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Summer is almost over. It's time to start thinking about your health insurance plan for 2017.

This article will discuss health insurance plans available through Covered California, the marketplace for personal and family health insurance plans provided by private insurers but regulated by the State of California in accordance with the Patient Protection and Affordable Care Act. If you are eligible for federal subsidies to help cover your insurance premiums, you will have to purchase insurance through the Covered California marketplace.

Fall Enrollment. Fall enrollment for the purchase of health insurance for 2017 is rapidly approaching. It is time to start thinking about what kind of insurance coverage you want for next year. Did your plan work out for you in 2016? Were you satisfied with the doctors, hospitals, clinics and other services available under you plan? Were you unpleasantly surprised by unanticipated co-pay or deductible costs? 

Covered California has recently announced the insurers and coverage plans that will be available in 2017. It is not too early to begin shopping for the plan best suited to your and your family's medical needs and budget. 

What kind of premium increases will I be looking at? And what can I do to control costs? In general, prices for 2017 will be going up. Covered California has announced a statewide weighted average increase in premiums of 13.2 percent. But it is important to recognize that this is a weighted average. Increases in particular plans will vary by the insurer, the plan, and your location within the state. You can be an active participant in controlling your health insurance costs for 2017 by getting involved now, learning what plans are available to you, and shopping around. This is what Covered California Executive Director Peter V. Lee had to say: "Almost 80 percent of our consumers will either be able to pay less than what they are paying now, or see their rates go up by no more than 5 percent, if they shop and buy the lowest-cost plan at their same benefit level. That's the power of shopping." 

Are insurers dropping out of the California market? As any consumer knows, shopping for a good product at a good price only works if there are a number of sellers out there competing for your business. Many of you may have read that health care costs are sky-rocketing in a number of states because insurers are dropping out the the Patient Protection and Affordable Care Act marketplace. But that is not the case in California, which maintains a robust health care market. There are eleven insurers that provide a range of health care policies in California. Not all eleven insurers offer products in all parts of California, but almost all consumers (92.6%) will be able to choose from three or more carriers, and every California consumer will have at least two carriers to select from. Consumers in San Francisco, Santa Clara and San Mateo Counties might do some comparison shopping for a 2017 policy with Oscar, an insurer that entered the California market in 2016, and is expanding into those counties in 2017. And consumers in Orange County might take a look at Molina, also a new entrant into California in 2016 and expanding into Orange County next year. And Kaiser, a long-time insurance provider in much of California will expand into Santa Cruz County in 2017. 

What else is new? Covered California has negotiated some general improvements in certain plan coverages that will become available for the first time in 2017. For example, consumers in Silver 70 plans (see some of the earlier Pfeifer Insurance articles on the differences among Platinum, Gold, Silver and Bronze plans) can save up to $55 on an urgent care visit and $10 on a primary care visit, and consumers in Silver, Gold and Platinum plans will pay a flat co-pay for emergency room visits without having to first satisfy a deductible requirement, which could save thousands of dollars. In addition, contractual agreements with health insurers for 2017 require that consumers select or be provisionally assigned a primary health care physician within 60 days of the effective date of the policy so that they have an established source of care.

So what should I be doing now? The key is to be an effective consumer. That means getting to know what plans will be available to you in 2017. And that means shopping around. Not everybody likes to shop. And not everyone who does enjoy shopping will find choosing a health insurance policy the most pleasant shopping experience. You will need to get familiar with and compare local markets, coverages, premiums, co-pays, deductibles, co-insurance, physician networks and hospital participation. Pfeifer Insurance Brokers knows the Covered California marketplace and can help you with your selection. We can also let you know whether you are eligible for federal subsidies (about 90 percent of those who purchase insurance through Covered California are eligible) and help you obtain them if you are eligible.

Alex Pfeifer
Pfeifer Insurance Brokers
650 762-8070

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