What Was New in 2023 for Covered California
This information appeared on our health insurance page a year ago, but we’re archiving it here as we update that page for 2024.
New carrier: Aetna
Aetna is entering the individual marketplace with an HMO product. It is competitively priced, but in our service area their provider network is not robust. The biggest impact of Aetna’s entry will be in eastern El Dorado County, where there will now be three carriers instead of two. Since the Affordable Care Act bases premium tax credits on the cost of the second cheapest silver plan in a given zip code, and because there is a wide gap between Aetna and Anthem’s prices, which are similar, and Blue Shield’s PPO, which is much higher, Blue Shield PPO subscribers in eastern El Dorado County are going to see significant cost increases in 2023. Switching to Aetna or Anthem will alleviate the price increase, but you may need to travel west for your medical care, except in an emergency situation where you are allowed to use out of network providers.
Changes to silver plans: higher deductibles and copayments
This table shows some of the substantial increases in deductible and copayments for silver plans in 2023. Costs shown are per-person, per visit, and in-network.
|Out of Pocket Maximum||$8,200||$8,750|
|Primary Care Visit||$35||$45|
Some relief for the
family glitch: Dependents will now be eligible for premium tax credits if your employer doesn’t subsidize the cost of their insurance, making it unaffordable
Prior to 2023, if an employer offered health coverage to an employee, the additional cost to cover the employee’s dependents was not considered when determining whether or not the employer’s coverage was affordable. This family glitch prevented many families from getting subsidies for dependent coverage from Covered California. For example, if an employer paid for an employee’s health insurance but charged $1,000/month to cover the spouse, the spouse’s coverage was considered affordable.
In 2023, the cost of covering the entire family is considered; if the family cost (employee plus dependents) exceeds 9.12% of the household’s income, then the dependents are eligible to receive premium tax credits for coverage through Covered California. Note that the cost of an employee’s coverage is still considered separately from the family cost; employees whose employee-only coverage costs less than 9.12% of household income cannot get premium tax credits for themselves, even if their dependents can. This means that the family glitch isn’t completely fixed. For example, if a married couple both work and each spouse’s cost for coverage through their respective employer costs 9% of the household’s income (total cost: 18% of household income), neither spouse would be eligible for premium tax credits.
The reason the glitch wasn’t fully fixed is because the wording of the Affordable Care Act as to whether or not an employee’s coverage is affordable is flawed, testing each employee’s affordability of coverage as a percentage of the entire household’s income. The Internal Revenue Service was able to add a regulation as to the affordability of coverage for dependents who aren’t employed by an employer who offers them health coverage, but it couldn’t work around the wording of the law with respect to a family member whose employer does offer them coverage. Completely fixing the family glitch will require Congress to amend the law, which has so far been impossible due to partisan politics.
Note that Covered California does not perform any of these tests; it is up to the applicant to correctly answer the
is this coverage affordable question in the Covered California application. Let us sign you up and we’ll do the math for you!