2020 OPEN ENROLLMENT ENDS (most states)

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Charles Gaba's blog

Missouri's final/approved avg. 2020 unsubsidized premium rate changes have finally been posted by CMS. For the most part they're following the same pattern as most other states this year with modest increases or decreases and a statewide weighted average decrease of 2.0% year over year. On average, unsubsidized ACA enrollees should pay about $13/month less next year than they are today.

However, what is noteworthy is that not one, not two but three new insurance carriers are entering the MO individual market this fall, bringing the total up to seven operating statewide: Cox Health Systems, Oscar Insurance (which was cofounded by Jared Kushner's brother, FWIW) and SSM Health Insurance.

When I first ran the preliminary 2020 avg. rate hike numbers for Nebraska in August, the sole carrier offering ACA-compliant policies in the state (Medica) was planning on reducing their average premiums by 5.3%. Yesterday the final, approved rates were posted by CMS, and unsubsidized 2020 premiums will be even lower, by 6.9% on average.

For 2020, Bright Health is joining the Nebraska exchange.

I'm not sure how this happened, but it looks like I missed posting about South Dakota's requested 2020 premium rate filings. No matter, though, because the approved avg. rate increases (for unsubsidized enrollees) are exactly the same as what Avera Health Plan and Sanford Health Plan asked for anyway.

Statewide, South Dakota is looking at 6.5% average hikes for 2020.

Utah's final weighted average rate increase is a bit tricky. On the one hand, I have the hard enrollment numbers for three of the five carriers offering ACA-compliant individual market policies. On the other hand, I have no idea what the numbers are for the other two...both of which happen to have the lowest average rate drops in the state (BridgeSpan and Molina).

The weighted average of the other three carriers is a 2.3% reduction. Assuming the other two have, say, 20,000 enrollees apiece, that would knock it down another 1.5 points or so, but until I have a better idea of how many enrollees those carriers have I'll stick with the -2.3% figure.

Oklahoma has three carriers on the Individual Market these days. Once again, all three rate filing memos are redacted, but I was able to dig up the number of current policy holders for one of them (CommunityCare HMO).

The final/approved rate changes are exactly the same as the requested changes from a few months back, but I've managed to lock down the actual enrollment numbers for two of the three carriers. Assuming I'm close on the third one (Medica), the weighted average rate increase statewide should be around 2.7%:

Back in August, I posted an analysis of the preliminary 2020 premium rate filings for the ACA Individual Market here in Michigan based on the actual filing forms from each of the 11 carriers participating in the market.

At the time, I concluded that the weighted average change marketwide was a 2.1% reduction in premiums compared to 2019, for around 333,000 Michiganders on the Indy market. This would mean roughly a $10 average premium reduction per unsubsidized enrollee per month, or $122 per year:

Massachusetts, which is arguably the original birthplace of the ACA depending on your point of view (the general "3-legged stool" structure originated here, but the ACA itself also has a lot of other provisions which are quite different), has ten different carriers participating in the individual market. MA (along with Vermont and the District of Columbia) has merged their Individual and Small Group risk pools for premium setting purposes, so I'm not bothering breaking out the small group market in this case.

Getting a weighted average was a bit tricky. On the one hand, only one or two of the rate filings included actual enrollment data. On the other hand, the Massachusetts Health Connector puts out monthly enrollment reports which do break out the on-exchange numbers by carrier. This allowed me to run a rough breakout of on-exchange MA enrollment. I don't know whether the off-exchange portion has a similar ratio, but I have to assume it does for the moment.

There's only 3 states which are looking at double-digit average unsubsidized premium increases on the 2020 ACA individual market: Indiana, Vermont and Louisiana.

There's actually only 3 carriers offering individual market plans in Louisiana, but there's seven listings because two of the carriers have broken out their submissions into several different product lines. Overall, HMO LA, LA Health Service & Indemnity (Blue Cross Blue Shield of LA) and Vantage Health Plan are requesting average premium increases of 11.7% statewide.

As far as I can tell, state regulators pretty much approved all of the requested rate filings exactly as-is...the weighted average is virtually the same as it was a few months ago with the preliminary requests.

I didn't have the actual enrollment data for the individual carriers when I ran the numbers for Kansas in August, so I had to go with an unweighted average unsubsidized 2020 premium rate change. At the time, that came in at a 3.1% reduction.

Since then, I've dug up the hard enrollment numbers, and just this morning CMS finally posted the final, approved 2020 rate changes. The weighted average comes in at a slight increase o 0.3% statewide:

When I ran the numbers for Iowa's preliminary avg. 2020 unsubsidized individual market rate changes, I had to use an unweighted average reduction of around 3.3%. However, knowing the relative market share of each carrier can make a big difference.

Case in point: It turns out that Medica holds something like 97% of Iowa's ACA-compliant market...whcih means the 11.3% rate drop by Medica heavily weighs the overall average. Wellmark is raising their rates by about 4.7%, but that only nudges the statewide weighted average to a 10.8% reduction overall.

When I ran the preliminary 2020 average unsubsidized premium rate change requests for Illinois in early August, I was frustrated because I had no idea what the actual enrollment numbers for the individual carriers were, making it impossible to run a weighted average change. I had to go with an unweighted average increase of 1.4% statewide.

Fortunately, since then, not only have the final rate changes been approved and posted, I've also acquired the enrollment data, allowing for a weighted average. In the end, average unsubsidized premiums are dropping ever so slightly (0.3%)...versus going up ever so slightly (0.1%) statewide.

Hawaii only has two carriers participating in the Individual health insurance market. For 2020, they're reducing unsubsidized premiums by 4%. This is a slight reduction from the preliminary unsubsidized rate change requests from back in August.

HMSA's average dropped from a 1.6% reduction to a 3.2% reduction, while Kaiser, which had been asking for a very slight increase, will actually be lowering rates by around 5.4% in 2020.

After several years with four carriers participating in their ACA individual market, the Peach State is gaining not one but two additional carriers this year: CareSource and Oscar are joining Alliant, Ambetter/Centene, Blue Cross Blue Shield and Kaiser.

When I ran the numbers for Georgia's preliminary 2020 unsubsidized premium rate changes back in August, they were averaging a 2.4% increase.

Today, however, CMS has posted the final/approved rate changes, and three of the four carriers already on the Georgia market (Alliant, Ambetter/Centene and Kaiser) are looking at slightly lower rates than they had requested. The fourth, Blue Cross Blue Shield, is bumping up their rates by an additional percentage point. Overall, Georgia carriers are dropping unsubsidized premiums by 0.9%.

When I ran the preliminary 2020 rate changes for unsubsidized ACA policies in Alaska back in August, it was pretty easy to do...there's only a single carrier offering ACA-compliant individual market policies for 2019, which means no weighting is required. Furthermore, Premera Blue Cross Blue Shield is basically keeping their rates flat for 2020 anyway.

Moda is re-entering the market for 2020, but there's no "rate change" for them since there's no base premiums to measure against year over year.

Anyway, CMS just posted the final, approved rate changes, and Premera's number is ever so slightly higher than it was: They went from a 0.05% reduction to...a 0.03% reduction.

When I first ran the preliminary 2020 ACA premium rate filing requests for Alabama in August, I came up with a weighted average increase of 3.9%.

CMS has just posted the final, approved rates for Alabama's 2 carriers (Blue Cross Blue Shield and Bright Health). Both carriers had their requested rate hikes approved without any changes, but the final weighted average for unsubsidized enrollees still dropped a bit to 3.3%...because I had the wrong market share ratios. It looks like Bright has an even smaller share of the market than I thought (less than 1%), bringing the weighted average down a bit.

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