Health & Medicine

Covered California announces 12.5 percent premium hikes in 2018, but what’s this new surcharge?

California consumers buying insurance for 2018 through the state’s insurance exchange will see average premiums increases of 12.5 percent, but by comparison pricing, many could limit their premium hikes to 3.3 percent, Covered California officials announced Tuesday.

The increase was a little lower than the average 13.2 Covered California premium hike implemented this year, despite uncertainty over the future of the Affordable Care Act amid Republican attempts to repeal the law. The average 2018 increase was also much lower than premium hikes seen in several other states.

“Covered California remains robust and strong, and we are pleased to welcome back all 11 plans to compete in regions across the state,” said Covered California Executive Director Peter V. Lee. “While there is ongoing uncertainty and a lack of clarity at the federal level, consumers who need affordable health insurance will continue to have good choices in Covered California next year.”

That “ongoing uncertainty” could mean that roughly 650,000 consumers who buy Covered California’s most popular insurance plans, those in the silver tier, will face a double whammy on their premium prices. The exchange said it may have to add a 12.4 percent surcharge to premiums in that tier because insurers are worried about continued federal funding that lowers out-of-pocket costs for enrollees.

The good news is that those policy holders won’t feel the full force of that increase. That’s because of a cap on out-of-pocket costs for policy holders whose income is 250 percent of the federal poverty level. Once consumers hit that out-of-pocket ceiling, Medi-Cal will pick up the tab.

Rate hikes are being implemented to guarantee insurers they’ll be reimbursed for discounts they are required to give consumers in the popular silver tier plans. The Affordable Care Act, commonly called Obamacare, mandates that co-pays and other fees be reduced on a sliding scale, depending on income.

But in a major flaw in the law, the U.S. House of Representatives created no mechanism to appropriate funds to reimburse insurers for those discounts. Under the Obama administration, the Department of Health and Human Services set aside the funds annually and paid it, but a lawsuit by House Republicans has challenged the constitutionality of those payments.

The Trump administration has committed to paying those so-called cost-sharing reductions only a month at a time, leaving insurers unwilling to commit to yearlong contracts with health exchanges such as Covered California.

The Covered California staff had to figure out a way to make the state’s health insurance marketplace work, spokeswoman Amy Palmer said, and that meant avoiding a mass exit because of increased premiums and keeping co-pays low enough that consumers would continue accessing care when needed.

Rather than broadly raising all premiums, they hit upon the idea of imposing surcharges only on the silver-tier plans. That would trigger the caps on out-of-pocket costs for policy holders, requiring the federal government to make payments that would allow insurers to continue offering lower co-payments and deductibles. Absent a decision by the federal government in the next few weeks, Lee said, Covered California will proceed with the surcharges.

“This action allows Covered California to keep the market stable and protect consumers from this uncertainty,” Lee said. “While most silver-tier consumers will not see the full impact of the ‘CSR surcharge,’ and every consumer could avoid paying any additional premium by shopping, we hope that we do not need to implement this work-around that would cause unnecessary confusion and ultimately cost the federal government more than it would to continue to make the payments directly.”

Covered California said that the silver-tier plans would no longer be a good option for consumers who receive no subsidy and that its representatives and independent insurance advocates would work to get out the message. All the rate changes must be approved by state regulators before they can be implemented.

Cathie Anderson: 916-321-1193, @CathieA_SacBee

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