It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
SACRAMENTO, Calif. — Covered California has announced a special-enrollment period for residents of Los Angeles and Ventura counties, where a state of emergency has been declared due to the Palisades and Eaton Fires that have destroyed over 12,000 homes and displaced hundreds of thousands of Californians.
“These fires have caused unprecedented destruction and have upended the lives of so many living in Southern California,” said Covered California Executive Director Jessica Altman. “Everyone who is uninsured and has been affected by these fires, directly or indirectly, will have an extended opportunity to obtain health insurance through Covered California or Medi-Cal over the next two months.”
Californians have 60 days from the date that the state of emergency was declared in their county to sign up for coverage, so this special-enrollment period will last until March 8.
Other resources made available to Californians affected by the fires can be found here:
The Centers for Medicare & Medicaid Services (CMS) announced today [January 10th] that additional resources and flexibilities are available in response to the 2025 Southern California Wildfires. CMS is working closely with the State of California and federal partners to put these flexibilities in place to ensure those affected by this natural disaster have access to the care they need – when they need it most.
On Jan. 8, 2025, President Biden determined that an emergency exists in California due to the emergency conditions resulting from the 2025 Southern California Wildfires beginning Jan. 7, 2025, and continuing. Additionally, on Jan. 10, 2025, Department of Health and Human Services (HHS) Secretary Xavier Becerra determined that a Public Health Emergency (PHE) exists in California and has existed since Jan. 7, 2025.
Covered California Hits Record Enrollment Before its First Key Open Enrollment Deadline on Dec. 31
SACRAMENTO, Calif. — Covered California has surpassed 1.8 million enrollees, reaching its record-high enrollment with over a week until the first open enrollment deadline on Dec. 31.
This open enrollment, 143,686 Californians have signed up for 2025 coverage as of Dec. 14, marking a 3 percent increase over the same period last year.
Another 1,647,162 Californians have renewed their coverage so far, a 4 percent increase over the same period last year.
Combined, that's 1,790,848 Californians who have selected ACA exchange coverage for 2025. Taking the percents above literally that would mean CA had ~1,723,311 QHP selections thru 12/14/23 last year (up 3.9% overall).
Covered California Continues “Let’s Talk Health” Campaign With Record Financial Support Available As Its 12th Open Enrollment Continues
BAKERSFIELD, Calif. — Covered California continued its “Let’s Talk Health” campaign at the Beale Memorial Library today with the 2025 open-enrollment period underway.
Regardless of the results of the 2024 election, open enrollment is ongoing and coverage through Affordable Care Act marketplaces throughout the nation, including Covered California, is unaffected for 2025.
“Our doors are open, and now is the time for Californians to sign up for health insurance,” Covered California Executive Director Jessica Altman said. “The Patient Protection and Affordable Care Act remains the law of the land, and the election results do not affect the financial assistance available to enrollees through federal and enhanced state subsidies next year. The most financial assistance ever offered to Californians to help pay for health care coverage remains available for 2025.”
Covered California announced the first-year results of its first-in-the nation health plan accountability program, the Quality Transformation Initiative(QTI), today at its board meeting.
The QTI — aimed at improving health care outcomes and reducing disparities for members — was created with input from consumer advocates, health care providers and health insurance companies. It was developed in collaboration with the Department of Health Care Services and CalPERS.
The QTI establishes direct and substantial financial incentives (up to 1 percent of premium in the first year, rising to 4 percent of premium in future years) for all Covered California health insurance companies by requiring payments for failing to meet specified benchmarks for a focused, meaningful set of health-outcome measures. These equity-centered outcome measures include blood pressure and diabetes control, colorectal cancer screening and childhood immunizations.
Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), approved section 1115 demonstration amendments that allow, for the first time ever, Medicaid and Children’s Health Insurance Program (CHIP) coverage of traditional health care practices provided by Indian Health Service (IHS) facilities, Tribal facilities, and urban Indian organizations (UIO). Today’s action is expected to improve access to culturally appropriate health care and improve the quality of care and health outcomes for tribal communities in Arizona, California, New Mexico, and Oregon, and will support IHS, Tribal, and UIO facilities in serving their patients.
However, that was actually only for the preliminary rate filings. In addition, at the time I only had access to California's on-exchange individual market enrollment data, so I had to guess at the off-exchange numbers.
The small group market was more frustrating: I only had enrollment data for about 1/3 of the carriers; the rest had redacted their enrollment information. This meant I couldn't even guess at a weighted average rate change.
SACRAMENTO, Calif. — Covered California announced that the statewide weighted average rate change for dental plans offered through the marketplace in 2025 will be 1.55 percent.
Covered California also announced that consumers will have more choice among dental plans with the addition of a new dental carrier, Humana, that will offer full statewide coverage in 2025.
via Covered California: (this is actually from nearly a month ago; somehow I missed it at the time):
SACRAMENTO, Calif. — Covered California announced its health plans and rates for the 2025 coverage year with a preliminary weighted average rate increase of 7.9 percent.
The rate change can be attributed to many factors, including a continued rise in health care use, increases in pharmacy expenditures, the rising cost of care, labor shortages and other issues affecting the health care industry.
Because of the robust financial help available to Covered California enrollees, many will see a small impact, if any, to their monthly cost. Covered California, with the support of Gov. Newsom and the California Legislature, has worked to reduce the impact of increased consumer costs in 2025 by providing more support for its state-enhanced cost-sharing reduction (CSR) program, which will eliminate deductibles and lower the cost of care for over a million Californians.
