Arlene Becker had little reason to pay attention, until the notices from Blue Shield began arriving one after another. On the first of the year, her premiums shot up, on top of the increase just a few months ago and the one a few months before that.
Soon, her Blue Shield premiums will rise again -- for the fourth time in a little over a year. "When is it ever going to stop?" asked Becker, who had to shop for her own insurance after liver cancer killed her husband nearly two years ago.
That same question is being asked by thousands of others, including Vernon Oshiro and his wife, Paulette, who run a dental lab in Folsom, Calif. "What are we going to have to give up next? Eating?"
Last year, the couple enrolled in a Blue Shield policy to escape the escalating premiums at their former carrier, Anthem Blue Cross. "And here we go again," said Paulette Oshiro.
With their monthly premiums eclipsing $900 -- compared to $600 a year ago -- the Oshiros, both in their 60s, are again shopping for a policy.
Health insurance premiums have been rising for everyone, but the 2.5 million Californians who buy insurance on their own rather than receiving it through an employer have been particularly hard-hit lately.
Since last fall, Blue Shield has raised rates three times, amounting to a 30 percent increase on average, for its nearly 200,000 individual customers. The company blamed rate hikes on rising costs for hospital care, doctors and drugs.
Since last summer, when former California Insurance Commissioner Steve Poizner began posting rate filings online, health plans submitted 43 rate notices for the individual market. Anthem Blue Cross filed 13 of those, Aetna filed eight, Health Net six and Blue Shield four.
Last week, Blue Shield informed policyholders that some of them would face increases of up to 59 percent.
Newly elected Insurance Commissioner Dave Jones responded by seeking a 60-day reprieve for Blue Shield customers. This week, Jones expanded his call to Aetna, Anthem and PacifiCare.
"Because of the weakened economy, a lot of healthy people are choosing to go without coverage, and those still with coverage are using it more frequently," said Nicole Kasabian Evans, spokeswoman for the California Association of Health Plans.
That puts pressure on insurers to raise premiums to cover their costs, she said, noting that 87 cents of every premium dollar on average is spent on medical care.
But that explanation can only go so far, say consumer advocates who note that premiums have outpaced inflation and rising medical costs.
"This is a market where rate increases are significant and frequent," said Kathleen Stoll, director of health policy for Families USA, a health advocacy group based in Washington.
Last year, the average premium for an individual policy was about $3,606 annually -- less than the $4,824 average for single coverage through an employer, according to the Kaiser Family Foundation.
But those in the individual market typically pay more out-of-pocket expenses, including large deductibles, for fewer benefits.
A new law that took effect Jan. 1 provides some tools to uncloak the process that determines the premiums individual consumers pay.
Insurers now must inform customers of rate increases at least 60 days in advance of new rates taking effect. They must post those rates online and include a justification. They must certify that the filing is "reasonable" under the new federal health care law.
Eventually, consumers may get more bargaining power. The federal law includes new exchanges to give individuals the same benefits as group coverage. Those exchanges don't open until 2014.