Fresno area to get new health plan options next year

Health consumers in Fresno, Kings and Madera counties will have two new choices of insurance companies offering health plans through the state’s insurance exchange in 2016.

UnitedHealthcare of California will be selling insurance in the three central San Joaquin Valley counties, and Health Net is expanding into the counties next year, Covered California officials announced Monday. The companies join Anthem Blue Cross, Blue Shield of California and Kaiser Permanente in offering health coverage in the region.

Consumers buying individual insurance plans in those counties may see only slightly different premium rates in 2016. Rates in Covered California Region 11 are expected to increase by an average of 3.3%, similar to the increase in 2015.

Rates, however, will increase by an average of 9.8% in Region 10 — Tulare, Merced, Mariposa, Stanislaus and San Joaquin counties. In 2015, the rates decreased by 1.9%.

Health plan options in Region 10 remain the same: Anthem, Blue Shield, Health Net and Kaiser Permanente.

The regional cost variation come down to the different hospitals and doctors in areas, said Mia Campitelli, senior manager of corporate communications at Blue Shield of California, which offers health plans in Region 10 and 11. “This is the first year we have actual data so we are pricing according to the claims data that comes in,” she said.

“I can’t speak to specific hospital rates, but I can tell you our pricing is based on what they charge,” she said.

Statewide, the average premium next year is increasing 4%, compared with a 4.2% increase in 2015, said Covered California Executive Director Peter V. Lee.

The majority of consumers get help paying monthly premiums, Lee said. About 88% of enrollees get federal subsidies and pay on average $150 a month out-of-pocket to get coverage, he said.

Lee said Covered California’s enrollment of more than 1.3 million consumers resulted in a good “risk mix.” The agency has among the healthiest enrollees in the country, he said, which gave it negotiating power with insurance companies. The decision to discontinue health plans that did not meet standards also stabilized the marketplace, he said.

Covered California’s Shop and Compare Tool for 2016 will be online beginning Aug. 3, Lee said. Open enrollment for 2016 will begin in November.

UnitedHealthcare of California is one of two new plans to win approval from Covered California to offer coverage in 2016. The other new plan is Oscar, a Southern California company that will offer plans to people in Los Angeles and Orange counties.

The addition of UnitedHealthcare, the largest insurance company in the United States, will bring coverage to areas of limited choice, said Anne E. Price, Covered California director of plan management. In addition to Fresno, Kings and Madera counties, it will be offering plans in Northern California and the Central Coast.

Brandon Cuevas, CEO of UnitedHealthcare of California, said: “We welcome the chance to serve Californians as a Qualified Health Plan in 34 counties, bringing more choice to under-served areas in 2016. People who choose our plans will have access to resources such as our Health4Me mobile app, which allows them to find nearby health care providers and get quality and cost information for medical services.”

Health Net’s move into Fresno, Kings and Madera counties was not a great leap for the company, which has managed Medi-Cal plans in Fresno. “We have experience in the Central Valley. We’re in the region with our employer-sponsored coverage,” said Health Net spokesman Brad Kieffer. “Health Net is in the Central Valley as well with Medi-Cal and we also administer Cal Viva Health. It’s a part of the state where we are already well known and we have a solid brand.”

But whether the addition of UnitedHealthcare and Health Net will expand the provider pool of doctors in the area remains to be seen.

“We’ve established a network already, but we are always open to expanding the number of providers in our network so long as they meet our criteria for affordability and accessibility,” Kieffer said.

This story was originally published July 27, 2015 at 2:25 PM with the headline "Fresno area to get new health plan options next year."