a state-wide PPO network available in 2020 managed by PHCS (Private Healthcare Systems, now owned by Multiplan). It’s smaller than some of the PPO networks in the past, but it does provide flexibility to see your doctors and will cover out-of-network expenses as long as it meets Medi-Share’s faith-based guidelines. Medi-Share won’t be for everyone, but is a worthy option to consider if it fits your personal convictions and lifestyle. Make sure to check out our Medi-Share review and compare it to other major medical plans on our website before you enroll.
Next steps: What’s my best option?
While more choices are a welcome change, hunting down and comparing all of these options can feel overwhelming. However, at TakeCommandHealth.com we help you compare all of your options side-by-side including off-exchange plans, marketplace plans, and faith-based options. You can use our award-winning tools to check your prescriptions, and even simulate conditions and health needs to make sure you get the most of for your money.
With growing demand, we’ve also put together a bigger support team ready to help you tackle any issue. You can get started by chatting with us on our website or emailing us at support@takecommandhealth.com.
Once open enrollment begins, you can visit our website and we’ll walk you through your options. Our goal is to help you get the most out of your money and find the plan that really works for you and your family. Remember you have until Dec 15th to select a plan that starts Jan 1st, 2021.
Extra perks with Take Command Health
We’ve negotiated some pretty awesome deals for our members. Call a doctor 24/7 for $0, enjoy medical bill negotiation support, a personal health advocate, dental, vision, and pharmacy discounts, etc. These really help save money with some of the higher deductible plans.
