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nationally, and that premiums would have dropped around 5.4% on average if not for the ACA's individual mandate being repealed & short-term & association plans being expanded.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.

   

(sigh) Kansas is yet another state where the enrollment data for each of the carriers is redacted on the filing forms this year. To run the weighted average, I'm using last year's estimated enrollment numbers for each, which may have shifted around this year.

Assuming things haven't shfited around too much, unsubsidized Kansans will likely be looking at roughly a 3.1% average premium reduction in 2020...which also happens to be the same as the unweighted average change.

Meanwhile, the small group market is looking at an unweighted average increase of 9.7% statewide.

(sigh) As is common this year, the rate filings for Iowa's Individual and Small Group market are heavily redacted, making it impossible to calculate a weighted average premium rate change. On the Indy market, Medica is reducing their unsubsidized 2020 premiums by 11.3%, while Wellmark is raising theirs by around 4.8%.

Seeing how Wellmark only re-entered the ACA-compliant individual market this year, I'm assuming Medica has the lion's share of enrollees...but who knows? Also, Wellmark is offering two different types of policies; I'm assuming that at most the two combine to be similar to Medica's total. If so, that should mean an average premium reduction of around 3.3%.

For the small group market, I just ran an unweighted average of the 12 different companies offering policies, coming up woth an average 5.4% increase.

There is one interesting tidbit in the Wellmark filing, however: They expect 100% of their 2020 enrollees to do so on-exchange, which basically means that their unsubsidized premiums have gone up so much that they don't expect anyone to be willing to pay full price (off-exchange) for them.

Hawaii only has two carriers participating in the Individual health insurance market. For 2020, they're reducing unsubsidized premiums slightly.

The state's small group market has four carriers; unfortunately, only one of the four (Kaiser Foundation Health Plan) has posted their enrollment data; the other three are redacted. The unweighted average increase on the small group market is a mere 0.8%, however.

The good news is that as of August 2nd, the preliminary 2020 ACA premium rate changes are now available for every state at the RateReview.HealthCare.Gov website.

The bad news is that more carriers appear to be redacting their filings, making it more difficult to run weighted averages based on relative market share. In the case of Illinois, all five carriers on the individual market either redacted or not listed in the summary memos at all.

As a result, all I can do is run an unweighted average, which comes to a 1.4% premium increase statewide. My guess is that Blue Cross Blue Shield likely has the bulk of the market, which means the weighted average is likely just about flat.

For the small group market I didn't even bother trying to get the enrollment data; the unweighted average there is a 4.7% increase.

Louise Norris did note a few other details:

The good news is that as of August 2nd, the preliminary 2020 ACA premium rate changes are now available for every state at the RateReview.HealthCare.Gov website.

The bad news is that while it does make it extremely easy to look up the average rate changes being requested for every carrier on the Individual and Small Group markets, they appear to have made it somewhat harder to dig up the other key data I need to run weighted averages...namely, the actual enrollment numbers for each, along with other noteworthy items like special circumstances, breakouts of the reasons for the rate changes and so on.

Every year some rate filing forms are redacted, but it seems to be more prevalent for 2020. I don't know if that's something being done by the carriers or at HC.gov's end, but for whatever reason, it's more difficult for me to run weighted averages this year.

Alabama only has two carriers offering Individual Market policies. Unfortunately, the rate filing forms are redacted in some states, so I'm having to patch together bits & pieces of data to try and estimate the weighted average rate changes. In the case of Alabama, the filing for Blue Cross Blue Shield lists 179,500 total individual market enrollees in 2018, but there's no data for 2019...while the filing for Bright Health Insurance (a relative newcomer to the market) doesn't list any enrollment data at all.

I'm assuming that BCBSAL holds a solid 90% of the market and that their total enrollment is around the same year over year. If so, that would give Bright around 20.5K enrollees and make the total Alabama Individual Market around an even 200,000 people. Again, assuming all of this is accurate, that means a weighted average increase of 3.9%, which in turn means unsubsidized enrollees are looking at average premium increases of around $26/month  or $312 for the year.

NOTE: This has been corrected from an earlier version.

The floodgates are now officially open for preliminary (not final) 2020 ACA rate filings for both the Individual and Small Group markets. There are several states which only have a single insurance carrier offering policies on the Individual Market, which makes it very easy to calculate the weighted average rate changes...seeing how a single carrier holds 100% of the market.

Among these states are Alaska, Nebraska and Wyoming, where the sole Indy Market carriers are once again Premera BCBS (AK), Medica (NE) and BCBS of Wyoming. Unfortunately, the rate filing forms for all three are partly redacted, making it impossible for me to determine how many total enrollees they have, although I have a pretty good estimate of the on-exchange number as of the end of March for each.

In Alaska, Premera's 2020 rates are virtually unchanged year over year. In Nebraska, Medica expects to reduce rates an average of 5.3%. And in Wyoming, BCBS is only looking to bump up average unsubsidized premiums by 1.6%.

I feel kind of stupid posting this in the aftermath of not one, but two massacres in El Paso, TX and Dayton, OH (at least one of which was a clear case of white nationalist terrorism inspired and encouraged by Donald Trump), but I was bout 80% done with this last night and this is part of my job, so here it is.

