2018 MIDTERM ELECTION

Time: D H M S

Rate Increases

*IMPORTANT: This assumes that everyone currently enrolled sticks with their current policy next year. If enough people shop around and consider their options, the average premiums for various plans, various companies, in vartious states and nationally could end up being considerably lower (possibly coming in under 10% overall).

Again: Do not blindly autorenew! Contact your ACA exchange website/call center (or your insurance carrier, if you're enrolled directly through them) and check out your options before committing to your existing plan! In many cases, there will be a different plan which is a better value for you!

At last!! It's been extremely frustrating trying to lock down the 2016 average premium hikes for Pennsylvania, especially because their Insurance Dept. website has actually been very good about posting every requested rate change in an easy-to-read, comprehensive fashion.

The problem with PA's rate filings hasn't been on the percentage change side, it's on the covered lives side. I was able to compile enrollment numbers for some carriers but not others...including First Priority, which was requesting a 29.5% rate hike. Without knowing whether they had a huge chunk of the market or not, posting the "average" rate hikes without including theirs was kind of meaningless, since it could potentially jack that average up or down dramatically.

So, I finally kind of gave up on it, figuring that even when the approved rates were posted, they probably still wouldn't include the number of covered lives for each insurance company.

Thankfully, it turns out I was wrong!

Thanks to David Snow for the heads up!

A couple of weeks ago, both Louise Norris and I crunched the South Carolina data and came up with different estimates of the weighted average requested 2016 rate hikes for the ACA-compliant individual market. She used a worst-case scenario and estimated it to be around 16.8%; I took a slightly more optimistic approach and came up with 15.2%.

Well, the South Carolina Dept. of Insurance just released their approved 2016 rates, and they ended up pretty much splitting the difference.

As you can see, even though there are only 5 carriers operating on the ACA exchange and another 5 offering policies off-exchange only, the overall average is still 15.9% either way:

With 47 states plus DC under my belt, at this point I'd say I have a pretty good feel for the overall national premium rate increase scene; it still looks like around 12-14% nationally on average, ranging from a low of under a 1% average hike in Maine and Indiana to a high of 40% or so in Alaska and Minnesota.

However, I admit it would be nice, as a point of personal pride, if I could squeeze in the last three states: Nebraska, Pennsylvania and Wisconsin. Fortunately, Louise Norris has brought to my attention the fact that the Nebraska Dept. of Insurance has issued the final approved rate changes for the individual market:

Ugh. Back in August I ran a ballpark estimate of the requested average rate hikes on the North Carolina individual market, and came up with 27% like so:

However, since then, 2 major NC insurers have revised their request upwards even further:

Two more health insurers in North Carolina are asking to increase their already-proposed rate increases. 

UnitedHealthcare, which had requested an average rate increase of 12.5 percent, now is asking regulators to allow an an average increase of 20.4 percent. The range is 2.5 percent to 50.3 percent.

Humana had requested 11.3 percent and is now asking for an average of 24.9 percent. 

Last month I wrote a quick post about the Montana individual market; with only 3 players, all of whom had requested >10% increases, it was pretty easy to plug the numbers in: 22.2%, 29.3% and 34.0%.

Last week, NBC Montana reported:

Commissioner Monica Lindeen's office says the average rate increase for all plans next year will range between 22 percent and 34 percent. For the popular Silver plan, the increase will range from $80 to $88 a month for a 40-year-old person.

Lindeen said Thursday the rates affect about 41,000 people. They don't include people who receive federal tax credits or those who have insurance through their employers.

The "good" news here is that the affected number is only 41K instead of the 76K I had on record. It's possible that the middle carrier had their rates changed, but overall it looks like the commissioner just signed off on the original requests, for a roughly 26% average increase.

When I ran the numbers for Georgia's individual market in August, I didn't have a whole lot to work with. The requested rate changes were only publicly available for carriers representing around 222,000 enrollees, out of a state-wide individual market of (likely) around 750,000. The weighted average increase for the companies I had data for was around 18.3%; all I knew about the rest of them is that they had asked for hikes of under 10%. My best ballpark estimate was that Georgia residents were likely looking at roughly a 10-13% increase overall.

Today I ran across an article in the Rome News-Tribune which gives some of the final, approved rate hike numbers for 2016...but just bits and pieces, nothing to hang your hat on:

Many Georgians buying individual or family health insurance will see double-digit increases in their premiums for 2016.

Hawaii was one of the first states I ran a weighted average rate increase for, way back in July. With only 2 insurance carriers offering individual market policies either on or off the ACA exchange, and a small membership to being with, it was pretty basic: 

For 2016, HMSA has proposed a 45.5 percent rate increase for their individual HMO plan, and nearly a 50 percent rate hike for their individual PPO plan (49.1 percent overall). The carrier justified their rate hikes based on claims costs, explaining that while virtually everyone in Hawaii was already insured, the uninsured pool – many of whom purchased new ACA-compliant plans – had significant medical needs.

Ouch. Yup, that's a pretty ugly requested increase, no way around it.

The following day, Kaiser proposed an 8.7 percent rate increase for their individual market policies.

If approved as is, this would have resulted in a 33.7% average rate increase, when weighted by market share between the two companies.

