Back in June, the New York Department of Financial Services published the preliminary annual rate filings for both the individual and small group health insurance markets. At the time, the NY DFS put the weighted average rate increases on the ACA-compliant individual market at 20.9% statewide, although my own calculations based on the officially-reported market share enrollment came in slightly lower, at 20.7%.
Meanwhile, they put small group market, NY DFS put it at a 15.3% average increase (almost identical to my 15.4%).
However, I made sure to include an important caveat:
It's important to remember that these are not final rate increases--New York in particular has a tendency to slash the requested rate hikes down significantly before approving them.
As the Writers Guild of America's ongoing strike enters its fifth month (and the Screen Actors Guild-American Federation of Television and Radio Artists, or SAG-AFTRA, approaches 50 days with their own strike for similar demands), Jackie Fortier has an interesting article at NPR about one of the less-discussed aspects which is often much higher profile in union strikes: Health insurance:
The health insurance offered by both unions is predicated on the notion that it is for members who work consistently and lucratively enough to make a minimum amount of money.
...the policy offered by the screenwriters guild, for instance, feels like a holdover from a bygone age. It has no monthly premiums, costs $600 per year to cover the rest of your immediate family and has deductibles that are in the hundreds – not thousands – of dollars.
At the time, the weighted average rate increases requested by insurance carriers in Maine were a steep 17.9% hike for the individual market and a 15.8% increase on the small group market.
CMS Takes Action to Protect Health Care Coverage for Children and Families
States must assess and fix their systems so eligible children and families can stay covered.
Today, and as part of its ongoing work to make sure all Americans have access to health care coverage, the Centers for Medicare & Medicaid Services (CMS) sent a letter to all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islandsrequiring them to determine whether they have an eligibility systems issue that could cause people, especially children, to be disenrolled from Medicaid or the Children’s Health Insurance Program (CHIP) even if they are still eligible for coverage, and requiring them to immediately act to correct the problem and reinstate coverage.
In July, Covered California announced the preliminary weighted average 2024 premium rate changes for the ACA individual market. They still haven't released the final/approved rates, or the small group market average rate changes, but today they released the final rate changes for standalone dental plans:
SACRAMENTO, Calif. — Covered California announced that the statewide weighted average rate change for dental coverage in 2024 will be 4.31 percent. The rate increase is the first since 2020 and continues a trend of holding costs steady for consumers.
Marketplace Hosts Informational Campus Events, Enrollment Assistors Help Eligible New Yorkers Maintain Health Coverage as Renewal Deadlines Approach
ALBANY, N.Y. (August 28, 2023) – NY State of Health, the state’s official health plan Marketplace, today announced a state-wide college campaign, with informational events taking place on campuses as students return. Certified enrollment assistors will be available in popular spots on campus to educate students on affordable, quality health insurance through the Marketplace, and help current enrollees renew their coverage.
There Are Just a Few Days Left for Friday Health Plans Customers to Avoid a Gap in Coverage
08/29/2023
Customers must enroll in a plan by this Thursday to have coverage that starts Sept. 1
DENVER— Friday Health Plans customers have less than three days to choose a new health insurance plan before their current health insurance coverage ends. Last month, the Colorado Division of Insurance announced that it had asked the courts to move Friday Health Plans into liquidation, ending coverage for all Friday Health Plans customers on August 31, 2023. Connect for Health Colorado, the state’s official health insurance marketplace, continues to urge Friday Health Plans customers to sign up for a new plan on or before this Thursday, August 31, to avoid a gap in coverage.
Since 2013, Navigators have helped Americans understand their health insurance options and facilitated their enrollment in health insurance coverage through the Federally-facilitated Marketplace (FFM). As trusted community partners, their mission focuses on assisting the uninsured and other underserved communities. Navigators serve an important role in connecting communities to health coverage, including communities that historically have experienced lower access to health coverage and greater disparities in health outcomes. Entities and individuals cannot serve as Navigators without receiving federal cooperative agreement funding, authorized in the Affordable Care Act, to perform Navigator duties.
New York's implementation of the ACA's Basic Health Plan provision (Section 1331 of the law) is called the Essential Plan. It currently serves over 1.1 million New Yorkers, or over 5x as many residents as ACA exchange plans do.
