California | 2023 | Health Plan Analysis (Event Driven)

California's health insurance exchange, Covered California, has the largest enrollment of all exchanges with Kaiser Foundation Health Plan, Blue Shield of California, and Centene as enrollment leaders. The marketplace saw the entry of new payer, Aetna/CVS Health, in 2023. In the private commercial marketplace, Kaiser Foundation Health Plans remains dominant. The Affordable Care Act continues to be a stabilizing force in the commercial sector, but carriers doing business in the heavily regulated state struggle to find ways to contain member drug costs. The job market dynamics indicate managed care organizations will continue to see room for growth, although large, well-entrenched carriers with broad provider networks will likely be the primary beneficiaries. The state has opted to carve out the Medicaid pharmacy benefit, taking control of the preferred drug list from managed Medicaid MCOs. The state awarded new Medi-Cal managed care contracts to five MCOs, to be implemented in January 2024, through December 2028. Medicare Advantage members continue to see more zero-premium plans and decreasing premiums.

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