Some relatively welcome news going into the home stretch: After a series of ugly (over 20%) rate hike averages from Alabama, Delaware, South Dakota and especially Minnesota, I've just completed the Virginia analysis:

Unlike many other states, there's no guesswork or educated guesses here; the Virginia Dept. of Insurance SERFF filings are quite complete and straightforward, so I have every company providing individual and/or sm. group coverage listed, both on and off the exchange, with the exact average rate changes and affected enrollee numbers for pratically every one of them.

The only exceptions are Piedmont Community Healthcare HMO, whose SERFF filings, oddly, included the enrollee count but not the rate change (usually it's the other way around). In addition, there's a couple of new additions to each (UHC of Mid-Atlantic on the indy market, Federated Mutual on the sm. group market). However, none of these have large enough enrollment numbers to amount to more than a rounding error in either category.

When I crunched the numbers for Minnesota's requested rate hikes, the results were pretty scary-looking; based on partial data, I estimated that the weighted average was something like a 37% overall requested increase:

Note that there were several crucial missing numbers: I didn't know the actual market share for several companies (I made a rough guess based on an estimate of the total missing enrollments), nor did I know what the requested increases were for Medica or PreferredOne, other than thinking that both were under 10%.

Just moments ago, however, the Minnesota Insurance Commissioner released the approved rate changes...and it's admittedly not pretty:

Individual Market

For most of the states I'm analyzing, I have hard enrollment numbers for the insurance carriers requesting rate hikes over 10%; it's the remaining companies (the ones seeking hikes of less than 10%) which are generally the big unknowns.

In Mississippi's case, this is flipped around: There appear to only be 4 companies offering individual policies in the entire state, and while I'm missing the enrollment number for the biggest one (BCBSMS), I can calculate a pretty close estimate due to a unique factor: Neither of the two asking for >10% hikes are offering exchange-based policies:

Assuming subsidies remain in place, none of the individual plans available in Mississippi’s exchange have requested double digit rate increases for 2016.  The only exchange plan requesting a rate increase of ten percent or more is a small group plan from United HealthCare.  Rate increases of at least ten percent are published on Healthcare.gov’s rate review tool, and the only individual market Mississippi plans on the list are off-exchange.

As I've plugged new states into my 2016 Rate Increase estimate project, many people have asked me whether I'm seeing any patterns emerging in terms of which states are seeing higher average rate hikes vs. lower ones. The main question being asked is whether Medicaid expansion seems to have an impact (and by extension, is there any sort of red/blue political pattern emerging).

Until now, I've always answered either "no" or "too soon to tell", mainly because there were still lots of states missing or because so many of the estimates are based on requested increases rather than approved. As of today, however, I've managed to put together at least a ballpark estimate for 44 states (+DC), leaving just 6 states left, so I think I have enough included to look for patterns.

Remember: that six states (Alabama, Mississippi, Nebraska, Pennsylvania, Virginia and Wisconsin) are missing from all of the following graphs.

First, here's the weighted state-wide averages with the states in alphabetical order:

As I just noted re. South Carolina, Louise Norris has picked up the ball on my "weighted average rate hike" project and seems to be filling in some of the missing pieces using my own methodology. Here's what she comes up with for North Dakota:

Rates for 2016 won’t be finalized until late summer or early fall, but of the three carriers that participated in the exchange in 2015, two – Blue Cross Blue Shield of North Dakota and Medica Health Plans – have requested double digit rate increases for 2016. BCBS of ND has proposed an average rate increase of 18.4 percent for their 29,000 individual market policy-holders (including on and off exchange plans) BCBS of ND has 70 percent of the on-exchange market share in 2015.

Medica has proposed an average rate increase of 16.5 percent, for an estimated 4,778 members, including on and off-exchange.

Sanford’s proposed rate increases were less than 10 percent, as they do not appear on Healthcare.gov’s rate review tool.

It's been awhile since I've crunched the numbers for a new state. As I noted a week ago, I've covered 42 states representing 87% of the total population, so any further changes assuming 100% of current enrollees stay with their current policy are likely to be fairly nominal unless various insurance regulators surprise me and slash the approved rate hikes significantly in a few states.

Thankfully, Louise Norris has picked up the ball and seems to be filling in some of the missing pieces using my own methodology, including North Dakota and South Carolina. I'll tackle the Palmetto State first:

Rates have not yet been approved for 2016, but Healthcare.gov’s rate review tool shows proposed rates from carriers that have requested rate increases of ten percent or more.  In South Carolina, that applies to two current exchange carriers:

For months now, regular readers know I've spent countless hours crunching the numbers in an attempt to figure out the national, weighted average rate increases for individual health insurance market premiums. I've dug into the numbers for just about every state, filling in hard data where I can and making educated guestimates where I couldn't.

For instance, If I found a state where I was able to get a hard weighted average of, say, a 15% increase for 50% of their market, but didn't know what increase the other 50% had been approved for other than it being "less than 10%", I've been assuming around 7% for the missing half, giving a total weighted average of (0.15 x 0.5) + (0.07 x 0.5) = 0.075 + 0.035 = 0.11 = 11.0%.

Pages