Numbers That Matter: Covered Lives and Care Made Truly Affordable

Over the past few years, much attention has been focused on some of Covered California “numbers” — the number enrolled, the amount spent on marketing, the number of enrollees who paid their premium, and premium rate increases, to name a few. These are important numbers that help explain the extent to which we are delivering on our promise.

Increasingly, though, we will be speaking about some new numbers as the primary indicators of our impact on the lives of Californians: covered lives and cost-sharing.

Covered lives means Californians who have selected a health plan through us, have paid their premium and have insurance coverage. As of March 2015, Covered California has more than 1.3 million active “covered lives” that are getting care throughout the state. Of them, 88 percent are receiving federal subsidies to lower their monthly premiums, and many also benefit from lower cost-sharing.

While this number is big — making Covered California one of the largest purchasers of health care in the state — it actually dramatically understates the number of Californians who have benefited from our coverage. Since Covered California opened its doors and began offering quality, affordable health care coverage, we have covered 1,864,014 lives. This means that since we started offering coverage in January 2014, more than 500,000 Californians beyond those covered today have benefited from coverage through Covered California. 

This is exactly the kind of “turnover” Covered California planned for. More importantly, this represents a new reality for Californians. Today, because of the Affordable Care Act, Californians are protected by a safety net that didn’t exist before. Now, if they lose their job and their employer-based coverage, they still have access to quality health care at an affordable price. Covered California or the expanded Medi-Cal program will be there when Californians need us. This is further proof that the Affordable Care Act is working in California. 

To see more about our enrollment numbers, how affordable coverage can be and how cost-sharing helps consumers save money, take a look at this graphic, which was included with last week’s press release: http://news.coveredca.com/2015/05/covered-california-has-served-18.html.

 Other numbers that often do not make the headlines are the numbers that are built into the benefit designs of all the health insurance plans we offer. Our designs for deductibles and copayments are part of how we put health care within reach of hundreds of thousands of people who could not obtain or afford coverage in the past, and we’re doing it in a way that is designed from the ground up to encourage consumers to get the right care at the right time. 

When a consumer enrolls in one of our plans, they are covered by our standard benefit design. That’s a fancy way of saying we standardized the insurance products we offer. We have limited out-of-pocket costs, to encourage consumers to see a doctor or get a test when it is necessary. This kind of benefit design makes it easier for consumers to get care when necessary, because it removes the financial roadblocks that could force them to ignore their health needs.

We are making changes for next year that build on our standard benefit designs. We know that when consumers face a deductible or high cost-sharing they may avoid getting needed care. When consumers can get minor problems treated before they become major issues, which helps keep health care costs down, which is good for all Californians.

Some of the changes Covered California is making for 2016 include:

• For consumers who enroll in a Bronze plan — the most affordable standard plan — they will get three office visits a year, whether it’s to a specialist or a primary care provider, without it being subject to a deductible. We will also remove the application of a deductible for other needed services, such as lab tests, rehabilitation and others. 
• For consumers with a Silver plan — the most popular standard plan — we will be simplifying consumers’ choices but reducing the number of services that are subject to “coinsurance” (which is often confusing to consumers). Already for the Silver, Gold and Platinum levels, every doctor visit, lab test and prescription is not subject to a deductible.
• As part of making sure high-cost drugs are available, Covered California is establishing “caps” on drug costs for consumers. This means that even the most expensive drugs will be available for those with expensive conditions. For more information on our specialty drug caps, see our press release here: http://news.coveredca.com/2015/05/covered-california-board-protects.html.

We know that even with these changes, insurance can be confusing. This is especially true for the many who have enrolled in Covered California who never before had insurance coverage. We have important work to do to educate consumers to be more “insurance literate.” 

We also know that “affordability” is relative. Many of those who are getting insurance, even with large subsidies, still struggle to make their monthly premium payments or to afford their out-of-pocket costs. Because of this, Covered California is doing research to better understand when costs are a barrier to care.

At Covered California, we know that numbers do matter, but we also know that, just as importantly, behind those numbers are individuals and families whose lives are being changed. Increasingly, Covered California looks forward to telling the story of how our standard benefit designs are helping consumers get the right care at the right time.

These are numbers that matter.