2021 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 tendency to jump in and out of the market, repeatedly revise their requests, and the confusing blizzard of actual filing forms 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nationally, and that premiums would have dropped around 5.4% on average if not for the ACA's individual mandate being repealed & short-term & association plans being expanded.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 five 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 2021 ACA-compliant individual (and sometimes small group) markets. Scroll down for individual state entry links.

For 2021, the biggest new factor is, of course, the impact of the COVID-19 pandemic on both 2020 and 2021 medical claims expenses. I've added a new column which attempts to separate that out, though not every carrier does so, while some simply refer to the impact of COVID-19 in a fairly vague way.

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South Dakota's 2021 individual & small group market rate filings are up, and there's not much to say about any of them: Individual premiums are going up around 2.6%, small group market policies around 2.8% overall statewide.

Back in July I posted a partial look at the preliminary 2021 ACA market landscape for Texas. I only had data for about 1/3 of the carriers at the time, so it was more of an overview than anything.

Now I have most of the data needed to analyze the individual market for 2021: Assuming no major changes in the approved rates, carriers are averaging around a 7.4% premium increase next year. This is actually unusually high for 2021 so far...other states are averaging less than 2% overall.

Most of the rate hike seems to be caused by Celtic/Ambetter ("Superior Health Plan"), which holds 1/3 of the entire market and is raising rates by nearly 12%. Blue Cross Blue Shield, which has another 36% market share, is only raising rates 3%, while the third and fourth largest carriers in the market, Molina and Oscar, are raising rates by 5.3% and 14.7% respectively.

There's also a couple of misleading numbers--both divisions of "Scott & White" are massively DROPPING their premiums for 2021, by 33% and 54%...but they have fewer than 2,000 people enrolled total to begin with; make of that what you will.

Utah's preliminary (and possibly final?) 2021 individual and small group market rate filings are listed below. Unless there's a change in the final/approved rates, individual marekt plan premiums will drop slightly by around 1.2% on average next year, while small group plans will increase by around 4.3%.

There are three insurance carriers offering ACA-compliant individual market plans in West Virginia: CareSource, Highmark BCBS and Optum, although Optum has barely any enrollees at all, and the other two combined only total around 21,000 people in the state. The preliminary 2021 rate filings for the WV individual marekt is around a 4.8% average increase.

I have no idea what the enrollment numbers are for WV's small group carriers, so I can't run a weighted average, but the unweighted average increase for 2021 comes in at around 3.8% across the five sm. group carriers:

Not much to this one: Wyoming has just a single carrier selling ACA-compliant individual market policies to their 577,000 residents, Blue Cross Blue Shield...which, after raising rates 1.6% for 2020 is now reducing them by a solid 10% on average for 2021. The ~25,000 enrollment figure is an estimate.

For the small group market there are two carriers: BCBSWY and UnitedHealthcare, asking for an unweighted average rate reduction of 0.2% (I don't have a clue how many enrollees either one has).

 

A week or so ago I noted that California's ACA exchange, CoveredCA, issued a press release which included several important items:

  • First, CA's Small Group Market premiums are increasing by just 1.5% in 2021 (the lowest average increase since the ACA passed)
  • Second, CA's Individual Market premiums are increasing by just 0.6% on average in 2021 (identical to the preliminary rate requests)
  • Third, that Open Enrollment technically already started back on October 1st...sort of.

The official launch of Open Enrollment in every state isn't until November 1st, but for the past couple of years California has allowed current enrollees already in their system to actively renew/re-enroll for the upcoming year starting on October 15th. This year, it turns out they quietly moved that date back even earlier--current enrollees have been able to re-enroll starting as early as October 1st! I don't recall them ever making a big public announcement about this; I sort of stumbled upon it by accident.

Way back in May (a lifetime ago!), the Oregon Insurance Dept. was one of the first states to release their preliminary 2021 ACA premium rate filings for the individual and small group markets.

At the time, the carriers were asking for a weighted average 2.4% increase on the indy market (OR DOI put it at 2.2%) and a 4% increase for small group policies.

