CalPERS Announces Health Plan Premiums for 2025 Along With Expanded Cost-Saving Options for Members
July 16, 2024
Communications & Stakeholder Relations
Contact: Office of Public Affairs
(916) 795-3991 - newsroom@calpers.ca.gov
SACRAMENTO, Calif. – The CalPERS Board of Administration has approved health plan premiums for calendar year 2025, at an overall weighted premium increase of 10.79%.
Basic (non-Medicare) plans will increase 9.08% overall. Members enrolled in CalPERS' Basic Health Maintenance Organization (HMO) plans will have an average premium increase of 8.72%. Preferred Provider Organization (PPO) Basic plans will have an overall increase of 9.82%.
Medicare plan premiums will rise 22.25% overall.
"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," said Ramón Rubalcava, chair of the Pension & Health Benefits Committee. "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."
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 the 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.
"We encourage CalPERS members to take a look at the options during open enrollment and find the plan that best fits their needs," said Chief Health Director Don Moulds. "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 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 and Solano counties.
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.
Also starting in 2025, Blue Shield of California and Included Health will assume the role of administrators for CalPERS PPO members. This new partnership marks a major milestone in CalPERS' continuing efforts to control healthcare costs, improve quality, and address the vital need for health equity. Blue Shield and Included Health will have strong financial incentives to improve the care that CalPERS members receive.
The following tables represents the overall percentage premium change for each health plan between 2024 and 2025 using the state, single-party premium.
| Basic Plans | % 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 Trio HMO | 12.20% |
| Health Net Salud y Más HMO | 14.73% |
| Kaiser Permanente HMO | 8.41% |
| Kaiser Permanente HMO Out-of-State | 8.37% |
| PERS Gold PPO | 9.82% |
| PERS Platinum PPO | 9.82% |
| Sharp Performance Plus HMO | 4.23% |
| UnitedHealthcare Alliance HMO | 8.88% |
| UnitedHealthcare Harmony HMO | 7.39% |
| Western Health Advantage HMO | 13.26% |
| Total Basic Weighted Average Change | 9.08% |
| Medicare Plans | % Premium Change |
|---|---|
| Anthem Medicare Preferred | 20.14% |
| Blue Shield Medicare | 14.16% |
| Kaiser Permanente Senior Advantage | 5.63% |
| Kaiser Permanente Senior Advantage Out-of-State | 5.74% |
| Kaiser Permanente Senior Advantage Summit | 5.63% |
| Kaiser Permanente Senior Advantage Summit Out-of-State | 5.72% |
| PERS Gold Medicare Supplement | 34.32% |
| PERS Platinum Medicare Supplement | 30.47% |
| Sharp Direct Advantage | 6.20% |
| UnitedHealthcare Group Medicare Advantage | 29.42% |
| Total Medicare Weighted Average Change | 22.25% |
CalPERS members can shop health plans and make a change during Open Enrollment, which runs September 16 through October 11. Beginning September 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. Premiums will take effect January 1, 2025.
Premiums will take effect January 1, 2025.
About CalPERS
For more than nine 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, making us the largest defined-benefit public pension in the nation. We also administer health benefits for more than 1.5 million members and their families, making CalPERS the nation’s largest purchaser of public employee health services behind the U.S. government. For more information, visit www.calpers.ca.gov.