L.A. Care Covered: 2018 Premium Rate FAQs

L.A. Care Covered: 2018 Premium Rate FAQs

Your questions answered on how this year's rate premiums will be calculated.

2018 Premium Rate FAQs

Covered California has released premium rates for 2018. Please take the time to review the below frequently asked questions on how these new rates will be implemented. We hope this information answers your questions however if you still need help applying for coverage or figuring out if you qualify for financial assistance, call us at 1-855-222-4239 (TTY/TDD 711).

Why do I see two sets of premiums?

Due to the ongoing uncertainty of the status of Congressional action to make changes to the Affordable Care Act, Covered California asked all of the health plans to submit two sets of rates for the coming open enrollment period. One set of premiums assumes no changes to the current amount of premium cost subsidies and tax credits for eligible purchasers on Covered California and another set that assumes those subsidies and credits are reduced or eliminated as part of any new federal legislation.

Why are the premium rates so high?

One set of premium rates is significantly higher for some metal levels due to the assumption that there would be a decrease in federal premium cost subsidy funding and a change in the tax credits that would normally offset a large part of the premium expense for a purchaser of coverage.

Will L.A. Care Covered continue participating in the Covered California market place?

Yes. L.A. Care’s mission is to provide access to quality health care for Los Angeles County's communities and residents and to support the safety net required to achieve that purpose.

How will I know these premiums will not change once I am enrolled?

Covered California will be providing all consumers with updates on any changes to premiums as more information becomes available. As of now, L.A. Care’s premiums are the most affordable across all of the different plan options in the two Los Angeles County regions.

Anthem is no longer listed on Covered CA. What will happen to their members?

Anthem is no longer listed as a health plan on Covered CA. What will happen to their members?

Anthem can provide information on the outreach they will be conducting to educate their affected members about what options they have during the upcoming open enrollment period. Continuity of coverage and care is likely the most important priority for these members and they will have the opportunity to make a choice for a new health coverage provider that best meets their needs with no lapse in coverage.

How will Anthem’s decision to exit Covered California affect L.A. Care?

How will Anthem’s decision to exit Covered California in Los Angeles County affect L.A. Care?

L.A. Care always looks forward to the open enrollment period as an opportunity to educate all L.A. County health insurance consumers about the advantages of becoming an L.A. Care member. We hope that many former Anthem members will see L.A. Care as an attractive health coverage option for themselves and their families.

What is L.A. Care’s reaction to Anthem exiting the Covered California exchange?

We are not focusing on why Anthem has made their decision. L.A Care’s unique mission is to serve the vulnerable and low-income populations in Los Angeles County as well as those who have had the most challenges obtaining health insurance coverage. This includes those whose only option is to purchase insurance themselves. Because of that mission, L.A. Care is committed to offer health insurance on Covered California to Los Angeles County residents for the foreseeable future.

Why is L.A. Care not participating in the Silver 70 Off Exchange plan?

L.A. Care does not feel that a plan at this price level is aligned with our unique mission to serve the low income and vulnerable population of Los Angeles County. An “Off Exchange” plan is health care coverage that you can purchase outside the Covered California Exchange that has similar benefits to coverage on the Covered California Exchange but which does not include premium cost subsidies.  We will continue to offer the same metal level plans we make available on Covered California to anyone who would like to enroll in them directly with L.A. Care.

When do I enroll?

The 2018 Open Enrollment runs from November 1, 2017 to January 31, 2018.

How will I know which premium I will be paying?

The rate you pay depends on your annual income, household size and primary age of the subscriber. To find out estimated rates, call 1-855-222-4239 (TTY/TDD 711) for free and confidential assistance. You can also visit lacarecovered.org to use the rate calculator to learn about coverage options.

Why should I choose L.A. Care Covered?
  • You can count on a health plan that was created to serve you - Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide quality health coverage to Los Angeles County residents. As a not-for-profit health plan, L.A. Care is dedicated to meeting the health care needs of all Angelenos. This includes keeping monthly premium rates affordable. 
     
  • You will have access to our large network of providers - L.A. Care continues to expand the number of doctors, hospitals and medical groups in our provider network within the communities where you live, work and play. Our network includes 64 hospitals, 2,000 physicians and 1,000 pharmacies, including CVS and Rite Aid stores.
     
  • You will get no-cost preventive and wellness care - This means that you may have no co-pays or co-insurance, and you do not have to meet your deductible (if there is one for your plan), before full coverage for preventive care services begin.
     
