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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.


Platinum Plan Rate Hike?

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Question: I have Blue Shield Platinum PPO that is $415 now and will increase to $521.99 in 2016. Why such a big hike? That seems unreasonable. I live in Santa Monica, CA. Have all plans done this under Obama Care? Where should I look for more reasonable coverage? I don't want to go down to Silver because sen generic drugs are $50 under it.

Answer: Platinum and Gold plan premiums went up more than Silver and Bronze plans on a percentage basis for 2016. The reason is "overutilization". That's insurance lingo meaning that there were more claims for those plans than anticipated in 2014 when the original rates were set. Platinum and Silver plans are usually purchased by people anticipating high medical expenses due to recommended surgeries or chronic medical conditions such as diabetes. Claims for these plans were higher than anticipated and the pricing had to be adjusted.

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