Under the ACA, most states have expanded Medicaid to people with income up to 138 percent of the poverty level. But people with incomes very close to the Medicaid eligibility cutoff frequently experience changes in income that result in switching from Medicaid to ACA’s qualified health plans (QHPs) and back. This “churning” creates fluctuating healthcare costs and premiums, and increased administrative work for the insureds, the QHP carriers and Medicaid programs.
The out-of-pocket differences between Medicaid and QHPs are significant, even for people with incomes just above the Medicaid eligibility threshold who qualify for cost-sharing subsidies.
Not much noteworthy here other than that Celtic is joining the Delaware individual market for the first time next year. Aetna Health seems to have added a second division in the small group market as well, but perhaps not since both the requested rate change and the current enrollment are identical to the existing Aetna Health listing, so I'm not sure what to make of that. It's a nominal number of enrollees, however, so it doesn't really move the needle anyway.
In any event, Delaware carriers are asking for an average 4.7% rate increase on the individual market and an 8.7% hike for small group plans...subject to state regulatory approval, of course.
The list includes 9 major items (some of which actually include a lot more than one provision within them). It really should include ten, since I forgot about implementing a Basic Health Plan program like New York and Minnesota have (and as Oregon is ramping up to do soon as well), but it's still a pretty full plate.
For the first time, Medicare will be able to negotiate prices directly with drug companies, lowering prices on some of the costliest prescription drugs.
For the first time, thanks to President Biden’s Inflation Reduction Act – the historic law lowering health care costs – Medicare is able to negotiate the prices of prescription drugs. Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced the first 10 drugs covered under Medicare Part D selected for negotiation. The negotiations with participating drug companies will occur in 2023 and 2024, and any negotiated prices will become effective beginning in 2026. Medicare enrollees taking the 10 drugs covered under Part D selected for negotiation paid a total of $3.4 billion in out-of-pocket costs in 2022 for these drugs.
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:
Georgia's health department doesn't publish their annual rate filings publicly, but they don't hide them either; I was able to acquire pretty much everything via a simple FOIA request. Huge kudos to the GA OCI folks!
Back in July, I compiled the weighted average requested rate changes for 2024 for both the Georgia individual and small group markets. At the time, individual market carriers were asking for rate hikes ranging from a relatively modest 6% (UnitedHealthcare) to a stunning 27.7% increase (Cigna). The weighted average came in at right around 15% even.
On the small group market, meanwhile, only around half the carrier filings were available at all, so I couldn't really run a proper average, although of those which had filed theirs, the average came in at 12.6%.
Earlier today I acquired the most recent rate filings for every carrier in both markets. I don't know for certain whether these are the final, approved rates for 2024, but it seems likely:
Medicaid recipients deemed ineligible for coverage may be eligible for financial assistance and are encouraged to contact Nevada Health Link to avoid a lapse in health coverage
CARSON CITY, Nev. – As the redetermination process associated with the unwinding of the Public Health Emergency continues, Nevada Health Link, Nevada’s health insurance marketplace, is continuing to work diligently to streamline the enrollment process for individuals and households whose increased income no longer qualifies them for Medicaid coverage.
2023-24 Enacted Budget Invests in Health Equity by Adopting Key Evidence-Based Interventions to Better Care for New York Parents and Newborns
ALBANY, N.Y. (August 24, 2023) – The New York State Department of Health announced several key initiatives aimed at improving maternal and newborn health. Enacted as part of the 2023-24 New York State Budget, the state is committing to multiple Medicaid investments that will expand access to prenatal and postnatal care and support better birth outcomes. This announcement is released on the heels of the State’s adoption of the federal option to extend Medicaid and Child Health Plus (CHPlus) postpartum coverage from 60 days to a full year following pregnancy.
The Inflation Reduction Act of 2022 was signed into law on August 16, 2022. The new law provides meaningful financial relief for millions of people with Medicare by improving access to affordable treatments and strengthening the Medicare Program both now and in the long run. The law makes improvements to Medicare by expanding benefits, lowering drug costs, keeping prescription drug premiums stable, and improving the strength of the Medicare program. The law also extends enhanced financial help to purchase HealthCare.gov and state-based Marketplace plans and expands access to Advisory Committee on Immunization Practices (ACIP) recommended vaccines for adults with Medicaid coverage.
