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nationally, and that premiums would have dropped around 5.4% on average if not for the ACA's individual mandate being repealed & short-term & association plans being expanded.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

Huh. This is interesting...after a couple dozen states with near-flat or even reduced 2020 premiums, Louisiana is just the third state I've come across where the carriers are seeking double-digit rate increases for next year.

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.

I should note that there's also one odd listing (see second screenshot below), from UnitedHealthcare. It claims to be for off-exchange ACA-compliant individual market plans, but two things about it make no sense:

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. Unlike a lot of the states I've crunched numbers for recently, I was able to acquire hard enrollment numbers for every single Georgia carrier...including both the Individual and Small Group markets, which is a rarity this year!

Statewide, GA's individual market carriers are requesting average unsubsidized 2020 rate hikes of just 2.4%, while the small group carriers are looking for a 12.8% average increase:

(sigh) The good news is that none of the five carrier rate filings for Utah's individual market have been redacted. Hooray! The bad news is taht only one of the five (Molina) included their current enrollment total on the filing at all. Boo!

As a result, I'm only able to run a "mostly" unweighted average...that is, it's an unweighted average of the other four carriers, plus a slight additional tweak based on the tiny number (448 people) enrolled in Molina policies. Utah's total individual market should be around 240,000 people, so that's barely a rounding error. My best guess is that unsubsidized enrollees are looking at roughly a 5.9% average premium drop next year.

For the state's small group market, the unweighted average increase is 2.7%.

West Virginia has three carriers offering policies on the Individual Market: CareSource, Highmark and The Health Plan of WV (aka Optum). I was ble to find the hard enrollment number for CareSource, while both HighMark and Optum are redacted, so I based my enrollment estimates on 83% of last year's (WV's total ACA exchange enrollment dropped 17% this year). Even if that ratio is off, it won't make that much of a difference since the two are pretty close anyway (+5.9% and +6.5% respectively).

Statewide, unsubsidized West Virginians will be seeing roughly a 6.7% average increase...to a whopping $1,000/month on average, one of the highest rates in the country. Of course, WV is also one of the few states which, to my knowledge, is still refusing to Silver Load or Silver Switch their premium increases, which makes it even worse for the few unsubsidized enrollees they have.

Meanwhile, the unweighted average increase on the WV small group market is +11.2%.

Just hours after explaining what a dramatic impact the nearly-flat average 2020 premium changes are going to have on this year's (and next year's) Medical Loss Ratio rebate payments, I've discovered that rates are going to be increasing even less than I thought nationally.

Back in late May, Virginia was one of the first states to post their preliminary 2020 premium rate filings. At the time, the 10 carriers participating in VA's individual market (one of which is new for 2020) were asking for average increases of 2.9% statewide:

I've now analyzed the preliminary average (weighted or, in a few unfortunate cases, unweighted) premium change requests for over 3 dozen states. Of the dozen or so left, the largest states unanalyzed are Georgia, Texas...and Florida.

Florida may be the third largest state, but it has the largest ACA Individual health insurance market. 18% more Floridians enrolled in ACA exchange policies this year than California, in spite of FL's total population being only 54% as large.

Two years ago I noted that for whatever reasons (demographics? state economy?), Florida's Individual market is twice as large as the rest of the country on a per capita basis. Today I found out that FL's indy market is actually larger than their large group market:

(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.

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