Note: Regardless of the presidential election results, Covered California is open for business. All consumers who need coverage should still apply. The information provided in this blog remains accurate.
Covered California’s fourth annual open enrollment begins November 1. While consumers can choose from a variety of plans with different costs and benefit structures, the second-lowest cost silver plan is particularly important because it serves as the benchmark by which federal premium subsidies are determined. Overall, 64% of Covered California consumers chose silver plans in 2016.
How to Use the Data
See what the 2017 total monthly premium is for the second-lowest cost silver plan in a region, how it compares to other regions, and the level of premium subsidies for which consumers are eligible based on their income. In the example below, the map on the left below shows the total monthly premium (before federal premium subsidies) by region. It ranges from a low of $258 in Los Angeles to a high of $450 in Contra Costa in 2017. (Premiums also vary based on age, although the Affordable Care Act limits the amount of variation. The premium figures used in ACA 411 are for a 40 year-old.)
However, most Covered California consumers pay less than the total monthly premium. Almost 90% earn less than 400% of the federal poverty level (FPL), making them eligible for federal premium subsidies. The amount they are required to contribute towards premiums is capped at a percentage of income (“individual share” in the chart above) with the premium subsidy (“government share”) covering the rest. ACA 411 shows this by region and by income level. The example above is based on a consumer earning 150% FPL, or about $17,820, for a one-person household.
The example below is for Region 7, Santa Clara.
It’s also possible to track how the total monthly premium for the second-lowest cost silver plan in a region has changed since 2014 and how it has compared to the Covered California average. Remember, these are the before-subsidy premium amounts, not the amount most consumers will pay. The example below is for Region 12, Central Coast.
Putting the Data in Context
Tracking the premium costs for the second-lowest cost silver plans on Covered California offers some important insights into the costs that many consumers will face in this upcoming open enrollment and how those costs have changed over time. But it is important to remember that consumers can choose other plan options, including different metal tiers, which have very different premiums (and benefit levels).
There has already been intense scrutiny and discussion of the proposed 2017 Covered California premiums, which are set to rise, on average, 13.2%. Keep in mind the following:
The 13.2% average premium increase masks the wide variation in premium costs and in the rate of increase by region.
The 13.2% average increase is before premium subsidies are taken into account. As the ACA 411 examples above illustrate, federal premium subsidies can significantly lower what consumers have to actually pay toward premiums. The subsidies will play a crucial role in shielding most consumers from having to absorb the full brunt of premium increases in 2017. (Notice that the amount the individual pays is often rather flat, while the government share and the total premium rise.)
Amy Adams is a senior program officer for CHCF’s Improving Access team, which works to improve access to coverage and care for low-income Californians.
Prior to joining the foundation, Amy worked for the Service Employees International Union (SEIU), leading a range of state and federal health care policy and research efforts. Her most recent work there focused on the Affordable Care Act (ACA), analyzing regulations and developing policy positions. Prior to that, she led a team working on Medicaid policy issues in California and other states, including public hospital and long-term care financing issues. Amy also brings program evaluation and assessment experience through her previous work as deputy director of a nonprofit research and policy organization and a private consultant to foundations, government agencies, and nonprofits. She received a bachelor’s degree in American Studies from Yale College and a master’s degree in social welfare from the University of California, Berkeley.