Wisconsin Governor Tony Evers posted the following press release:

Gov. Tony Evers today announced that 2020 rates on Wisconsin’s individual health insurance market will be 3.2 percent lower on a weighted average compared to 2019 rates. This encouraging news further demonstrates that the individual market is stabilizing and Wisconsin residents are able to access more affordable coverage options.

The rate decrease also highlights the positive impact of that the Wisconsin Healthcare Stability Plan (WIHSP), or the state’s reinsurance program, is having on the individual market. WIHSP was fully funded in the recently signed 2019-2021 state biennial budget. Without the WIHSP, rates in the individual market were expected to increase by 9 percent in 2020.

This Just In from the New Hampshire Insurance Dept:

Federal Government Announces 2020 Premium Rates
Website details proposed decreases for health plans to be sold in NH

CONCORD, NH – The federal government has published information on proposed rates for New Hampshire’s health insurance exchange (HealthCare.gov) in 2020.

The New Hampshire Insurance Department looks at premiums each year from a market-wide perspective, comparing the median premium for an on-exchange silver-level plan covering a 40-year-old non-tobacco-user. For 2019, the median premium at this level was $440; the median premium at this level for 2020 would be $429, based on the carriers’ proposed rates. If these rates are ultimately approved, this would represent a 2.5% decrease between next year’s and this year’s median premium in the individual market.

Missouri has also released their preliminary 2020 Individual and Small Group market premium rate change filings. 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 1.8% year over year. On average, unsubsidized ACA enrollees should pay about $11/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.

The Small Group market, meanwhile, is looking at roughly 6.9% premium increases, although this could be a bit off since I had to use the 2018 enrollment number for UnitedHealthcare, which also happens to have the largest market share of the six companies in that market:

This Just In from the Nevada Insurance Dept...

Proposed rate change averages for health insurance are available to the public for review

Consumers who shop for health insurance in the individual market, can now view new rate information for Plan Year 2020 on the Nevada Division of Insurance website.

Based on the rate submissions the Division has received for 2020 plans, there are three insurance companies that submitted proposed rates for plans on the Silver State Health Insurance Exchange (Exchange): Health Plan of Nevada, SilverSummit, and HMO Colorado, with up to 26 individual health plans to choose from. The proposed average increase is 0.5% for those health insurance plans sold On-Exchange through Nevada Health Link.

This just in from the Idaho Insurance Dept:

Individual Medical Plans

The Department of Insurance received preliminary 2020 health plan information from insurance carriers on June 1 and began reviewing the proposed plan documents and rates for compliance with Idaho and federal regulations. The Department of Insurance does not have the authority to set or establish insurance rates, but it does have the authority to deem rate increases submitted by insurance companies as reasonable or unreasonable. After the review and negotiation process, the carriers submit their final rate 2020 increase information. The public is invited to provide comments on the rate changes. Please send any comments to Idaho Department of Insurance.

NOTE: This post re. North Carolina's 2020 individual market premium rate change is incomplete because it only includes one of the three carriers participating in NC's market (Blue Cross Blue Shield of NC). The rate change requests for Cigna and Centene haven't been released yet.

Normally I'd wait until I had data for the other two as well, but BCBSNC held around 95% of the state's Individual Market share last year, with Cigna holding the other 5% (Centene was a new entry to the market, so they didn't have any of it). I don't know how much the relative share has changed this year, but I'm assuming that BCBSNC still holds the lion's share of the total.

That being said, BCBSNC just posted their own preliminary rate filing summary on their corporate blog:

Blue Cross NC is decreasing 2020 Affordable Care Act (ACA) rates by an average of 5.2 percent for plans offered to individuals and an average of 3.3 percent for plans offered to small businesses with one to 50 employees. With this reduction, we take 238 million steps towards more affordable care in North Carolina.

The good news about the Ohio Insurnace Dept. is that they make it easy to find out which insurance carriers are participating on the ACA market and what the overall, weighted premium change is statewide.

The bad news is that they don't break out that statewide average by carrier rate changes, nor do they make it easy to find out the actual enrollment in the individual carriers...even on the SERFF database, they don't post the relevant filing forms until much later in the year, and tend to redact the critical data.

Still, the big number in the Buckeye State is a 7.0% average premium decrease year over year for 2020:

Ohio Health Insurance Exchange 2020

This Just In from the Pennsylvania Insurance Dept:

Insurance companies offering individual and small group health insurance plans are required to file proposed rates with the Pennsylvania Insurance Department for review and approval before plans can be sold to consumers. The Department reviews rates to ensure that the plans are priced appropriately -- that is, they are neither excessive (too high) nor inadequate (too low) -- and are not unfairly discriminatory.

Rates reflect estimates of future costs, including medical and prescription drug costs and administrative expenses, and are based on historical data and forecasts of trends in the upcoming year. In its review, the Department considers these factors, as well as factors such as the insurer's revenues, actual and projected profits, past rate changes, and the effect the change will have on Pennsylvania consumers. For more information on this process, watch our How Are Health Insurance Rates Decided?Opens In A New Window video.

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