  • You can take advantage of all the programs and services we offer - Other features include a free Nurse Advice Line that is available to all members, 24 hours a day, 7 days a week. Our Family Resource Centers offer health education, exercise classes and disease management programs all available at no cost.
How fast is the enrollment process?
  • Every situation is unique. Time may vary depending on whether you enroll as an individual or as a family. Expect to spend an average of about 40 minutes (sometimes less, sometimes more) to completely fill out your application.
     
  • After you have enrolled with L.A. Care Covered you must make your initial binder payment for your coverage to start on January 1 of the enrollment year.
     
  • Once your payment is received, Covered California will send you welcome information, including a welcome letter and a brochure on how to use your plan.
     
  • L.A. Care Covered will then mail your ID card and a New Member Kit to guide you through your plan. (Please note that once Covered California processes your payment, L.A. Care Covered has 10 business days to send your ID card and New Member Kit. Please call our member services department at 1.855.270-2327 (TTY 711) if you do not receive these items). 
     
  • L.A. Care Covered has representatives ready to answer your questions and help you receive free and confidential assistance. Simply call 1.855.222-4239 (TTY 711) to enroll by phone or to schedule an appointment, or visit us at lacarecovered.org to enroll online.
     
  • To expedite the process, please have handy Social Security numbers, birthdates, legal status documents and current income information for the family members in your household and you.
What is Special Enrollment Period?
  • Special Enrollment is a time outside the yearly Open Enrollment Period when you can sign up for health insurance. If you experience a qualifying life event, you can enroll in a L.A. Care Covered health plan during Special Enrollment.
  • You must enroll within 60 days from the date on which the qualifying life event happens to enroll in a L.A. Care Covered health plan.
  • Below is a list of common qualifying life events for special enrollment that apply year-round:
    • Losing health coverage. For example: you no longer qualify for Medi-Cal, or you lose health coverage through your job or spouse’s job.
    • Income changes so much that a current Covered California enrollee becomes newly eligible or ineligible for help paying for their insurance. For example, if a consumer is already getting help paying for their insurance premium, and their income goes down, they may be able to get extra help.
    • Turning 26 years old and no longer being eligible to stay on a parent’s plan.
    • Moving. For example: moving to California from another state or moving to a new region within California that allows a current consumer to gain access to new Covered California health insurance plans. This also applies to individuals who are released from jail or prison.
    • Having a child or adopting a child, receiving a child into foster care, or placing a child into adoption or into a foster home.
    • Getting married or entering into a domestic partnership.
    • Becoming a citizen, a national or becoming lawfully present (where the individual was not previously lawfully present).
    • Being a member of a federally recognized American Indian or Alaska Native tribe. A consumer in this category may enroll in health insurance or change health insurance plan once a month, even if the Open Enrollment Period is over.
    • Covered California can also determine, on a case-by-case basis, that the consumer experienced an exceptional circumstance, which could allow for a Special Enrollment Period.
  • If you have questions about the Special Enrollment Period, please call 1-855-222-4239 (TTY/TDD 711)) for free and confidential assistance.
What is Open Enrollment?
  • Open Enrollment is the yearly period when you can enroll in a L.A. Care Covered Health Plan. The 2017 Open Enrollment ended January 31, 2017. 
  • The 2018 Open Enrollment runs from November 1, 2017 to January 31, 2018.
How can I see which providers are in your network?

To see a list of providers in your community, use our Find a doctor or pharmacy tool. You can also call 1-855-222-4239  (TTY 711) and a representative can assist you with finding a provider close to where you live or work prior to enrolling.  If you are already a member of L.A. Care Covered, please call our member services department at 1-855-270-2327.

Why do some metal level plans have lower premiums than what I'm paying right now?

I am a current L.A. Care Covered™ member. Why do some of the other metal level plans have much lower premiums than what I am paying right now? (Source: Covered California)

