2020 Rate Changes

Every year, I spend months painstakingly tracking every insurance carrier rate filing for the following year to determine just how much average insurance policy premiums on the individual market are projected to increase or decrease.

Carriers jump in and out of the market, their tendency repeatedly revise their requests, and the confusing blizzard of actual filing forms which sometimes make it next to impossible to find the specific data I need. The actual data I need to compile my estimates are actually fairly simple, however. I really only need three pieces of information for each carrier:

  • How many effectuated enrollees they have enrolled in ACA-compliant individual market policies;
  • What their average projected premium rate increase (or decrease) is for those enrollees (assuming 100% of them renew their existing policies, of course); and
  • Ideally, a breakout of the reasons behind those rate changes, since there's usually more than one.
  • In 2015, I projected that the overall average rate increases for 2016 would be roughly 12-13% nationally. It turned out to be around 11.6%.
  • In 2016, I projected that the overall average rate increases for 2017 would be roughly 25% nationally. It turned out to be around 22%, but that only included on-exchange Silver plan enrollees across 44 states (I included all metal levels, both on and off exchange, across all 50 states).
  • In 2017, I projected that the overall average rate increases for 2018 would be around 29% nationally, and that 60% of that would be due specifically to deliberate Trump Administration actions designed to sabotage the ACA markets. It turned out to be around 28% nationally.
  • In 2018, I projected that the overall average rate increases for 2019 would be around 2.8% nationally, and that premiums would have dropped around 5.4% on average if not for the ACA's individual mandate being repealed & short-term & association plans being expanded. Hhealthcare think tank Avalere Health came to almost the exact same estimates on the actual rate changes, while Brookings Institute healthcare analyst Matthew Fiedler concluded that unsubsidized ACA individual market premiums would indeed have dropped by around 4.3% nationally on average in the absence of mandate repeal and expansion of #ShortAssPlans.

In other words, I've had a pretty good track record of accurately projecting average premium increases for the upcoming year for four years in a row. With that in mind, below you'll find a table tracking the state-by-state preliminary and final rate changes for the 2020 ACA-compliant individual (and sometimes small group) markets. Scroll down for individual state entry links.

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.

I've been expecting this exact press release from Trump's HHS Dept. to drop for awhile now:

Premiums for HealthCare.gov Plans are down 4 percent but remain unaffordable to non-subsidized consumers

Today, the Centers for Medicare & Medicaid Services (CMS) announced that the average premium for the second lowest cost silver plan on HealthCare.gov for a 27 year-old will drop by 4 percent for the 2020 coverage year. Additionally, 20 more issuers will participate in states that use the Federal Health Insurance Exchange platform in 2020 bringing the total to 175 issuers compared to 132 in 2018, delivering more choice and competition for consumers. As a result of the Trump Administration’s actions to stabilize the market, Americans will experience lower premiums along with greater choice for the second consecutive year.

Back in early August, I ran the preliminary average unsubsidized 2020 individual market rate changes in Arizona. At the time, I had the requested rate changes for both the individual and small group markets, but not the actual enrollment numbers for each carrier, so I had no way of calculating the weighted average. I instead settled for a simple unweighted average, which came in at around a 2.4% reduction in premiums on the individual market and a 5.2% increase on the small group market.

A few days ago, the Arizona Insurance Dept. released the final/approved 2020 rate changes, and there was only one significant change: Health Net of AZ (dba Arizona Complete Health), which had requested a 2.9% rate reduction, will instead be keeping their premiums flat year over year on average. With Health Net holding over 50% of the market share, this meant that the statewide average is a bit higher than I had it previously.

Back in July, the Pennsylvania Insurance Dept. posted the preliminary/requested 2020 average premium rate changes for the individual and small group markets. The ACA-compliant individual market average increase was around 4.6%; for small businesses, the average was 9.6%.

Today they finally posted the approved rate changes for each...and the indy market average has dropped to a 3.8% increase, while the small group market has gone up just a hair to 9.7%.

