Important information about changes to your premiums

Premium increases are expected in 2018 for Covered California® Silver-tier plan members.

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Covered California® has required all health plans to make changes to their benefit plans. In addition, the federal government has stated they will not provide Cost Sharing Reductions that would help reduce your premium in 2018. These circumstances have caused your 2018 premium to increase significantly. Below please find answers to frequently asked questions about this topic.
What are cost sharing reductions (CSRs)?

Cost sharing reductions, or CSRs, are additional financial coverage that’s included automatically in Silver-tier plans for certain customers based on income. They help reduce copays and deductibles when accessing care, and lower out-of-pocket maximums for members.


What is a Silver-tier plan?

A Silver-tier plan is a type of benefit plan. All health plans in the individual market are required to offer certain benefit plans (or metal tiers). These metal tiers (Bronze, Silver, Gold and Platinum) are intended to allow customers to compare plans with varying levels of coverage to meet essential health benefits.


Why is continued funding for CSRs uncertain?

The federal government has decided to stop funding CSR payments to health insurance companies, but the cost-sharing reduction benefits to members (lower service costs for doctor’s office or hospital visits, and lower annual out-of-pocket maximums) are not going away. As a result, premiums on all Silver-tier plans are increasing significantly in 2018. This is partly due to a surcharge included in all Silver-tier plans to deal with the lack of these payments, and partly due to normal increases due to rising costs of healthcare.


How will this impact me?

As premiums increase, so may financial help in the form of Advance Premium Tax Credits, or APTC. The increase of your monthly premium may be offset by an increase in the amount of financial help you receive, and you could see little or no change in what you actually pay each month. To make sure you get the full premium tax credit you deserve, update your information with Covered California at coveredca.com/members/renewal/. This will ensure you get the correct premium tax credit, and help you avoid owing money on your next tax return. Even if you were not eligible for APTC in the past, we recommend that you check and see if you might be eligible for financial help in 2018 to help lower your monthly premium.


What are Advance Premium Tax Credits (APTC)?

Advance Premium Tax Credits, or APTC, are premium subsidies that allow consumers to buy health coverage at a reduced monthly premium based on their projected total income at the end the year. To make sure you get the full premium tax credit you deserve, update your information with Covered California at coveredca.com/members/renewal/. This will ensure you get the correct premium tax credit, and help you avoid owing money on your next tax return. Even if you were not eligible for APTC in the past, we recommend that you check and see if you might be eligible for financial help in 2018 to help lower your monthly premium.


I’m enrolled in a Silver-tier plan with Sharp Health Plan. What should I do?

While price is an important driver for plan selection, we encourage all customers to shop for a health plan based on the quality of plan they are choosing. Sharp Health Plan continues to be recognized in California and nationally for our high-quality care and service, and we remain the most affordable access to Sharp.

  • We are the only health plan in California to receive a 5-star Summary Quality Rating, and a 5-star Members’ Care Experience Rating from Covered California.1
  • We are the highest member-rated health plan in California, and we have the highest member ratings for health care, personal doctor, specialist, getting care quickly and customer service among reporting California health plans.2
  • We also have an Excellent accreditation status — the highest status awarded by the National Committee for Quality Assurance (NCQA).
  • We are one of the highest-rated health plans in the nation with a rating of 4.5 out of 5 in NCQA’s Private Health Insurance Plan Ratings 2017-2018.
Sharp Health Plan provides the only access to all of Sharp through Covered California, including Sharp Community Medical Group (SCMG), Sharp Rees-Stealy (SRS) and all Sharp hospitals. And, we provide the most affordable access to Sharp through Covered California.


How should I pick a new plan?

We recommend confirming your APTC premium subsidy with Covered California. You can do that by logging into your Covered California account. If you are a new member, you can see an estimate of your APTC premium subsidy under the “shop and compare” tool at CoveredCA.com.

We can help you potentially save money, and find a better value for your 2018 coverage with a new plan through Sharp Health Plan. Based on your unique situation, you might want to consider one of the following:

  • Off Exchange Silver plan at a much lower premium. If you are eligible for a premium subsidy through Covered California, we can also help you understand which option is best for you.
  • Gold plans that might cost you less in premium than your current Silver plan. These are highly recommended for those who might access care more in the coming year and those who prefer lower out-of-pocket costs when accessing care.
  • Bronze plans for as low as $1 depending on your income. Please note, we recommend choosing this option ONLY if you plan on accessing care less in the coming year and if you are comfortable with higher deductibles and higher out-of-pocket costs when accessing care.


What will happen if I don’t pick a new plan?

If you don’t actively renew or select a new plan, you will be automatically re-enrolled in the same benefit plan you had in 2017. Even after you are automatically re-enrolled you can make changes until December 15, 2017 for coverage beginning January 1, 2018. Please note, we cannot move you to a new plan without your consent.


What should I do if I need help picking a plan?

We’re here to help! If you have questions, you should call your broker or one of our Certified Sales Agents at 858-499-8211. We’re available to assist you Monday – Friday, 8 a.m. to 5 p.m. We’d also encourage you to attend one of our personalized enrollment workshops. To register for a workshop, visit sharphealthplan.com/events.


1 Health plan quality ratings are calculated by Covered California using data the plans provided to the federal government in 2017.  Qualified Health Plans (QHP) contract with approved survey vendors that independently conduct the QHP Enrollee Survey each year. Quality ratings and QHP Enrollee Survey results may change from one year to the next.  For more information, please see CMS’ Health Insurance MarketplaceSM Quality Initiatives website at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment Instruments/QualityInitiativesGenInfo/Health-Insurance-Marketplace-Quality-Initiatives.html.

 

2 The source for this data is Quality Compass® 2017 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass® 2017 includes certain CAHPS® data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass® is a registered trademark of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Sharp Health Plan achieved the following summary ratings (9+10): 58.90 for Rating of the Health Plan compared to the California all LOBs average (excluding PPOs & EPOs) of 47.71; 64.62 for Rating of Health Care compared to the California all LOBs average (excluding PPOs & EPOs) of 52.34; 70.45 for Rating of Personal Doctor compared to the California all LOBs average (excluding PPOs & EPOs) of 64.26 and 77.18 for Rating of Specialist compared to the California all LOBs average (excluding PPOs & EPOs) of 65.86. Sharp Health Plan earned the following composite scores (Usually+Always): 90.37 for Customer Service compared to the California all LOBs average (excluding PPOs & EPOs) of 84.90 and 86.56 for Getting Care Quickly compared to the California all LOBs average (excluding PPOs & EPOs) of 77.58

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