Beginning tomorrow, many Californians will be able to enroll in or switch health insurance plans through the state’s insurance exchange, Covered California. In its first six months, Covered California enrolled 1.1 million people in private insurance plans and 2.2 million in Medi-Cal. This year the goal is to further expand enrollment and reduce the number of uninsured in the state. The open enrollment period will last for three months, although people will have to enroll in private plans by December 15 for coverage to kick in on January 1, 2015, and those who are eligible for Medi-Cal can enroll year-round.
What has happened so far?
- California was one of the first states to implement the Affordable Care Act and set up its own exchange. Although there were some bumps along the way, the rollout was relatively smooth, and enrollment numbers were strong.
- Of the 1.1 million people who enrolled in private insurance plans, approximately 88% were eligible for federal subsidies to offset their out-of-pocket costs.
What’s different this year?
- In 2015, insurers and policymakers are hoping to enroll a large number of the estimated 3-5 million California residents with no insurance. A recent survey estimated that 30% of the remaining uninsured are undocumented immigrants, who are ineligible for ACA coverage.
- Covered California is trying to make enrollment easier by increasing staffing and hiring more workers who speak more than one language.
- Covered California monthly premiums will increase modestly—by around 4.2 percent, on average. Some premiums may increase by more than that, and some plans may become less expensive.
- The tax penalty for uninsured individuals will be considerably higher:
- In 2014, the penalty was 1.0% of household income or $95 per adult and $47.50 per child, whichever is greater.
- In 2015, it will be 2.0% of household income or $325 per adult and $162.50 per child, whichever is greater.
- Small businesses (with fewer than 50 employees) will be able to offer plans in two tiers through the Small Business Health Options Program (SHOP); they can also offer separate adult dental plans.
- The tax penalty for firms with 50 to 100 employees that do not offer insurance coverage has been delayed until 2016.
What to look for in the months ahead?
- Covered California is expecting to enroll around 500,000 people of all ages in private plans over the next few months. Policymakers are eager to enroll young adults (under 35) in insurance plans, because they are likely to be healthy, which will help keep premiums low and encourage insurers to enter the marketplace. Covered California has also allocated more than $100 million for Latino outreach.
- There is currently a backlog of Medi-Cal applications waiting for approval from the Department of Health Care Services. A big influx of new enrollees could create longer wait times. Department officials are working to improve the system that processes applications; to clear the backlog, it will begin granting temporary approval to applicants younger than 19 to speed up their enrollment.
- The U.S. Supreme Court will hear a challenge to the Affordable Care Act’s federal subsidy provisions next year. Because California does not participate in the federal insurance marketplace, it will not be directly affected by the court’s decision. But there could be significant implications for the program as a whole.
The Kaiser Family Foundation is a reliable source of information about enrollment specifics.