I posted Wisconsin's preliminary 2020 rate filings in early August. Yesterday the state insurance department posted this press release, which includes the final, approved rate changes. As far as I can tell, nothing has changed (the final statewide weighted average is a 3.2% average premium reduction over last year, thanks primarily to them implementing a fairly robust ACA Section 1332 reinsurance waiver:

​Gov. Evers Announces More Health Insurance Options for Wisconsinites in 2020 Ahead of Open Enrollment

Back in July, the Colorado Insurance Dept. announced the preliminary 2020 avg. premium rate changes for the individual and small group markets, including making the important point that their then-pending Section 1332 Reinsurance Waiver program, if approved, would cut down on unsubsidized premiums by over 18% on average (18.2%, to be precise, according to the CO DOI, although my own analysis based on the preliminary rate filings brought it in at a 17.5% reduction).

Today they announced the final, approved 2020 rate changes...and the average premium is expected to drop even lower yet:

Gov. Polis: 2020 ACA Premiums Going Down by an Average of 20.2%

The South Carolina Insurance Dept. released their final/approved 2020 Individual and Small Group Market premium rate changes a few days ago.

Previously, I only had the unweighted averages, which were a 1.9% decrease on the Indy market and an 11% increase for small group enrollees...but SCDOI has included the weighted averages for each in their approved numbers: A 3.9% drop and 7.6% increase respectively.

It's also worth noting that the Individual market is growing from three carriers to five next year--both Bright Health Co. and Molina Healthcare are joining the South Carolina market for the first time.

This Just In, via the New Jersey Dept. of Banking & Insurance...

NJ Department of Banking and Insurance Releases Health Plan Rates
On Average, NJ Individual Market Rates for 2020 Remain 1.4% Lower Than 2018

The New Jersey Department of Banking and Insurance today released rates for health insurance plans in the individual market effective January 1, 2020. On average, rates for 2020 will remain 1.4 percent lower than they were in 2018, due to policy actions taken by the Murphy Administration to stabilize the insurance market. 

OK, hold up, read that again: 1.4% lower than 2018 premiums, not 1.4% lower than 2019. That's kind of an important distinction. Don't get me wrong, this isn't a bad thing to note, but it's not that impressive considering some other states are seeing rate reductions from 2018. Of course, there's a lot of factors at play which vary from state to state as well.

Normally I write two separate annual premium rate change filing entries for each state: One when the preliminary/requested rate filings are submitted, and another one when the final/approved rates are published.

In the case of California, it turns out that the rate rview/negotiation process is...more complicated. The press release/report released by Covered California back in July referred to preliminary 2020 premiums only, but it turns out that Covered California exchange personnel had already completed all their negotiations before posting any numbers.

It also turns out (thanks to "Dena M." aka @HealthEDena) that in California, insurance policy premiums are not reviewed/approved by the state insurance department...but by an entirely different department called the Dept. of Managed Health Care, or DMHC.

Back in early July, the Indiana Insurance Dept. posted the preliminary requested 2020 rate increases for the carriers participating in the ACA-compliant individual market. Technically there's three carriers there (CareSource Indiana, Celtic/Ambetter and Anthem), though Anthem only has 4 (yes, four) people enrolled in off-exchange policies total.

At the time, the IN DOI stated that the requested rates came in at an average premium increase of 9%:

INDIANA 2020 ACA FILINGS

The overall average rate increase for 2020 Indiana individual marketplace plans is 9.0%. CareSource and Celtic (MHS/Ambetter) have filed to participate in the 2020 Indiana Individual Marketplace. The Department of Insurance anticipates that all 92 counties in Indiana will be covered by both CareSource and Celtic (MHS/Ambetter).

Anthem has filed to offer a 2020 Off-Marketplace plan in Indiana. This plan is a catastrophic plan and is offered only in Benton, Jasper, Newton, Warren and White Counties.

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