NJ Department of Banking and Insurance Announces Federal Approval of Section 1332 State Innovation Waiver Extension to Continue Reinsurance Program
Reinsurance Program Improves Health Insurance Affordability
TRENTON – The New Jersey Department of Banking and Insurance today announced the state received federal approval of a Section 1332 State Innovation Waiver Extension to continue a reinsurance program that lowers health insurance premiums in the individual market by 15 percent. The reinsurance program increases certainty and stability in New Jersey’s individual health insurance market.
ST. PAUL, Minn.—The Minnesota Insulin Safety Net Program was created in 2020 to help Minnesotans who face difficulty affording their insulin. During the 2023 legislative session, the Minnesota Legislature made important changes to the program that will improve access to this life-saving drug for undocumented Minnesotans who are struggling to afford their insulin.
Starting August 1, 2023, Minnesotans can use an Individual Taxpayer Identification Number (ITIN) as an accepted form of identification for program eligibility. This change provides a pathway to access the program for those who do not have a valid Minnesota identification card, driver’s license or permit, or tribal-issued identification. For minors under the age of 18 who need help affording insulin, a parent or legal guardian can use an ITIN as an accepted form of identification.
Open Enrollment Period at Get Covered New Jersey Begins November 1, 2023
Historic Levels of Financial Help Remain Available for the Upcoming Year
TRENTON — The New Jersey Department of Banking and Insurance today announced it is accepting applications for community organizations to serve as Navigators to assist residents with health insurance enrollment for the upcoming Get Covered New Jersey Open Enrollment Period and throughout 2024. This year, the department is making available a total of $5 million in grant funding for Navigators in an effort to ensure enrollment assistance is available in the community for residents seeking coverage through Get Covered New Jersey, the state’s official health insurance marketplace.
Last month the Centers for Medicaid & Medicaid Services (CMS) director of the Center for Consumer Information & Insurance Oversight (CCIIO...yeah, those names & acronyms just roll off the tongue, don't they?) informed the state of Georgia that they're gonna have to wait one more year before launching their own fully state-based ACA exchange (SBE) platform.
There were several reasons given for the 1-year delay, but many of them stemmed from the fact that Georgia was attempting to skip the "Federally-Facilitated" SBE phase which every other state which has made the transition to their own full state-based platform has undergone for at least one year.
Individual Coverage Health Reimbursement Arrangements, or the unfortunate-soundingICHRA for short, are a type of health insurance arrangements which were created via Trump administration-era regulations back in 2019.
So far, about 46 percent of these customers have picked a new plan*
DENVER— Friday Health Plans customers have about two and half weeks* to choose a new health insurance plan before their current health insurance coverage ends. Connect for Health Colorado, the state’s official health insurance marketplace, is urging Friday Health Plans customers to sign up for a new plan before the end of the month to avoid a gap in coverage.
*Note that this press release was issued 9 days ago, so CO Friday enrollees actually only have 8 days left.
OK, after several weeks of this site turning into AnnualRateFilingsDotCom, I'm finally catching up on some other important ACA/healthcare-related developments which are happening.
I've finally completed my Annual Individual & Small Group Market Rate Filing project for preliminary 2024 rate filings, having analyzed & crunched the numbers for the individual and small group markets across all 50 states + DC, so it's time to step back and see where things stand nationally.
It's important to remember that these are preliminary filings only--many of the carriers will have their final 2024 rate changes reduced, although in many cases they tend to be approved as is.
It's also important to note that I only have weighted average rate changes for 30 states (+DC). For the other 20 states, I've only been able to generate unweighted average rate changes--that is, I have to assume every carrier in that state has the same number of ACA enrollees since their rate filing forms are either unavailable or heavily redacted, making it impossible for me to know how many people are enrolled in their policies.
