Monday, August 21 , 2017, 7:16 am | Overcast 66º

 
 
 
Your Health: A Noozhawk partnership with Cottage Health

Anthem Blue Cross Quitting Covered California Market in Santa Barbara County in 2018

Insurer cites uncertainty over continued federal subsidies as state health insurance exchange forecasts 12.5% average increase in plan premiums next year

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 .(JavaScript must be enabled to view this email address). Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.

Covered California Consumer Choice 2018

  • Ask
  • Vote
  • Investigate
  • Answer

Noozhawk Asks: What’s Your Question?

Welcome to Noozhawk Asks, a new feature in which you ask the questions, you help decide what Noozhawk investigates, and you work with us to find the answers.

Here’s how it works: You share your questions with us in the nearby box. In some cases, we may work with you to find the answers. In others, we may ask you to vote on your top choices to help us narrow the scope. And we’ll be regularly asking you for your feedback on a specific issue or topic.

We also expect to work together with the reader who asked the winning questions to find the answer together. Noozhawk’s objective is to come at questions from a place of curiosity and openness, and we believe a transparent collaboration is the key to achieve it.

The results of our investigation will be published here in this Noozhawk Asks section. Once or twice a month, we plan to do a review of what was asked and answered.

Thanks for asking!

Click here to get started >

Support Noozhawk Today

You are an important ally in our mission to deliver clear, objective, high-quality professional news reporting for Santa Barbara, Goleta and the rest of Santa Barbara County. Join the Hawks Club today to help keep Noozhawk soaring.

We offer four membership levels: $5 a month, $10 a month, $25 a month or $1 a week. Payments can be made through PayPal below, or click here for information on recurring credit-card payments.

Thank you for your vital support.



 

Special Reports

Heroin Rising
<p>Lizette Correa shares a moment with her 9-month-old daughter, Layla, outside their Goleta home. Correa is about to graduate from Project Recovery, a program of the Santa Barbara Council on Alcoholism & Drug Abuse, and is determined to overcome her heroin addiction — for herself and for her daughter. “I look at her and I think ‘I need to be here for her and I need to show her an example, I don’t want her to see me and learn about drugs’,” she says.</p>

In Struggle to Get Clean, and Stay That Way, Young Mother Battles Heroin Addiction

Santa Barbara County sounds alarm as opiate drug use escalates, spreads into mainstream population
Safety Net Series
<p>Charles Condelos, a retired banker, regularly goes to the Santa Barbara Neighborhood Clinics for his primary care and to renew his prescription for back pain medication. He says Dr. Charles Fenzi, who was treating him that day at the Westside Clinic, and Dr. Susan Lawton are some of the best people he’s ever met.</p>

Safety Net: Patchwork of Clinics Struggles to Keep Santa Barbara County Healthy

Clinics that take all comers a lifeline for low-income patients, with new health-care law about to feed even more into overburdened system. First in a series
Prescription for Abuse
<p>American Medical Response emergency medical technicians arrive at Santa Barbara Cottage Hospital with little time to spare for victims of prescription drug overdoses.</p>

Quiet Epidemic of Prescription Drug Abuse Taking a Toll on Santa Barbara County

Evidence of addiction shows an alarming escalation, Noozhawk finds in Prescription for Abuse special report
Mental Health
<p>Rich Detty and his late wife knew something was wrong with their son, Cliff, but were repeatedly stymied in their attempts to get him help from the mental health system. Cliff Detty, 46, died in April while in restraints at Santa Barbara County’s Psychiatric Health Facility.</p>

While Son Struggled with Mental Illness, Father Fought His Own Battle

Cliff Detty's death reveals scope, limitations of seemingly impenetrable mental health system. First in a series