September 21, 2015
Area(s) of Interest: Access to Care Advocacy Health Care Reform
California has enrolled more people through its Affordable Care Act (ACA) health insurance exchange of any state, with about 1.4 million enrollees as of June 30, according to new federal data. California surpassed Florida – with 1.3 million exchange enrollees as of the end of June – to have the highest exchange enrollment.
Nationwide, 9.9 million U.S. residents signed up for the ACA. About 7.2 million consumers purchased coverage through the federal exchange and 2.7 million purchased coverage through state-based exchanges.
Of those who purchased coverage in California, 9,302 people who just purchased catastrophic coverage; 350,225 bought a bronze plan; 895,657 bought a silver plan; 74,067 purchased a gold plan; and 64,316 bought a platinum plan.
Covered California open enrollment for 2016 begins November 1, 2015, and ends January 31, 2016. For more information on the exchange’s 2016 offerings, click here.
With so many patients relying on exchange plans for their health care, it is even more critical that physician practices understand their participation status. For help verifying your participation status, see the California Medical Association's (CMA) "Surviving Covered California" tip sheets. These documents are available free to members in the CMA Store.
CMA also continues to monitor the problem of health plan network directory accuracy. Last November, the California Department of Managed Health Care (DMHC) released the results of an audit of the Anthem Blue Cross and Blue Shield Covered California networks. Among other things, the audit found that 12.8 percent of the physicians listed on Anthem’s network were not accepting Covered California patients, while 12.5 percent were not in practice at the location listed in Anthem’s directory.
In the case of Blue Shield, only 56.7 percent of the physicians listed in its Covered California directory could be verified as accepting Covered California patients. These inaccuracy rates were consistent with CMA’s and some county medical societies' own verification efforts and analyses.
DMHC will be conducting a follow-up of its audit this fall to determine whether the health plans have resolved their inaccurate network directories. Physicians who are misidentified as participating in a Covered California network when in fact they are not, or whose information in a network directory is inaccurate, are urged to contact CMA’s Center for Economic Services at (888) 401-5911 or firstname.lastname@example.org.