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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.


Covered California Benefit Plan Designs

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Question: You have posted some Covered California benefit plan outlines. Are these pretty much what qualified plans in the Exchange will look like?

Answer: The Covered California benefit plan designs are preliminary and meant for discussion only at this time. The deductible, co-payment and coinsurance mix, are subject to adjustment after the release of the federal actuarial value calculator. But these plans provide us with a perhaps “quarter-final” look at how Covered California is trying to balance the cost-sharing variables within the ACA framework of essential health benefits and actuarial value guidelines. Notice that HMO Plans are called Copay Plans and PPO plans are called Coinsurance Plans in the Exchange.

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I had hoped to see copays similar to those charged by medium and large employer plans. Typical 15 minute office visit copay is $20. Most generic drugs are already $4 without a prescription plan. For covered drugs generics are often $10 while branded medications typically cost $25-50.

Lab and Radiology copays were a major surprise. Even when I worked for a small company the lab and radiology copays were $0.

Usually hospital stays are free and outpatient surgery copay equal to an office copay when performed in an office and $100 when performed at an outpatient surgery center. The premium cost and the extremely higher copays, hospital, lab and radiology copays make getting sick while covered by these plans expensive. All of them are at best disaster coverage.

Why doesn’t California offer a non profit state govt run plan? I still don’t see the wisdom or morality of allowing profiteering on the misery of others.

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