202 4 O UTLOO K
With open enrollment in full swing, 2024 promises to bring a year of change in the health insurance market. Nationally, Kaiser Family Foundation (KFF) is projecting an average 6% premium increase over 2023 and Covered California says marketplace rates in the state are set to go up a weighted average of 9.6%. But premiums aren’t the end of the story when it comes to health care in the coming year. From repercussions of the Medicaid unwinding to the changing nature of spousal coverage, and even the coming costs of the new breed of weight loss drugs, several areas bare watching in the coming months.
2024
Medicaid rolls unwind Prior to this year, Congress had frozen Medicaid rolls, meaning that thousands of people who no longer qualified for the program because of higher incomes stayed enrolled. Now that those restrictions have ended, states have been working to update their rolls. About a quarter million Medi-Cal policyholders have been disenrolled since the COVID-19 restrictions have ended. Many of those people were struck from the rolls even though they still would have otherwise qualified. That is often because of procedural reasons, such as not responding to requests to update their information in a timely way, leading to horror stories of patients only learning that their coverage had ended when they were in the doctor’s waiting room and their coverage was declined. For patients who still have incomes low enough to qualify for Medicaid, they can re-enroll at any point because Medicaid has a rolling enrollment that is open all year. But patients who got dropped because of their income qualified for a limited special qualifying period. That meant that they could have purchased a new policy outside of open enrollment. However, many didn’t act in time and have been without a policy for months now. For brokers and agents, that population represents a promising potential market as they need to have coverage according to the California Individual Mandate.
Heralds Cost Increases Educate your clients on the details By Michael Giusti
20 | CALIFORNIA BROKER
Spousal surcharges implemented For some employee-sponsored plans, companies apply spousal surcharges when both spouses are employed and have access to subsidized coverage through their employers. Most employers offer generous subsidies for their workers. Some also extend that subsidy to families, to the point that it is a better deal for both spouses to be on the more generous plan. That inevitably raises the health care costs for the employer with the more generous subsidy. To combat this, about a quarter of employers charge a spousal surcharge, with another 10% saying they intend to do so. These surcharges can run as much as $250 or more per month, often eliminating the savings the family would have otherwise enjoyed by combining into a single plan.
CalBrokerMag.com
DECEMBER 2023
