Many unknowns remain about exchange

Health insurance brokers, employers and individuals are all eagerly awaiting full-scale implementation of the California Health Benefits Exchange, a centerpiece of the Affordable Care Act, but it's still anyone's guess as to what it will look like.

While details of what the exchange, also known as Covered California, will look like have emerged recently, a key piece of just how effective it will has not yet been determined: the monthly premiums for plans that will be offered to individuals and employers.

[caption id="attachment_72289" align="alignleft" width="180"] Victor McKnight[/caption]

"People are confused," said Victor McKnight, a principle with EPIC Insurance in Petaluma.

Specifically, no clear answer has emerged to the question on everyone's mind as open enrollment season quickly approaches in October, when Covered California will launch with plans taking effect on Jan. 1, 2014: Should employers continue providing coverage for employees or should they opt out and send them to the exchanges, where they may be eligible for subsidies to purchase individual health plans?

Covered California has released a basic framework of how its plans will be structured. It will have a tiered system for its plans -- ranked by "metal levels" -- as such: Platinum level plans will have a coverage level of 90 percent by the health plan and 10 percent by the individual. Gold level plans will cover 80 percent of all costs and 20 percent will be paid by the policy holder. Platinum plans will have no deductible and doctors' visits would cost $25 (platinum) and $45 (gold). Silver plans cover 70 percent and will have a $2,000 deductible with $45 doctor visits, plus an additional $500 deductible for medication. Bronze plans will cover 60 percent and will have a $5,000 deductible for both medical and costs and prescription drugs.

The higher the level of the plan, the higher the monthly premium will be, but brokers and the exchange doesn't anticipate on getting an idea of the premiums by July 1.

A number of factors could dictate how much monthly premiums will cost, said Jordan Shields, a broker with The SSM Group, a division of United Benefits Advisers in Novato.

[caption id="attachment_72290" align="alignright" width="144"] Jordan Shields[/caption]

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