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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.

2015 Covered Ca Rates?

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Question: There’s confusing talk about how much Covered California will increase for the 2015 year. When will the new rates be published.

Answer: Rates will be public in early August. As of June 1st, Covered California has been receiving submissions from the insurers in the exchange. An evaluation process will follow, and then a negotiation process through the month of July. Peter Lee announced at the June board meeting that Ca rates will be public “first week in August”.


Anthem says it will no longer pay any commissions on health policies where an enrollee initially enrolled without an agent, but then who later designates an agent.

This is contrary to the commitment of Covered California for any enrollee to designate an agent (or change an agent) at any time.

Anthem expects designated agents to be uncompensated if Covered California Anthem plan enrollees who first enrolled without an agent later designate an agent for their Anthem plan, or any other Anthem plan.

Quite strange. Anthem desperate to cut-out agents getting compensated, it seems. Rather give the premiums to shareholders.

No commissions for Gold or Platinum plans? Who announced this and where did you see it? As I understand it, an insurer who wanted to do this would also have to stop paying commissions for its Bronze or Silver plans as well to avoid charges of discrimination. I have not seen such an announcement.

One national health insurer just announced that they will stop paying commissions to brokers on sales of Gold and Platinum plans. I assume that this is because those individuals who need the most medical care are buying into these low-deductible policies. Is this practice legal under the Affordable Care Act?

“There’s confusing talk about how much Covered California will increase for the 2015 year.”

The real confusion seems to be what Covered California actually is.

First, CoveredCA is NOT the provider of health insurance to anyone in the state of California, and as such, it has no “rates” to increase, decrease, or tread water.

Second, CoveredCA is a centralized place to view Premium Tax Credit Subsidy-eligible health plans available to a person/family in a given ZIP Code. A person who seeks Premium Tax Credits, by federal law, must purchase his/her insurance through the Health Benefits Exchange.

Third, and perhaps most important, CoveredCA is a collecting point for Medi-Cal applications from folks who do not earn enough money to be able to afford “affordable” health insurance.

What doesn’t CoveredCA do? It doesn’t have any authority to set, approve, or disapprove premiums for health insurance in the state of California. Even the Insurance Commissioner has never been given the authorization to reject proposed rates or rate increases. All the insurance commissioner may do is say to an insurer, “I believe your rates are too high, and you should reduce them.”

CoveredCA does not sell health insurance. And according to some agents who post here and elsewhere, it doesn’t pay commissions to agents in the SHOP exchange. I’m not involved in that market, so I can’t verify the accuracy of those claims.

CoveredCA does not pay the claims of persons who purchased insurance through the exchange, and it does not establish networks of physicians, hospitals, or other service providers. Only the insurance companies do this.

CoveredCA does not send correspondence by email to persons who requested their notices come by that method. CoveredCA does not correspond with the “authorized” representatives designated by applicants. I know this, because I am listed as the authorized representative for about 30-40 persons whose applications I initially submitted outside my agent portal (even though I was later designated as their agent).

CoveredCA does not ask for nor, as far as I can tell, does it want feedback from the agents who, collectively, submitted or assisted with some 40% or more of all individual applications for 2014, and who know how the system could be made better.

As for Peter Lee, I don’t believe much of what he says. He runs a bureaucracy with absolutely no transparency, and there is virtually no way for outsiders to independently verify anything he says. I won’t hold my breath waiting for premiums to be released in August for 2015.

What I fully expect is that premiums for almost all persons will increase. How much? That’s what we’ll have to wait for.

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