Health & Medicine

Covered California attracts few Central Coast health plan buyers in first month

Just a fraction of Central Coast residents who could buy health insurance through Covered California applied for a policy during October, the first month the state’s online health insurance marketplace was operating, a new report shows.

Some 5,246 Central Coast residents in a three-county area filled out applications for health insurance and only 1,537 people went further and actually chose a policy last month, according to Covered California.

Enrollment data for each of Covered California’s 19 regions was released for the first time on Thursday. San Luis Obispo, Santa Barbara and Ventura counties are combined into Central Coast Region 12.

While the numbers of Central Coast applicants were low in October, they were similar to activity around the state.

On Thursday, Covered California Executive Director Peter V. Lee told the agency’s board of directors that the momentum has built dramatically in November. By this week, 10,000 people a day were completing applications statewide, compared to about 2,000 per day at the end of October.

“We’re seeing enrollment in every part of the state,” Lee said during the meeting in Sacramento. “We should be very pleased with that.”

The data by region was available only through October and showed that people who would most benefit from Covered California — those with incomes low enough to qualify for a federal subsidy to help pay their monthly premium — were slow to sign up.

About 143,000 Central Coast residents qualify for the subsidy, according to Covered California, but just 1,725 subsidy-eligible residents filed applications in October.

Two-thirds of Central Coast residents who applied were not subsidy-eligible, according to the report, although Covered California estimates that about half its customers are expected to meet the threshold to qualify for a subsidy.

The subsidies are on a sliding scale based on household income and family size. For instance, an individual would qualify for a subsidy with an income between $15,856 and $45,960, while a family of four would qualify with an income between $32,499 and $94,200. Those with incomes below those levels would qualify for Medi-Cal, which also can be obtained through the Covered California website.

On Thursday, Lee told the Covered California board he was ramping up marketing to encourage people to sign up.

Along the Central Coast, that marketing has been noticeably lacking. While Covered California has run high-profile events in urban areas, none have been held in San Luis Obispo County. Some local groups and individuals have stepped up to fill that void.

Offering free help

Among the busiest has been San Luis Obispo insurance agent Michael Framberger. Since September, Framberger has held 23 free seminars hosted by Twin Cities Community Hospital and Sierra Vista Regional Medical Center to explain the law. More than 500 people have attended.

“Covered California has done no outreach or education here, which is why I agreed to go ahead and do this,” said Framberger, who is one of about 100 insurance agents in the county that are certified by Covered California to assist people with their applications.

“What’s amazed me is that we’ve had so little response from the public. As we’re getting closer to the deadlines to apply, people are going to wake up and realize they have to do something.”

Framberger said that for all his outreach, only a dozen people have come to him for free help signing up for Covered California health plans.

“All but two of those people already had coverage,” he said. “The others enrolled through Covered California because it was a better deal for them with the federal subsidy.”

Framberger said he’s hoping the Covered California website doesn’t crash when Californians realize that applications must be filed by Dec. 15 to obtain insurance that starts on Jan. 1. While the Covered California website hasn’t suffered the kind of meltdown the federal website has faced, it does have glitches and balky performance when busy, Framberger said.

Customer experience

The website wasn’t a problem for Cambria resident Lorienne Schwenk, who got some advice from the Community Health Centers of the Central Coast about the application process before filing online on Oct. 2.

Schwenk works in retail and qualified for Medi-Cal under the newly expanded program that starts Jan. 1 as part of the new health-care law.

"I'm so excited. There was no way I could afford even the most basic health insurance plan on my own, so I’m counting the days until Jan. 1,” she said. “Fortunately, I've been blessed with good health and have been able to pay out of pocket if I needed to go to the doctor. But as I get older, that may change."

San Luis Obispo resident Sarah Shotwell said she, too, had little trouble with the website. But she did have trouble with the cost of the health plan since her household income disqualifies her for a subsidy.

Shotwell, 29, works part-time as a teacher and her husband works as a salesperson for a large retailer.

Shotwell had bought individual insurance because it was cheaper than joining her husband’s employer-based policy. Her insurance plan from Anthem Blue Cross was a bare-bones catastrophic version with a $5,000 annual deductible; it cost $93 per month.

“I was happy with it because the premiums were low and we could save money for any emergencies,” she said.

In October, Anthem Blue Cross notified her that her policy would be canceled at the end of the year because it didn’t provide essential health coverage required by law starting in 2014.

“The letter suggested I go on the Covered California website,” she said. Shotwell did, and found that the cheapest Bronze plan would cost her $340 per month. The deductible was high and only covered 60 percent of her health-care costs.

“I felt a little like I was trapped,” she said.

Shotwell eventually decided to go on join her husband’s policy — which has a $2,000 deductible and covers 80 percent of costs — adding an unanticipated $270 per month to their household expenses.

Shotwell said that she had supported one of the main goals of the Affordable Care Act, which was to ensure that people with pre-existing medical conditions could get affordable insurance. But covering those people requires spreading their medical costs among healthy policyholders like Shotwell.

“I think sick people need to be able to find the care they need to get well,” she said. “I just wasn’t expecting it to work out this way.”

Paso Robles resident RoseAnn Keating, 63, said she’s had both website hassles and sticker shock on the Covered California website.

Keating went looking for insurance when Aetna notified her that her policy would be canceled at the end of the year when the company stops selling individual policies in California under the new regulations.

Keating visited the Covered California website and found that she was not eligible for a subsidy. She also discovered that in the Central Coast region, Covered California offers insurance only through Anthem Blue Cross and Blue Shield. Other regions of the state have as many as 10 provider choices.

“How glad am I that my doctor participates in those,” Keating said.

She decided that the least expensive Bronze plan through Anthem Blue Cross was the closest to her Aetna policy. That is, except for cost. Her Aetna plan had cost $468 per month, and the Anthem Blue Cross policy will cost $568 per month. “All I can say is, what a mess,” Keating said.