  • As the metal category increases in value, so does the percentage of medical expenses that a health insurance plan covers, compared with what you are expected to pay in co-pays and deductibles.
  • Plans in the higher metal tiers have higher monthly premiums, but you pay less when you need medical care. If you choose to pay a lower monthly premium, then you will pay more when you need medical care. You can choose the level of coverage that best meets your health needs and budget.
  • Here is a breakdown of the different metal plans:
    • Bronze: On average, L.A. Care CoveredTM pays 60 percent of your medical expenses, and you pay 40 percent.
    • Silver: On average, L.A. Care CoveredTM pays 70 percent of your medical expenses, and you pay 30 percent.
      • In some cases, individuals may qualify for an Enhanced Silver plan. This means that when they choose a Silver plan, they have – based on their income – enhanced out-of-pocket savings through lower copays, coinsurance and deductibles. Individuals in these savings categories get the benefits of a Gold or Platinum plan for the price of a Silver plan. In the three categories of Enhanced Silver, L.A. Care CoveredTM pays either 94 percent, 87 percent or 73 percent of expenses, with you responsible for the rest.
    • Gold: On average, L.A. Care CoveredTM pays 80 percent of your medical expenses, and you pay 20 percent.
    • Platinum: On average, L.A. Care CoveredTM pays 90 percent of your medical expenses, and you pay 10 percent.
    • In addition to the metal tiers, L.A. Care CoveredTM offers a Minimum Coverage Plan for those who qualify.
    • Minimum Coverage Plan: If you are under 30, you may be able to buy an additional health plan option called Minimum Coverage Plan. These plans usually have lower premiums and mostly protect you from worst-case scenarios. Those who have minimum coverage plans do not qualify to receive premium assistance (also known as Advanced Premium Tax Credits). Minimum coverage plans through L.A. Care CoveredTM cover three doctor visits or urgent care visits, including outpatient mental health/substance use visits, with no out-of-pocket costs, and free preventive benefits. All other services will be full price but at the negotiated in-network price, until you spend $7,150, after which all in-network services are covered at 100 percent.
  • If you have questions about the metal plans and the price variations, please call 1-855-222-4239  (TTY 711) for free and confidential assistance.
Should I move to the lower cost plan during Open Enrollment?
  • The annual Open Enrollment Period is a great time to review your plan benefits and make changes for the upcoming year. If you’re happy with your metal tier plan and expenses, then you don’t need to make any changes.
  • Here are some things to consider if you are deciding to move to a lower cost plan:
    • How many times did you see a doctor this past year?
    • Did you fill any prescriptions on a regular basis?
    • Do you anticipate your use of health services to increase, decrease, or remain the same in 2018?
    • Did you pay more in out-of-pocket expenses than you expected?
  • If you are deciding to move from a Silver or Enhanced Silver Plan to Bronze plan, here are some differences you might want to consider:.
    • Bronze Plans offer the lowest monthly premiums but have the highest out-of-pocket costs when you use services.
    • Silver Plans have higher monthly premiums than Bronze Plans but have lower out-of-pocket costs than Bronze Plans.
    • Enhanced Silver Plans are available based on your annual income level and provide additional out-of-pocket savings.
    • Enhanced Silver Plans offer out-of-pocket savings through lower co-pays, or co-insurance and/or deductibles.
    • Enhanced Silver Plan enrollees, in general, get the benefits of a Gold or Platinum Plan for the price of a Silver Plan.

If you have questions about switching plans and your benefits, call 1-855-222-4239  (TTY 711) for free and confidential assistance.

Will these premiums be subject to change when open enrollment begins?

Will any of these premiums be subject to change when open enrollment begins on October 1 (current member) or November 1 (new members)?

Covered California will be providing all consumers with updates on any changes to premiums as more information becomes available.

I am looking to enroll with L.A. Care Covered. Why should I join your plan?

I am looking to enroll with L.A. Care Covered because I can’t afford the new rates of my current carrier. Why should I join your plan?

  • Our plans are priced among the lowest and, in some cases, we offer access to more hospitals than some of our competitors.
  • L.A. Care continues to expand the number of doctors, hospitals and medical groups in our provider network within the communities where you live, work and play. Our network includes 42 hospitals, 2,000 physicians and 1,000 pharmacies, including CVS and Rite Aid stores.
  • Since L.A. Care has more members in L.A. County than any other health plan, and focuses only on L.A., we have designed our services to best meet the needs of all Angelenos.
Where can I look for my doctor/ hospital /PPG?

To see a list of providers in your community, use our Find a doctor or pharmacy tool. You can also call 1-855-222-4239 (TTY/TDD 711)and a representative can assist you with finding a provider close to where you live or work prior to enrolling.  If you are already a member of L.A. Care Covered, please call our member services department at 1-855-270-2327 (TTY 711).

What if I enroll and my doctor is not on the plan?

L.A. Care representatives can help you find a doctor close to where you live or work. You can also call 1-855-222-4239 (TTY 711) and a representative can assist you with finding a provider close to where you live or work prior to enrolling.  If you are already a member of L.A. Care Covered, please call our member services department at  1-855-270-2327 (TTY 711).