The CalPERS Board of Administration has approved health plan premiums for 2025, at an overall weighted premium increase of 10.79%
Basic (non-Medicare) plans will increase 9.08% overall next year. Members enrolled in CalPERS' Basic Health Maintenance Organization (HMO) plans will have an average premium increase of 8.72%. Preferred Provider Organization (PPO) Basic premiums will increase 9.82%.
CalPERS Medicare plan premiums will rise 22.25%. Premiums will take effect Jan. 1, 2025.
"The health care landscape remains challenging, and while medical trend costs in our HMO plans are slightly lower than the national average, we are seeing significant increases in pharmacy costs across all plans,” CalPERS Pension & Health Benefits Committee Chair Ramón Rubalcava said.
“The good news is that CalPERS offers numerous plans in a competitive marketplace, where members may have more affordable options that provide the same high-quality care."
Reasons for Rate Changes
The primary drivers of this year's rate changes are the higher cost of providing services and the increased use of high-cost specialty and brand name drugs. In addition, Medicare premiums are being driven higher by significant changes in the way the federal government reimburses employer plans, which is adding new costs for plan sponsors like CalPERS.
Another factor in this year's rate change is that CalPERS will be completing its transition to a single risk pool to improve the stability of its Basic PPO plans. The change is expected to stabilize enrollment across HMOs and PPOs by pricing the plans based on the value of their benefits and network, instead of the mix of healthy or unhealthy members in a plan.
Premium Increases, by Plan
The following tables represent the overall percentage premium change for each health plan between 2024 and 2025 using the state, single-party premium.
Basic Plan
|
Premium Change
|
|
Anthem Blue Cross Select HMO
|
10.39%
|
|
Anthem Blue Cross Traditional HMO
|
9.28%
|
|
Blue Shield Access+ HMO and EPO
|
8.22%
|
|
Blue Shield PERS Gold PPO
|
9.82%
|
|
Blue Shield PERS Platinum PPO
|
9.82%
|
|
Blue Shield Trio HMO
|
12.20%
|
|
Health Net Salud y Mas HMO
|
14.73%
|
|
Kaiser Permanente HMO
|
8.41%
|
|
Kaiser Permanente Out-of-State HMO
|
8.37%
|
|
Sharp Performance Plus HMO
|
4.23%
|
|
UnitedHealthcare Alliance HMO
|
8.88%
|
|
UnitedHealthcare Harmony HMO
|
7.39%
|
|
Western Health Advantage HMO
|
13.26%
|
|
Average Weighted Increase
|
9.08%
|
Medicare Plan
|
Premium Change
|
|
Anthem Medicare Preferred PPO
|
20.14%
|
|
Blue Shield Medicare PPO
|
14.16%
|
|
Blue Shield PERS Gold Medicare Supplement
|
34.32%
|
|
Blue Shield PERS Platinum Medicare Supplement
|
30.47%
|
|
Kaiser Senior Advantage HMO
|
5.63%
|
|
Kaiser Senior Advantage Out-of-State HMO
|
5.74%
|
|
Kaiser Senior Advantage Summit HMO
|
5.63%
|
|
Kaiser Senior Advantage Summit Out-of State HMO
|
5.72%
|
|
Sharp Direct Advtantage HMO
|
6.20%
|
|
UnitedHealthcare Medicare Advantage HMO
|
29.42%
|
|
Average Weighted Increase
|
22.25%
|
Expanded Coverage
CalPERS will be providing members with more options to choose from as the Board approved the following health plan expansions for 2025, including:
- Blue Shield's Trio HMO will expand into all of Contra Costa County and a portion of Shasta County.
- Health Net's Salud y Más HMO will be offered throughout Imperial County.
- Kaiser Permanente's HMO will expand into portions of Monterey County.
- UnitedHealthcare's Harmony HMO will expand into all of Napa County and portions of Contra Costa County and Solano County.
"We have several lower cost health plans expanding into new parts of the state, giving our members more options and potentially more ways to save money on their health insurance," CalPERS Chief Health Director Don Moulds said.
New Benefits
In addition, members will see two new benefits in their coverage that will improve the quality-of-care they receive:
- Doula Services: Provides non-medical care for pregnant and postpartum members to improve health education and provide physical and emotional support before, during and after pregnancy. In addition, the doula service will improve health equity and decrease the known disparities in maternal and infant health care, especially for Black, Native American, and Pacific-Islander communities.
- Travel for Medically Necessary Care: Standardizes coverage of travel and lodging for eligible medically necessary services that cannot be accessed locally for all Basic and Medicare members
Blue Shield to Manage PPO Plans
CalPERS has chosen Blue Shield of California and Included Health to administer its PERS Gold and PERS Platinum PPO plans starting in 2025. There are no changes to copays, coinsurance, or deductibles with this transition to Blue Shield.
For the Basic plans, Included Health will provide member services and care coordination.
PERS Gold and Platinum Medicare Supplement members will contact Blue Shield for member services, while the Centers for Medicare Services (CMS) will continue to provide care coordination services.
Open Enrollment
CalPERS members can shop health plans and make changes during Open Enrollment, which runs Sept. 16 through Oct. 11.
Beginning Sept. 9, members can find Open Enrollment information on the CalPERS website and customized information in their myCalPERS accounts.
Using the Search Health Plans tool in myCalPERS, members can compare plan monthly premiums and copays, and search for primary care doctors and specialists to see the plans in which they participate.
For details on health plans, service areas, and benefit design changes for 2025, please visit the CalPERS Annual Health Plan Changes page.