Anthem Blue Cross dramatically raising rates for Californians with individual health policies

Policyholders are incensed over rate hikes of as much as 39%, which they say come on top of similar increases last year. State insurance regulators say they'll investigate.

"I've never seen anything like this," says Mark Weiss, a Century City podiatrist whose Anthem Blue Cross policy for himself and his wife will rise 35%. The couple's annual insurance bill will jump to $27,336 from $20,184. (Glenn Koenig / Los Angeles Times / February 4, 2010)

By Duke Helfand

February 4, 2010 | 7:17 p.m.

California's largest for-profit health insurer is moving to dramatically raise rates for customers with individual policies, setting off a furor among policyholders and prompting state insurance regulators to investigate.

Anthem Blue Cross is telling many of its approximately 800,000 customers who buy individual coverage -- people not covered by group rates -- that its prices will go up March 1 and may be adjusted "more frequently" than its typical yearly increases.

The insurer declined to say how high it is increasing rates. But brokers who sell these policies say they are fielding numerous calls from customers incensed over premium increases of 30% to 39%, saying they come on the heels of similar jumps last year.

Many policyholders say the rate hikes are the largest they can remember, and they fear that subsequent premium growth will narrow their options -- leaving them to buy policies with higher deductibles and less coverage or putting health insurance out of reach altogether.

"I've never seen anything like this," said Mark Weiss, 63, a Century City podiatrist whose Anthem policy for himself and his wife will rise 35%. The couple's annual insurance bill will jump to $27,336 from $20,184.

"I think it's just unconscionable," said Weiss, a member of Blue Cross for 30 years.

Woodland Hills-based Anthem declined to say how many individual policyholders will be affected or what a typical increase will be under the new pricing, which will vary from one individual to another. But the company defended its premiums, even as it tried to strike a sympathetic tone.

"We understand and strongly share our members' concerns over the rising cost of healthcare services and the corresponding adverse impact on insurance premiums," the company said in a statement.

"Unfortunately, the individual market premiums are merely the symptoms of a larger underlying problem in California's individual market -- rising healthcare costs."

About 2.5 million Californians have individual insurance policies, accounting for a small portion of the state's overall insurance market. By contrast, nearly 21 million people in California are covered by health maintenance organizations.

Individual policies are often the only option for those who are uninsured, self-employed or do not receive health coverage through employers.

Insurers are free to cherry-pick the healthiest customers in the lightly regulated individual market. They can raise rates at any time as long as they notify the state Department of Insurance and prove that they are spending at least 70% of premiums on medical care.

The size of the individual rate increases prompted state Insurance Commissioner Steve Poizner recently to call for a review of Anthem's charges.

"Commissioner Poizner is very concerned by these large rate increases," spokesman Darrel Ng said.

Poizner directed his department to retain an "independent outside actuary to examine Blue Cross' rates" to ensure that the company spends at least 70% of the premiums on medical care, as required by state law, Ng said. Anthem said it had already hired an actuary who found that the rates were sound.

Anthem is not the only health insurer imposing double-digit rate increases. Competitors such as Blue Shield of California and Aetna also have raised premiums significantly in recent years, insurance brokers said. But they said the impending Anthem increases are the largest they have seen.

"Do they really think they are going to keep clients this way?" asked Bill Robinson, a Palm Springs broker who has informed his Anthem clients that they will face increases of as much as 39% on March 1.

Anthem sent letters to agents a few weeks ago informing them of the March 1 increases and followed up with similar notices to policyholders last week.

That's when Mary Feller of San Rafael learned that the rate for herself and her husband will jump 39%, or $465 a month, driving the couple's annual premium to $19,896 from $14,316.

Feller, 56, said the premium for her 26-year-old daughter also will rise 38%, costing the family an additional $1,572 a year.

As a result, starting March 1, the Fellers' health insurance bill will surpass the family's monthly mortgage payment on their home north of San Francisco.

"It's breathtaking," said Feller, an entertainment journalist. "We're going to have to cut back somewhere else. This kind of stuff strikes fear in the heart."

Feller said she was troubled by another part of the Anthem letter. Besides detailing the premium increase, it said: "Anthem Blue Cross will usually adjust rates every 12 months; however, we may adjust more frequently in accordance with the terms of your health benefit plan."

She and others voiced anger about the increases as Anthem's parent company, WellPoint Inc., sees big profits. Last week the company announced an eightfold increase in profit for the last three months of 2009, a surge attributed largely to the sale of subsidiaries.

Broker and insurance industry analysts said the California rate increases will leave individual policyholders with few good options: Anthem subscribers such as the Fellers can switch to a company plan with a higher deductible. Or they can try to switch insurers, a dicey proposition because carriers in the individual market can reject applicants who have preexisting medical conditions.

"It's putting people's backs up against the wall," said Shana Alex Lavarreda, director of health insurance studies at the UCLA Center for Health Policy Research. "They are finding new ways to create new problems for consumers."

The insurer said it had a team of workers to help customers balance costs and insurance.

"Anthem offers a variety of health benefit plans," the company said, "and we are dedicated to working with our members to find health coverage plans that are the most appropriate and affordable for their needs."

duke.helfand@latimes.com