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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

Rates in the Exchange vs Non-Exchange

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Question: In my conversation with my carrier rep, I was told that they anticipate the exchange individual plans to be more expensive than their plans outside of the exchange. Why?

Answer: That is incorrect. The Exchange is very aware that adverse selection is one of the greatest threat its success. To the extent that rules (including premiums) are different outside the Exchange versus inside, there is room for market manipulation. In fact, the ACA addresses this issue definitely. “A qualified health plan means, among other things, a plan offered by a health insurance issuer that agrees to charge the same premium rate for each qualified health plan it offers without regard to whether the plan is offered through an Exchange or whether the plan is offered directly from the issuer or through an agent. (See ACA § 1301(a)(1)(C)(iii), 42 USC §18021(a)(1)(C)(iii))

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