Health Insurance Blog

Open enrollment for Medicare Advantage plans is rapidly approaching (November 15 - December 31).  We thought we’d blog about some of the top rated plans in each state according to US News and World Reports annual rankings.

In California, Kaiser Foundation Health Plan boasts the 2 top ranked plans in the state. Kaiser Foundation Health Plan of Southern California was the top rated Medicare health plan in California with an overall score of 88.1, followed by Kaiser’s plan covering Northern California (86.8).  These two plans were followed by Health Net of California (83.2), Pacificare of California (81.7) and Aetna Health of California (80.4).

None of the twenty California Medicare Plans ranked in this study received a customer assessment score of greater than three stars out of five.  However, both Kaiser plans faired very well in both treatment and prevention measures, with five stars.

More information about California health insurance.

Effective January 1, Blue Shield of California will be removed from the Major Risk Medical Insurance Program (MRMIP) because their premiums were substantially higher than the rates offered by the other two insurers that make up the Program.

The MRMIP currently covers almost 7,000 California residents who are unable to purchase private health insurance due to pre-existing conditions.

Health insurance companies that participate in the MRMIP Program are allowed to charge 25% higher premium than the market rate for a given health insurance policy, and if the insurer loses money they will be reimbursed by the state.  Despite the state subsidization, Blue Shield’s health insurance rates were much higher than both Kaiser Permananete’s or Anthem Blue Cross of California.

Current enrollees in the MRMIP Program via Blue Shield will be able to keep their existing coverage until January 1, and then must enroll with one of the other health plans that participate in the Program.

More information about California health insurance.

A rare bi-partisan bill in the California legislature, allowed more than 700,000 children in low-income California families to maintain their health insurance coverage through the Healthy families Program.

The deal restored about $200 Million that was slashed from the budget this summer.  For this to happen, health insurance companies agreed to impose a tax on themselves.  In addition, Healthy Families participants will pay slightly higher premiums.

Healthy families provides health, vision and dental coverage for nearly 1 million children whose families aren’t poor enough to qualify for Medi-Cal but can’t afford private health insurance.

More information about California health insurance.

According to the PRWeb article through medicaresupplementplans.com entitled “California Health Insurance Assistance Program Awarded 2009 Grant Funding”, California health insurance assistance programs are expected to receive about $3 million in grants to help Medicare beneficiaries in need of information on health insurance topics.

This is an ongoing effort to better assist these citizens who are often lacking comprehensive and accurate information about their health care options.  The funds being used are part of a $35.8 million grant from the Centers for Medicare and Medicaid Services.  The grants to California health insurance assistance programs are part of the 1st installment of funding that began in April ‘09 and will end in March ‘10.

Seniors often underestimate how time consuming researching and understanding their benefits can be.  And sometimes it gets really complicated.  These funds will support programs designed to make this process for them a little easier.  The assistance is personalized and local while providing a wide range of health insurance information best suited to each individual.

According to J.D. Power and Associates, Kaiser Foundation Health Plan was the top rated California health plan based on their 2009 survey.

Based on their survey and analysis of more than 130 health plans nationally (broken up into 17 distinct regions), Kasier Foundation Health plan was the tops in the California region and among the best nationally.

The other health plans from California that were surveyed all performed below average.  They included:  Blue Cross of California, Blue Shield of California, Aetna, HealthNet, Pacificare, and CIGNA.

More information about the J.D. Power 2009 Health Plan Ratings.

More information about California health insurance.

Bobby Caina Calvan from the Sacramento Bee reports that the state of California has settled with Anthem Blue Cross regarding its cancellation of individual health insurance policies. The settlement requires that the insurer reinstate coverage for those whose policies were unfairly rescinded between 2004 and 2008, regardless of any medical conditions they may have. Qualified consumers will be contacted over the next three months via phone. In addition, Anthem Blue Cross must reimburse $14 million worth of out-of-pocket health expenses paid by these consumers.

The California health insurance company also has to pay a $1 million fine to the Insurance Department, with an extra $2 million tacked on if they fail to change their policies, Bobby says.

The city of San Francisco has filed suit against California insurance regulators alleging that they have approved a health insurance rating system that allows California health insurance companies to charge women more than men for health insurance coverage.

In the state of California, gender rating is permitted in setting health insurance rates, which allows a customers gender to be used as a rating factor in determining their health insurance premium.  A practice that has resulted in women paying on average 39% more than men for identical coverage.

Currently 10 states outlaw the practice of gender rating with regard to individual health insurance rates, however California is not one of them.

Blue Shield of California representatives have claimed that their actuaries crunched the numbers based on healthcare data and indeed found that women are more injury prone than men and more likely to break bones or become sick, thus justifying the relevance of using gender as a rating factor.

Erin Allday from the San Francisco Chronicle recently reported on a proposal from the S.F. Attorney General that would eliminate bias in health insurance rates. Health insurance companies claim that they should be allowed to charge women under 55 more for health insurance than men, since they are more likely to suffer from some chronic illnesses and visit doctors for preventative care more often.

While 12 states ban or restrict the practice of gender rating, California does not. Women who buy individual health plans in California pay up to 39% higher premiums than men, according to Erin. The city of San Francisco is getting involved because women end up going to city clinics or emergency rooms because they can’t afford health insurance, costing the government money. 

A spokesman from America’s Health Insurance Plans, an industry group, states that gender rating is not discriminatory since women use more services. In addition, older men pay more for health insurance than older women. However, the Equal Employment Opportunity Commission prevents women from being charged more for their premiums based solely on their gender.

The National Women’s Law Center report found that women nationwide pay up to 48% more for health insurance than men, excluding maternity coverage. Maternity coverage is the most obvious factor that could drive up the cost of women’s health insurance.

It has been proven that preventative health care (check-ups and screenings) ends up costing insurance companies and society less in the long run. Should younger women be punished for taking responsibility for their well-being?

(Photo credit: Adria Richards under CC 2.0)

The LA Times reports that Blue Shield of California has agreed to reinstate the health insurance policies of roughly 700 California residents whose health plans were canceled after they got sick.  Blue Shield also agreed to the way they handle their individual health insurance plans. In exchange for the agreement, the state of California dropped its lawsuit against Blue Shield and will not pursue $12.6million in fines.

In September the state reached a similar settlement with Health Net, who agreed to reinstate nearly 1,000 policy holders whose health coverage was canceled when they got sick.  In addition, Anthem Blue Cross, Kaiser Permanente and other California health insurance companies reached similar agreements with the state last year.

The health insurance companies have maintained no wrong doing and maintain that the state allows them to review old medical records after the policy holder becomes ill, and determine if the policy holder left vital information off of their enrollment application.

California’s state sponsored health insurance program for working poor and uninsured children received a last minute contribution from First 5 California.  The $16.8 Million contribution will allow Healthy Families California to continue accepting new members through June of ‘09.  Without this last minute lifeline, an estimated 162,000 California children would have went without health insurance for at least the next six months.

The Managed Risk Medical Insurance Board, which runs the Healthy Families program, had scheduled a meeting for today December 17th  to limit new enrollments into the health care program, which currently provides California health insurance for 900,000 children who would otherwise be uninsured.

First 5 California is an organization that is tasked with improving the healthcare of young children in California.