2021 PLAN YEAR INFORMATION MOVING AHEAD IN UNCERTAINTY 2021 AND BEYOND September 2020 IMPORTANT NOTES Version 12/16/2020 • This document was created on September 1, 2020 for reference only, and should not be used as the fixed premium rates to give to consumers. This document has been updated to fix the footer on the bronze and silver rate tables to reflect the correct APTC amounts. • Premium rates shown are for a 25-year-old and a 40-year-old single individual. • The lowest-priced plan for each metal tier is shown in bold green font. • The second-lowest silver plan is shown with a red square. • Plans that are not offered in all ZIP codes in the county are shown with an asterisk (*). • Use the Covered California Shop and Compare Tool to see the premium rates for specific ages, household size, incomes, and ZIP codes. 1 2021 PLAN BENEFIT YEAR OVERVIEW 2020 Covered California Enrollment Profile Qualified health plan enrollment Enrollment by metal plans 2019 Enrollment data as of 6/30/2019 . 3 Policies and Outreach Make a Difference in 2020 Plan Year Average dollar amount of financial help received by middle income households between 400-600% of Federal Poverty Level* 25% 23% 20% ~625,000 17% (42%) 15% 1.5 15% 13% QUALIFIED 11% MILLION FOR STATE 10% 8% SUBSIDES 7% 7% PLAN SELECTED FOR 2020 PLAN YEAR 5% 0% $1 - $50 $51 - $101 - $201 - $401 - $600 - $801 - $1,001 + $100 $200 $400 $600 $800 $1,000 Nearly 32,000 middle-income consumers qualified for the new financial help, which averaged $504 per month for eligible households, and lowered their monthly premium by half. 4 2021 State Subsidy Program • Maintain the current level of state subsidies as adopted in the 2020 state subsidy program $349 Million design into 2021. • Maintain requirement to allocate 17% of the subsidies to individuals between 200%-400% Nearly 58,000 FPL. Enrollees in the • Estimates still anticipate enrollment growth in 400%-600% FPL the 400 to 600% FPL group that are receiving will state subsidies for 2021, relative to 2020. receive state subsidy 5 2021 Program Design Required Contribution Curve 6 APTC - 3 Major Components INCOME / FPL FAIR SHARE % / AMOUNT SECOND-LOWEST If consumer selects (FEDERAL AND STATE) SILVER PREMIUM the second-lowest silver plan George: Federal: Expected to contribute:8.29% Benchmark Plan 40 years old, in (fair share) of his income = $2588 in Sacramento Sacramento annually or $215 per month before the Premium = $482 earns $31,225/year = state subsidy. Subtracts the 250% FPL Federal Fair Share = - $215 State: Expected to contribute: 7.8% Federal APTC Monthly Cost: (fair share) of his income = $2,435 Amount = $267 Total Premium = $482 annually or $202 per month. Take the Adds the State Total APTC = $280 federal required amount and subtractthe Subsidy Amount= +$13 Consumer state required amount to get the state Total APTC = $280 Premium = $202 subsidy amount = $13. George can shop for a more expensive plan, but will continue to receive only $280 toward the cost of those more expensive plans. If the consumer decides on a less expensive plan, the APTC applied cannot exceed the amount of the premium. *Footnote: Using 2020 Shop and Compare data 7 2021 California Individual Market Rate Statewide WeightedAverage Shop & Switch Statewide WeightedAverage 8 Rate Change Year over Year 3 Year Overall Average 2015 2016 2017 2018 2019 2020 2021 Average (2019- 2021) Weighted 4.2 4.0 13.2 12.5* 8.7 0.8 0.6 6.3 3.3 Average Shop & - -4.5 -1.2 3.3 -0.7 -9.0 -7.3 -3.2 -5.7 Switch *The weighted average rate increase in 2018 was 21.1 percent, but much of that increase was directly offset for consumers by an increase in federal subsidy which lowered their netpremium. California’s Efforts to Build on the Affordable Care Act Lead to a Record-Low Rate Change for the Second Consecutive Year: https://www.coveredca.com/newsroom/news-releases/2020/08/04/californias-efforts-to-build-on-the-affordable-care- act-lead-to-a-record-low-rate-change-for-the-second-consecutive-year/ 9 California’s Individual Market Rate Change by Carrier Weighted Average Rate Carrier Change Anthem Blue Cross 6.0 Blue Shield of California - 2.4 CCHP - 1.3 Health Net 3.4 Kaiser Permanente 1.0 LA Care Health Plan - 4.6 Molina Healthcare - 3.8 Oscar Health Plan of California 7.6 Sharp Health Plan - 0.5 Valley Health Plan 9.0 Western Health Advantage - 2.6 Overall 0.6 Averages for on-exchange plans 10 2021 Covered California Health Plan Offerings • 2 carriers will be expanding their coverage areas • Nearly all Californians (99.8%) will have a choice of 2 carriers • 87% Californians will have a choice of 3 or more carriers 11 *NEW* Anthem HMO • HMO plan product will be available in rating region 18, Orange County • Continue to offer rating regions 11, 15, 16, 17 12 *NEW* Anthem EPO • EPO plan product now available in rating region 13 and 14, Inyo, Mono, Imperial, and Kern counties. • Continue to offer in rating regions 1, 7, 9, 10, 12, 13, 14 13 *NEW* Oscar EPO • EPO plan product now available in rating region 8, San Mateo County • Continue to offer in rating regions 4, 16, 18 and partial in 15. 