They issued some slightly revised rates later on in the summer, and sometime in August I believe they issued the final approved rates...which are just slightly lower on a few carriers.

In the end, 2021 Oregon enrollees are looking at weighted average premium hikes of 2.1% for indy plans and 3.7% for small group policies:

Back in early August, Covered California issued an extensive analysis of their upcoming 2021 individual market offerings, including the preliminary weighted average premium rate changes of just a 0.6% increase. Officially, this was just the average of the preliminary requests; the approved rates were presumably forthcoming at a later date.

Well, the 2021 Open Enrollment Period has technically already started in California...while new enrollees still have to wait until November 1st, current CoveredCA enrollees have apparently been able to re-enroll for 2021 since October 1st! (In previous years, CoveredCA opened up the renewal period starting on Oct. 15th)

A month ago the Oklahoma Insurance Department posted the preliminary 2021 individual & small group market rate filings, including the following press release:

Oklahoma Consumers to Have More Health Options for 2021 ACA Plans

OKLAHOMA CITY – Insurance Commissioner Glen Mulready announced today the 2021 preliminary rate filings for health insurance plans under the Affordable Care Act (ACA). Insurers that currently offer coverage through the Oklahoma Marketplace filed plans requesting average statewide increases of 2.7 percent.

In August, the Nevada Insurance Dept. issued their preliminary 2021 rate filings for the individual and small group markets. Unfortunately, while the filing summaries were easy to find, the actual enrollment numbers weren't. As a result, I only had the department's press release to go on for the weighted overall average on the individual market, and I had to go with an unweighted average for the small group market.

Fortunately, now that the NV Insurance Dept. has issued the approved 2021 rates, they've also added more detailed summaries for both markets, meaning I have effectuated enrollments for every carrier. This allows me to run a proper weighted average rate change across both:

Back in June, Maryland's Insurance Dept. posted the preliminary 2021 rate requests for the individual and small group markets. At the time, carriers were seeking an average 4.8% premium reduction on the individual market and a 5.1% average increase for the small group market.

Recently, state regulators posted the approved rate changes for each, and the final 2021 rates have been reduced from the original requests:

Governor Hogan Announces Third Consecutive Year of Lower Individual Health Insurance Premiums

In early August, the Kentucky Insurance Dept. posted preliminary 2021 rate filings for the individual and small group markets. At the time, the carriers were requesting average increases of 11.6% on the individual market (unusually high this year) and 9.7% for the small group market.

More recently, they posted the approved 2021 rate changes, and the individual market hikes have been cut by more than half, to just a 5.0% increas on average.

Small Group plans have also been shaved down slightly, from a 9.7% average increase to 8.8%.

Normally by early October I have the preliminary rate filings analyzed & posted for nearly every state and the approved rate changes for at least half of them. This year I'm lagging way behind for several reasons, some personal, some professional.

Having said that, I'm trying to play catch-up this week. Case in point, today I'm posting Iowa's preliminary individual and small group market filings for 2021.

Wellmark is dropping their premiums by a jaw-dropping 42% next year, which would normally be a huge story except that they only have around 3,000 Iowans enrolled to begin with (which may explain the massive rate drop, of course). Oscar Insurance appears to be expanding into the Iowa individual market, while Medica continues to hold nearly 95% of the market and is only raising premiums by around 2.5%. Overall, 2021 rates are essentially flat on averae.

The small group market is much the same...there's a bunch of carriers which only have a few dozen enrollees statewide, and four which hold over 90% of the market share (realistically more like 2-3 carriers depending on how you define UnitedHealthcare and Wellmark subsidiaries).

The Delaware Insurance Dept. has posted the approved 2021 individual market rates and it's about as unexciting as you can imagine: There's a single carrier in the state (Highmark BCBS), which asked for a 0.5% average premium reduction and was approved for...a 1.0% average premium reduction. Unsubsidized Delaware enrollees will average around $80 in savings per year.

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