California Sets Benefit Standards for Health Plans in Exchange -AND- Admission Rates from Emergency Departments Vary Widely

Mon Feb 25 23:40:24 PST 2013

February 14, 2013

California Sets Benefit Standards for Health Plans in Exchange

California Healthline

On Wednesday, California became the first state to set benefit standards for health plans offered through its state health insurance exchange, Kaiser Health News' "Capsules" reports (Appleby, "Capsules," Kaiser Health News, 2/13).

The state posted the standards on its new CoveredCA.com website.

Background

The Affordable Care Act requires states to launch online insurance marketplaces by 2014. California's exchange -- named Covered California -- primarily will serve individuals and small businesses.

The exchange is expected to open for registration in October.

In January, exchange officials told Gov. Jerry Brown (D) and the Legislature that health plans offered through Covered California will be classified by "metal ratings" -- including platinum, gold, silver and bronze -- based on the coverage they offer.

The officials said that:

Platinum plans will offer 90% coverage;
Gold plans will offer 80% coverage;
Silver plans will offer 70% coverage; and
Bronze plans will offer 60% coverage.

Plan members will have to pay out of pocket for the percentage not covered by the plan, according to officials (California Healthline, 2/13).

Details of Standardized Rates

Under the standards released Wednesday:

Platinum and gold plans will have no annual deductibles and will charge as low as $25 for physician office visits;
Silver plans will have $2,000 in annual deductibles and will charge $45 for physician office visits; and
Bronze plans will have $5,000 in annual deductibles and will charge $70 for physician office visits ("Capsules," Kaiser Health News, 2/13).

Monthly premiums will vary, based on the plan chosen and the income level of the policyholder.

For example, a family of four with an income between $22,000 and $35,000 annually would pay between $39 and $118 each month for a silver plan (Weintraub, HealthyCal, 2/13).

Response to Release of Standards

Anthony Wright -- executive director of Health Access California -- said, "The standardization of benefit designs will make it easier for consumers to compare health plans." He added, "It will force insurers to compete on cost and quality and customer service, rather than consumer confusion."

Patrick Johnston -- president and CEO of the California Health Plans Association -- said that it is too soon to tell how the design of the marketplace will affect premiums.

Johnston said, "By requiring the same benefits and deductibles for each category of coverage, Covered California may reduce confusion among consumers about the differences in pricing among plans but may also increase premiums" (Lin, AP/U-T San Diego, 2/13).

February 19, 2013

Admission Rates from Emergency Departments Vary Widely

PubMed.gov

A new study in the January 6 issue of Medical Care and Research Review found a greater than 2.5-fold variation in the admission rate from the emergency department in a sample of hospitals across 28 States. This indicates wide variation in a costly, everyday decision that will require further study, in light of the major impact that hospital admissions play in rising health care costs, according to the study authors from AHRQ and George Washington University. For-profit hospitals, trauma centers, and hospitals with higher proportions of Medicare and uninsured patients had higher admission rates. Also, local practice patterns and availability of primary care doctors were important factors. Fewer primary care doctors were associated with higher admission rates, while some admissions decisions were influenced by local care standards.

Bryan Sloane
Deputy Editor, CAL/AAEM News Service

Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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