14 2021 REGIONAL HEALTH PLAN RATES Bronze and Silver Metal Tier Plans BRONZE 2021 Region 1 Rates 2020 2021 Lowest YOY Consumer Market Health Plan Monthly Monthly Price Gross Gross Change Pays Share • 4.4% weighted Premium Premium average increase 1 Kaiser $377 $392 3.9% $42 0.8% • Kaiser remains 2 Blue Shield PPO $495 $480 -2.9% $130 36.5% as the lowest priced bronze 3 Anthem EPO $446 $485 8.7% $136 62.7% plan Monthly Gross Premium and Consumer Pays amount based on 40 year old at 250% FPL - $337 APTC & $13 State Subsidy 16 SILVER 2021 Region 1 Rates 2020 2021 Lowest YOY Consumer Market Health Plan Monthly Monthly • 0.04% weighted Price Gross Gross Change Pays Share Premium Premium average rate decrease 1 Kaiser $468 $485 3.7% $135 1.5% • Kaiser remains as the lowest priced 2 Anthem EPO $542 $557 2.8% $207 41.5% silver plan but 3.7% price increase 3 Blue Shield PPO $633 $619 -2.2% $269 57% • $188 price spread 4 Blue Shield HMO $695 $673 3.2% $323 0.04% (consumer could save by switching from highest to lowest) Monthly Gross Premium and Consumer Pays amount based on 40 year old at 250% FPL - $337 APTC & $13 State Subsidy 17 BRONZE 2021 Region 1: Butte County Rates for Zip Code 95926 2020 2021 Lowest YOY Consumer Market • 4.4% weighted Health Plan Monthly Monthly Price Gross Gross Change Pays Share average Premium Premium increase 1 Blue Shield PPO $495 $480 -2.9% $130 36.8% • Blue Shield PPO reduced price by 2.9% 2 8.7% $136 63.2% Anthem EPO $446 $485 from last year Monthly Gross Premium and Consumer Pays amount based on 40 year old at 250% FPL - $337 APTC & $13 State Subsidy 18 SILVER 2021 Region 1: Butte County Rates for Zip Code 95926 • 2.1% weighted 2020 2021 average decrease Lowest YOY Consumer Market Health Plan Monthly Monthly Price Gross Gross Change Pays Share Premium Premium • Anthem EPO remains as the lowest silver 1 Anthem EPO $542 $557 2.8% $146 2.5% plan but price increase by 2.8% from last year Blue Shield 2 $633 $619 -2.2% $207 97.5% PPO • $62 price spread (consumer could save by switching from highest to lowest) Monthly Gross Premium and Consumer Pays amount based on 40 year old at 250% FPL - $398 APTC & $13 State Subsidy 19 BRONZE 2021 Region 2 Rates 2020 2021 Lowest YOY Consumer Market Health Plan Monthly Monthly Price Gross Gross Change Pays Share Premium Premium 1 Western HMO $399 $397 -0.3% $70 18.8% • 2.2% weighted 2 Kaiser $397 $412 3.9% $85 68.1% average increase Blue Shield 3 $545 $520 -4.6 $192 12.2% PPO 4 HealthNet EPO $511 $608 19% $280 1% Monthly Gross Premium and Consumer Pays amount based on 40 year old at 250% FPL - $315 APTC & $13 State Subsidy 20 SILVER 2021 Region 2 Rates 2020 2021 Lowest YOY Consum Market Health Plan Monthly Monthly Price Gross Gross Change er Pays Share Premium Premium 1 Kaiser $492 $510 3.7% $183 73% • 2.1% weighted average increase 2 Western HMO $539 $535 -0.7% $207 11.7% • $401 price spread Blue Shield 3 $697 $670 -3.9% $342 14.9% (consumer could save PPO by switching from Blue Shield 4 $716 $693 -3.2% $365 0.2% highest to lowest) HMO HealthNet 5 $765 $911 19% $583 0.2% EPO Monthly Gross Premium and Consumer Pays amount based on 40 year old at 250% FPL - $315 APTC & $13 State Subsidy 21 BRONZE 2021 Region 3 Rates 2020 2021 Lowest YOY Consumer Market Health Plan Monthly Monthly Price Gross Gross Change Pays Share Premium Premium • 2.5% weighted 1 Western $431 $387 -10% $110 6.1% average increase 3.9% 77.3% 2 Kaiser $377 $392 $114 • Western reduced HealthNet price by 10% from 3 $456 $506 11.1% $229 3.8% PPO last year Blue Shield 4 $545 $530 -2.7% $253 12.8% PPO Monthly Gross Premium and Consumer Pays amount based on 40 year old at 250% FPL - $337 APTC & $13 State Subsidy 22 SILVER 2021 Region 3 Rates 2020 2021 Lowest YOY Consum Market Health Plan Monthly Monthly Price Gross Gross Change er Pays Share Premium Premium • 0.3% weighted 1 Blue Shield HMO $482 $462 -4.2% $184 32.2% average increase 2 Kaiser $468 $485 3.7% $207 53.7% • $258 price spread (consumer could 3 Western HMO $573 $516 -10% $238 1.6% save by switching from highest to 4 Blue Shield PPO $697 $683 -1.9% $406 11.9% lowest) HealthNet PPO $648 $720 11.1% $443 0.6% Monthly Gross Premium and Consumer Pays amount based on 40 year old at 250% FPL - $337 APTC & $13 State Subsidy 23 BRONZE 2021 Region 4 Rates 2020 2021 Lowest YOY Consumer Market Health Plan Monthly Monthly Price Gross Gross Change Pays Share Premium Premium • 1.2% weighted 1 Kaiser $417 $433 3.9% $70 51.8% average increase 2 CCHP