Citing market uncertainty, Anthem Blue Cross will no longer offer health insurance plans on the Covered California exchange for Santa Barbara County as of Jan. 1, the company announced this week.
In all, Anthem is withdrawing from 16 of California’s 19 Covered California regions, where it currently serves about 153,000 consumers, according to state health officials.
Anthem’s departure won’t have any impact on 2017 plans, but people enrolled in Covered California Anthem plans in Santa Barbara County will have to choose a new plan for 2018.
It also means there will probably be only one insurance company — Blue Shield — offering plans through the exchange next year in Santa Barbara County.
This could have a huge impact on Covered California consumers who use providers at Sansum Clinic, which has 23 primary, specialty and urgent care clinics on the South Coast.
Anthem is the only Covered California plan that is in-network for Sansum providers, and has been since the exchange started in 2014.
“We just learned about this yesterday,” Sansum spokeswoman Jill Fonte said Wednesday.
“We don’t know what other companies will be offering plans in our region. Historically, it has been Blue Shield. We don’t know if there will be a new entrant.”
Fonte said it was unlikely that Sansum would get quick clarity on the situation.
“Once we know what options are available, we will work with those plans to try and get a contract so that continuity of care will be preserved,” she said.
It’s too early to know what the local impacts will be, but if no agreement with Blue Shield can be made, Covered California consumers would theoretically have to pay out-of-network costs for all Sansum Clinic visits, or find new providers to get in-network rates.
As of March, Covered California had 17,020 enrollees in Santa Barbara County, which includes Anthem and Blue Shield plans.
In a statement announcing the pullout, Anthem blamed the move, in part, on uncertainty over whether the Trump administration would maintain the Affordable Care Act’s federal subsidies for insurers.
“The market for these plans has become unstable,” said Brian Ternan, Anthem’s president. “With federal rules and guidance changing, it’s no longer possible for us to offer some of those plans.
“This was not an easy decision for us. We know that changes like these can have a real impact on the people we serve.”
No changes are in store for 2017, and Anthem leaving the exchange will not affect people with Anthem employer-based insurance, Medicare Advantage, Medicare Supplement, Medi-Cal, or individuals and families whose plans are “grandfathered,” meaning they were purchased prior to March 23, 2010, according to the company.
Consumers in the Central Coast region — Santa Barbara, San Luis Obispo and Ventura counties — who buy health insurance through the Covered California exchange will have the option of Blue Shield PPOs and for part of the region, Blue Shield HMO or Kaiser Permanente HMO plans in 2018.
For the current year, Santa Barbara County consumers had the options of Anthem and Blue Shield PPO plans.
Blue Shield is expanding its HMO plan coverage to a larger part of the Central Coast region for 2018, according to Covered California, but the expansion will not include Santa Barbara County.
Many states have been struggling with “bare counties,” where there are no state exchange plan options, but all California counties have at least one choice, Covered California officials said Tuesday.
Open enrollment for 2018 starts Nov. 1.
Covered California Rate Changes
Covered California plan premiums are expected to increase an average of 12.5 percent next year.
Some consumers can reduce that to a 3.3-percent increase if they switch to a lower-priced plan in the same metal tier, officials said Tuesday.
Subsidies are linked to the price of the silver plans, so those amounts could increase as premiums do, they noted.
There is uncertainty about the continuation of cost-sharing payments, which health insurance companies are required by the Affordable Care Act to offer to low-income consumers, with the federal government reimbursing the companies for the balance.
“While health plans are required to help these consumers lower their out-of-pocket costs, those payments are in jeopardy because the administration has stated it will only commit to making these payments on a month-to-month basis,” Covered California officials said Tuesday.
Congress has pursued numerous legislative moves to partially repeal or revise the health-care reforms enacted with the Affordable Care Act, also known as Obamacare, in recent months, but no changes have been approved.
Last week, the Senate rejected a partial repeal measure, a bill that proposed, among other things, ending the Affordable Care Act’s individual mandate and the employer mandate for health insurance coverage.
— Noozhawk managing editor Giana Magnoli can be reached at gmagnoli@noozhawk.com. Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.
Covered California Consumer Choice 2018