Open enrollment underway for Medicare and Obamacare

Open enrollment for Obamacare and Medicare-related health and prescription drug plans is underway, and this year the state has a new tool to help consumers get the best health care at the lowest cost.

In some cases, medical groups that are paid the most money do not necessarily provide higher quality care, said Elizabeth Abbott, director of the state Office of the Patient Advocate, or OPA.

“Some people say, ‘I’m willing to pay any price for good health care,’ but what people should want to do is get the very best health care at the lowest price,” Abbott said.

For the past 16 years, OPA has published something called a health care quality report card that rates health plans and medical groups on both medical outcomes and patient satisfaction. This year, OPA added a cost rating based on the average amount health plans and patients pay for a year’s worth of care.

A rating of five stars means a health plan and patient pay a medical group $3,394 or less, on average, for each patient annually, while a single star represents a cost of $5,024 or more on average for each patient annually.

The price of insurance plans offered through Covered California, the state’s health insurance exchange under President Barack Obama’s Affordable Care Act, is set to rise about 12 percent next year. That’s double the average increase of the two previous years under Obamacare, but far less than the double-digit increases seen yearly before the Affordable Care Act, according to Covered California.

Covered California spokesman James Scullary said those who obtained their insurance through the state health exchange last year should visit the Covered California website to see if they can get a better deal than the one they have. Eighty percent of existing consumers could either pay lower premiums or limit the increase they’ll see this year to no more than 5 percent by switching to a different plan at the same benefit level.

“Every existing consumer has the opportunity to come and check things out,” Scullary said.

The open enrollment period for 2017 health plans purchased through Covered California begins Nov. 1 and ends Jan. 31, 2017.

Scullary said California’s health exchange, unlike those in some other states, is on much firmer financial ground. In North Carolina, for example, all but one health insurance carrier has pulled out of that state’s health exchange. Blue Cross and Blue Shield of North Carolina is the only carrier selling individual coverage through the state’s health exchange.

Other states are seeing similar exoduses by insurers that faced dramatic financial losses by covering people with higher health risks.

Scullary said Covered California has lost only one carrier, UnitedHealth, for 2017. Covered California took a number of steps before launching to ensure that the state’s health exchange would remain competitive.

For example, the state dramatically expanded its Medi-Cal program, the state version of the federal Medicaid program that provides care for low-income Americans. States that expanded their Medicaid programs had lower health insurance premiums, Scullary said, citing figures from the U.S. Department of Health and Human Services.

Scullary also said that California was among the few states in the country that didn’t grandfather existing plans for purchase through the exchange. The state required all plans sold through the exchange to meet set standards, creating one common risk pool as of 2014.

“I know that that situation is not the same for every state,” he said. “Really you’re dealing with 50 different marketplaces.”

Open enrollment has also begun for Medicare recipients who purchase their coverage through private carriers. This includes Medicare Advantage, known as Medicare Part C, and Medicare Part D, for prescription drugs.

With basic Medicare, a person receives their medical care from their choice of providers who accept Medicare, and Medicare pays for that care on a fee-for-service basis. But those who chooses a Medicare Advantage plan contract with participating private insurance companies and use their plan’s network.

Kim Seamans, director of economic assistance for the county’s Human Services Department, said there are a number of factors an individual would want to consider when choosing among Medicare options. Seamans said her agency often refers people to the Health Insurance Counseling and Advocacy Program for assistance. HICAP can be reached at 800-434-0222 or 707-526-4108.

The Medicare open enrollment period began Oct. 15 and ends Dec. 7.

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @renofish.