The main reason for this was the implementation of a so-called "reinsurance" program which was originally passed by the (then Democratically-controlled) state legislature:
The most significant thing to impact Virginia carriers 2023 filings was the state's Section 1332 Reinsurance Waiver. I wrote about this way back in 2018 when the state was originally considering applying for one, but it didn't actually go into effect until January 2023:
Wisconsin has the most competitive ACA markets in the country, at least in terms of the sheer number of insurance carriers offering policies on both the individual (14) and small group (18) markets. They're losing two carriers in 2024 (WPS Health Plan in both markets and Humana in the small group market only), but it's still pretty robust.
The bad news is that it's once again extremely difficult to acquire Wisconsin's actual rate filings prior to the actual Open Enrollment Period launching, meaning I can only run unweighted average requested rate increases/decreases.
With that in mind, individual market carriers are requesting unweighted increases of around 6.8% (ranging from 1% - 15.7%), while small group carriers are seeking hikes of around 7% overall, ranging from a 25.9% reduction (wow!) to a 16.3% increase.
The bad news for Wyoming residents who earn too much to qualify for any federal ACA subsidies is that the state has the second highest unsubsidized premiums in the country after West Virginia. The good news is that, thanks to the Inflation Reduction Act, there are far more residents who do qualify for federal subsidies, which chop those premiums down to no more than 8.5% of their income.
The other good news for them is that for 2024, average premiums across the two insurance carriers which participate on the ACA exchange pretty much cancel each other out, with Blue Cross Blue Shield of Wyoming dropping their average premiums by 7% even as the Montana Health Co-Op seeks to raise theirs by 7.6%. Unfortunately, once again, I've been unable to get ahold of enrollment data for each carrier so this is an unweighted average only; if, say, 90% of enrollees are in Montana Co-Op plans, the weighted average would obviously be more like a 6% increase or whatever.
West Virginia is yet another state where I'm unable to acquire unredacted actuarial memos and/or filing summaries in order to run weighted average rate changes, so I have to settle for unweighted averages. On the other hand, on the individual market, at least, WV only has three carriers and their requested rate changes for 2024 are in a very narrow range anyway (from flat to a 2.1% increase), so it doesn't matter much.
The good news is that West Virginia's individual market rates are only increasing by around 1% next year, one of the lowest avg. rate increases in the country.
The bad news is that West Virginia already has by far the highest unsubsidized individual market rates in the nation, at nearly $1,200 per month (second highest this year is Wyoming at $965/month).
In any event, small group market carriers are requesting an unweighted average increase of 9.6% overall.
Utah's preliminary 2024 individual and small group market rate filings are listed below. They launched a handy new website specifically dedicated to insurance filings, which is nice to see.
Unless there's a change in the final/approved rates, unsubsidized individual market plan premiums are increasing by around 11.3% in 2023, while small group plans will go up 10.5% on average (caveat: I had to estimate the actual enrollment numbers for two of the small group carriers, so the weighted average may be slightly off). Both market hikes are significantly higher rate increases than they were last year.
I should note that both Aetna and Imperial Health appear to be newly entering the Utah individual market next year.
As always, the Texas individual and small group markets are pretty messy. For starters, they have up to 20 individual market carriers depending on the year, along with over a dozen small group market carriers some years.
On top of that, as is also the case in some other states, some of the names of the insurance carriers can be confusing as hell. There's the "Insurance company of Scott & White" which seems to have changed its name to "Baylor Scott & White Insurance Co.," which isn't to be confused with "Scott & White Health Plans" and so on.
In addition, this year there seem to be a lot of carriers bailing on the Texas market altogether: Ambetter, Ascension and FirstCare appear to be pulling out of the states individual market, while Aetna (up to four different divisions?) along with Humana are leaving the small group market.
I was only able to acquire hard enrollment data for six of the remaining carriers. There's another six where the rate filings include the number of policyholders but not the actual number of covered lives; for those, I'm using an average 1.6x multiplier (assuming around 1.6 covered lives per policy). I could be way off on that, of course.
Tennessee's preliminary 2024 individual & small group market health insurance rate filings are now available, including actual enrollment numbers, which allows me to run weighted averages for both markets.
For the most part they're fairly straightforward: The individual market is looking at average rate increases of around 4.8%, while the small group market averages around +7.8% overall.
