Tuesday, October 16, 2018

A glance at silver loading in Covered California 2019

Covered California is up and running for 2019; its 3-month enrollment period has begun. This time last year, with silver loading a brand new thing, I charted the cheapest bronze, silver and gold plans in a sampling of the 19 California rating areas, specifically Los Angeles Regions 15 and 16 (CA's most populous); San Francisco/Region 4; Santa Cruz in Region 16; and the always-anomalously priced, lightly populated Imperial County in Region 13.

In all the sample cases for 2018, the spread between the cheapest bronze and the cheapest silver plan widened in comparison to 2017, and the spread between cheapest silver and cheapest gold narrowed. That's the result of silver loading. For the enrollment population as a whole, accordingly, bronze plan selection upticked from 27% to 29% and gold doubled, from 5% to 10%.


I took the sample prices for a 40 year-old with an annual income of $25,000, or slightly over 200% FPL, and so eligible for the weakest level of Cost Sharing Reduction. In that range, gold plan discounts resulting from silver loading could make gold (actuarial value 80%) a better value than silver (AV 73%).  In the event, in 2018 bronze enrollment in this income range (200-250% FPL) stayed flat compared to 2017 at 34%, but gold selection nearly tripled, from 5% to 14%, and platinum rose from 3% to 4%. The zero deductible for gold in California's standardized plans, compared to a $2,200 medical deductible for silver at this low CSR level, was likely a draw (though many services are not subject to the deductible).

Below, I've added 2019 to the chart. Price isn't everything, of course, and in many cases an option from Kaiser or a Blue or Oscar is not radically more expensive from those of the discount carriers Health Net and LA Care (or in SF, Chinese Community Health Plan). Crude as they are, the spreads give a fair idea of the direction metal level selection is likely to go, I suspect.

Metal level choices: 40 year-old with $25,000 income (207% FPL)

LA 91343 (Area 16)

Metal level
2017
2018
2019
Cheapest bronze
$ 72
$ 59
$  21
Cheapest silver
$128
$134
$119
Cheapest gold
$159
$148
$135
Bronze-silver spread
$ 56
$  75
$  98
Silver-gold spread
$ 31
$  14
$  16


LA 90639 (Area 15)

Metal level
2017
2018
2019
Cheapest bronze
$  80
$ 42
$  66
Cheapest silver
$134
$130
$140
Cheapest gold
$165
$142
$155
Bronze-silver spread
$ 54
$ 88
$  74
Silver-gold spread
$ 31
$ 12
$  15


Imperial 92222 (Region 13)

Metal level
2017
2018
2019
Cheapest bronze
$  1
$1
$1
Cheapest silver
$  1
$1
$1
Cheapest gold
$28
$1
$1  (platinum $34)
Bronze-silver spread
$  0
$0
$0
Silver-gold spread
$28
$0
$0


Santa Cruz 95062 (Region 6)

Metal level
2017
2018
2019
Cheapest bronze
$ 24
$    1
$   1
Cheapest silver
$137
$137
$128
Cheapest gold
$181
$121
$148
Bronze-silver spread
$113
$136
$127
Silver-gold spread
$  41
$ -16
$  20


SF 94116 (Region 4)
40 year-old with $25,000 income (207% FPL)

Metal level
2017
2018
2019
Cheapest bronze
$  13
$   1
$   1
Cheapest silver
$106
$113
$127
Cheapest gold
$191
$120
$158
Bronze-silver spread
$ 93
$112
$126
Silver-gold spread
$ 85
$    7
$ 31


For the most part, changes in spread this year are not radical, though a really good gold deal in Santa Cruz has been lost, and the silver-gold spread has widened considerably in SF as well. Some bronze spreads have widened, some narrowed. Silver discounts (spread between cheapest and benchmark silver) are modest: the premium is about $140 when there's no discount, i.e. when the cheapest silver plan is within a dollar or two of the benchmark (second cheapest). Imperial remains a bonanza for those who find Molina acceptable.

If these counties prove representative, gold selection may be scaled back a bit this year. But the environment looks fairly stable for the subsidized.

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