People who live in rural Northern California聽will see more choice and competition in the health insurance marketplace next year, giving consumers a better chance of finding a plan 鈥� and a聽doctor 鈥斅爐hat can meet their needs.
The changes, unveiled聽last week by the state鈥檚 Affordable Care Act marketplace Covered California, will now allow some consumers to cross state lines for care. That means Californians living聽near the Oregon or Nevada borders can get subsidies to聽buy聽plans that pay for routine care in those states, something that previously was allowed only in emergencies.
In addition, all聽22 counties that had areas with only one choice of insurer in 2015 and 2014聽will now have at least three insurers selling plans.
Northern California customers may notice a jump in their premium costs next year, however. Region-wide, they will have a 10.6聽percent聽increase over this year, while the statewide average increase is 4聽percent.
Lori Lomas, an insurance agent with Feather Financial in Quincy, Calif., welcomes the increased choices聽Covered California will have for mountain communities in 2016. 聽(Photo by Pauline Bartolone)
Lori Lomas, a health insurance agent with Feather Financial in Quincy, California, said not being able to travel to Reno, Nevada for medical care has been聽a hardship for many of her clients who live in isolated communities in the Sierra Nevada mountains.
鈥淚t鈥檚 disrupted their care,鈥� she said. 鈥淚t鈥檚 affected people鈥檚 relationship with their doctors and it鈥檚 affected their trust in their insurance companies, big time.鈥�
Next year, the two major insurers in the area, Anthem Blue Cross and Blue Shield of California, will offer聽routine out-of-state doctor coverage in 2016 individual policies.
A minimum of three insurers will be offering plans in each zip code of a 22 county region,聽a聽vast rural area that stretches south from the border of Oregon to the Sacramento County line. Two additional聽insurers will be selling in some parts of the area.
Anthem Blue Cross, which has 91.7聽percent聽of the health exchange鈥檚 market share in the Northern California region, says it made the decision to reinstate out-of-state coverage after hearing from consumers that they wanted the benefit.
鈥淎t the earliest opportunity to make substantive changes to our Covered California policies, we did,鈥� says Darrel Ng, spokesman for Anthem Blue Cross.
Consumer demand also motivated Blue Shield of California to expand into areas where they had retreated from in 2014. Before new market rules under the Affordable Care Act, it had sold individual policies in all areas of the state. After January 1, 2014, it stopped selling in about 250 zip codes, including vast areas of Northern California, in order to keep 鈥減remiums low.鈥�
The company now says that decision 鈥渃reated a lot of disruption in the marketplace,鈥� and in 2016, the company will be selling again in all zip codes.
鈥淲e鈥檝e been able to now provide a network that would support us offering coverage in those zip codes that we didn鈥檛 have covered in 2015,鈥� said Jeff Smith, General Manager and Vice President for Individual and Family Plans for Blue Shield of California.
In the individual market next year, the company will be offering statewide preferred provider organizations (PPOs) and will discontinue the exclusive provider organizations聽(EPOs) offered this year, which restricted coverage to doctors only in a fixed geographic area.
Covered California would not comment on how its negotiations with insurers may have influenced the companies鈥� decision-making, but the exchange says it is pleased that consumers will more choices next year.
鈥淚t鈥檚 no secret that Covered California looked to plans to expand and provide stronger and more comprehensive value to consumers, 鈥� says Dana Howard, Deputy Director of Communications for Covered California.
United Healthcare and Health Net聽will also be selling policies in Northern California next year. Covered California consumers may take a good look at those new options next open enrollment period. Lomas says the restricted doctor coverage and Blue Shield鈥檚 black out in certain zip codes had聽given the two companies a 鈥渂ad name.鈥�
鈥淣ow I鈥檓 going to show people the screen and it will be [more] choices for everyone,鈥� says Lomas about the next open enrollment period.
In some areas of Northern California, health insurance shoppers will see even more options.