CalPERS Announces Health Plan Premiums for 2023
July 12, 2022
Communications & Stakeholder Relations
Contact: Deb Reyman, Information Officer
(916) 795-3991 - email@example.com
SACRAMENTO, Calif. – The CalPERS Board of Administration today approved health plan premiums for calendar year 2023, at an overall premium increase of 6.75%.
Overall premiums for CalPERS’ Medicare Advantage plans decreased for the third straight year.
Members enrolled in CalPERS’ Basic (non-Medicare) Health Maintenance Organization (HMO) plans will see an average premium increase of 4.35%. Preferred Provider Organization (PPO) Basic plan members will see an overall increase of 15.76%.
“We pressed our health plans to sharpen their pencils and deliver the best premiums possible for our members,” said Rob Feckner, chair of the Pension & Health Benefits Committee. “We focused on giving our members even more choices of plans offering lower out-of-pocket costs while also adding benefit designs focused on equity and high-quality care.”
Cost drivers for the overall 2023 premium increase include medical inflation, pharmaceutical inflation, and buydown adjustments made to 2022 premiums.
The Basic plan premiums include risk mitigation approved by the board in November 2020. The risk mitigation strategy prices premiums based on the value of their benefits and network instead of the mix of healthy or unhealthy lives in a plan. The approach is expected to result in smoother and more predictable premium changes across the Basic portfolio in future years.
The following chart represents the overall percentage premium change for each health plan, between 2022 and 2023 using the state, single-party premium.
|Basic Plans||% Premium Change|
|Anthem Blue Cross Select HMO||+6.58%|
|Anthem Blue Cross Traditional HMO||-6.80%|
|Blue Shield Access+ HMO and EPO||-6.40%|
|Blue Shield Trio HMO||+2.42%|
|Health Net Salud y Más||+29.88%|
|Health Net SmartCare||-1.36%|
|Kaiser Permanente Out-of-State||+1.45%|
|PERS Gold PPO||+17.79%|
|PERS Platinum PPO||+14.48%|
|Sharp Performance Plus||+9.40%|
|United Healthcare Alliance||+2.90%|
|United Healthcare Harmony||-2.04%|
|Western Health Advantage||+2.55%|
|Total Basic Weighted Average Change||+7.21%|
|Medicare Plans||% Premium Change|
|Anthem Medicare Preferred||+14.83%|
|Blue Shield Medicare||+2.49%|
|Kaiser Permanente Senior Advantage||-6.37%|
|Kaiser Permanente Senior Advantage Summit||New plan|
|Kaiser Permanente Senior Advantage Out-of-State||-7.27%|
|PERS Gold Medicare Supplement PPO||+4.05%|
|PERS Platinum Medicare Supplement PPO||+9.97%|
|Sharp Direct Advantage||-5.33%|
|UnitedHealthcare Group Edge||+3.02%|
|Western Health Advantage||+5.13%|
|Total Medicare Weighted Average Change||+3.69%|
“Our HMO and managed Medicare plan premium increases are well below national benchmarks for premium inflation,” said Don Moulds, chief health director, CalPERS. “For Medicare Advantage, our premiums actually went down for the third straight year. The investments we’ve made to spark plan competition by adding more affordable narrow network products and Medicare Advantage plans is paying dividends as our members benefit from more choices. We also understand the impact that rising health care costs have on our members and we’re diligently working on strategies to curb future costs, particularly for our PPO products.”
New health plans, service expansions, and benefit design changes for 2023 were approved by the board in November 2021. Highlights of the changes for 2023 include:
- Blue Shield Access+ Exclusive Provider Organization (EPO) plan expansion into 11 counties: Alpine, Calaveras, Inyo, Lake, Modoc, Mono, Plumas, Siskiyou, Tehama, Trinity, and Tuolumne.
- Blue Shield Trio expansion into seven counties: Butte (pending state approval), Kern, Kings, Monterey, Riverside, San Bernardino, and Tulare.
- Basic health plans will include new health equity benefit language for reproductive and fertility care, expanded coverage for medically necessary hearing aids for members under the age of 26, and a new match to a primary care provider for PPO members that does not change the ability to see a specialist.
More information on the 2023 health plan changes and premiums for the HMO, PPO, and Association plans are available on the CalPERS website.
The 2023 Basic and Medicare premiums for the three association plans offered within the CalPERS health program will increase 4.01% and decrease 2.08%, respectively. The association boards independently negotiate the plan premiums and benefit designs for their dues-paying members.
CalPERS members can change health plans during the annual Open Enrollment period, September 19 to October 14, 2022. Open Enrollment information will be available on the CalPERS website and through members’ myCalPERS accounts beginning September 12, 2022.
Premiums will take effect January 1, 2023.
For more than eight decades, CalPERS has built retirement and health security for state, school, and public agency members who invest their lifework in public service. Our pension fund serves more than 2 million members in the CalPERS retirement system and administers benefits for more than 1.5 million members and their families in our health program, making us the largest defined-benefit public pension in the U.S. CalPERS' total fund market value currently stands at approximately $440 billion. For more information, visit www.calpers.ca.gov.