PEMHCA/CERBT

2023 CalPERS Medical Premiums

08-12-2022 |

CalPERS Board approves 2023 health plan premium rates

Summary

CalPERS stated the combined weighted average increase for 2023 was 6.75% for its program.  The average increase for Basic (non-Medicare) HMO plans is 4.35% and 15.76% for Basic (non-Medicare) PPO plans.  Premiums for Medicare Advantage plans decreased on average 3.23%, and Medicare Supplement plans increased on average 9.83%.  Cost drivers for the overall 2023 premium increases include medical inflation, COVID-19, and discontinuance of buydowns.

Basic plan premiums reflect the second year of the 2-year phase-in of the new portfolio rating approach approved by the Board in November 2020. Per CalPERS, this new risk mitigation strategy better aligns plan premiums with the value of benefits and network instead of the mix of healthy or unhealthy lives in a plan. CalPERS expects the new risk mitigation strategy to result in less year-over-year premium volatility in Basic premiums over time. 

Premium increases/decreases varied significantly by region and plan, with adjustments for the second year of the risk-mitigation phase-in playing a significant role in the differences for some plans.  By plan, the largest increases for basic plan premiums were for Health Net Salud y Mas in the regions it covers (2 and 3). In Region 1 the highest increase was for PERS Gold.  The biggest decrease for Basic plan premiums was for Blue Shield Access+ in Regions 1 and 3 and for Anthem Blue Cross Traditional in Region 2. 

The largest increase for plans covering Medicare participants was for the Anthem Medicare Preferred PPO followed by PERS Platinum. The largest decrease was for Kaiser Senior Advantage.
 
Changes for 2023 include: 

Basic Plans (non-Medicare)
Blue Shield Access+ entered Alpine, Calaveras, Inyo, Lake, Modoc, Mono, Plumas, Siskiyou, Tehama, Trinity, and Tuolumne counties and BS Trio has been expanded into the counties of Butte (pending State approval), Kern, Kings, Monterey, Riverside, San Bernardino, and Tulare.

Primary care providers will be assigned to participants in PPO plans. Participants may choose a different primary care provider and may go directly to a specialist without consulting their primary care provider. Also, new health equity language for reproductive and fertility care has been added to all plans.

Medicare Plans
There is one new plan: Kaiser Senior Advantage Summit, which has a zero co-pay for most services. Supplemental benefits have been added to the Anthem Blue Cross Preferred, Kaiser Senior Advantage, and Western Health Medicare plans.  

Here is a comparison of the 2022 and 2023 CalPERS medical premiums for contracting Public Agencies, by region: 
202​3 PEMHCA Premiums

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202​​2 Bartel Associates, LLC

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