Pretty straightforward in the Mount Rushmore state. Three carriers on the individual market; around 48,000 enrollees total; requested rate changes ranging from a slight drop to a 5.9% increase. The weighted average across all three is +2.5%. No one new seems to be entering the market and none of the current ones are pulling out.
For the small group market, there are six carriers (again, no one new, no one dropping). The requested rate increases for these range from 2.5% to 10.3%, with a weighted average increase of 5.2% statewide.
Unfortunately, South Carolina is another state where they don't make unredacted rate filings available, either on the state insurance dept website, the federal Rate Review websiteor the SERFF database.
As a result, I'm limited to unweighted averages for both the individual and small group markets:
Not a whole lot to report in the smallest (physically) state of the Union. Rhode Island only has two insurance carriers participating in the individual health insurance market, while six of them compete in the small group market. Thankfully, the SERFF database not only has all eight of these filings, each of them has at least one document which includes the actual number of RI residents enrolled in the carriers policies.
As a result, I can run a fully weighted average for both markets: In the individual market, carriers are requesting an average rate hike of 6.6%, while small group market insurers want to bump up premiums by 6.8% overall.
Shapiro Administration Announces Public Comment Period On Proposed 2024 Health Insurance Rate Increases
Harrisburg, PA – Pennsylvania Insurance Commissioner Michael Humphreys today welcomed public comment on the requested rate changes insurance companies currently operating in Pennsylvania's individual and small group market filed for 2024. The comment period on the proposed rate increases will close on September 8.
"The Shapiro Administration is committed to raising awareness about the importance of health insurance and providing increased access to affordable, comprehensive health coverage," said Humphreys. "We strongly encourage individual market consumers to shop for coverage on Pennie® where they may qualify for financial assistance that, as we consistently hear from Pennsylvanians, makes coverage more affordable than they thought might be possible."
Oklahoma is another state where I have no access to the actual enrollment data--all I have to go by are the average requested rate changes for each carrier on the individual and small group markets. As a result, the averages for each market are unweighted.
For individual market plans, that unweighted average is just 2.2%, though the carriers range from as low as a 3.5% drop to as high as a 6.1% increase. It's also worth noting that Friday Health Plans are kaput.
Similarly, for the small group market, average requested rate hikes range from as little as 0.8% for CommunityCare to as much as a 9.3% for Aetna. The unweighted average is 4.9%.
As a result, I've been able to put together a weighted average requested rate increase for the individual market (I estimated the one missing enrollment number based on the overall Ohio indy market total); it comes in at 7.6%.
For the small group market, I have to go with an unweighted average of +10.8%. It's also worth noting that, once again, Humana appears to be bailing on the entire small group market nationally from what I can tell.
Not much to report about the 2024 individual and small group market rate filings. I could only find current enrollment numbers for two of the three indy market carriers and for three of the five small group market carriers. However, based on last year's total enrollment, I'm estimating ND's total indy market at being roughly 50,000 people, which means I was able to make an educated guess at how many are enrolled in Sanford Health Plan policies.
Based on this, I have a (mostly) weighted requested average rate increase of 4.4% for individual market plans and an unweighted average of 6.5% for small group market plans.
Ah, at last, another state which includes both the average requested rate changes for 2024 as well as the number of enrollees each carrier has for both the individual and small group markets in clear, transparent language!
Generally, according to NC Insurance laws, health insurance rates must not be excessive, inadequate, or unfairly discriminatory, and must exhibit a reasonable relationship to the benefits provided in the policy.
This one is particularly frustrating. In addition to the filings being listed at the federal Rate Review website, every individual & small group market carrier also has their filings listed via the SERFF databaseand via New Mexico's own internal, searchable rate filing database...and yet I still can't run a weighted average rate change for either market because almost none of the filings at any of these three databases includes the actual enrollment data (Presbyterian on the individual market is the exception).
As a result, I have to once again settle for unweighted averages, which come to +5.6% on the individual market and +7.7% for small group plans.
New Jersey individual & small group market carriers are asking for unweighted average rate increases of 6.7% and 13.0% respectively for 2024. However, the unweighted averages don't tell the whole story--the carriers are asking for rate hikes ranging from as low as 3.8% to as high as 13.8% on the individual market, and from as low as 2.3% to a stunning 25.9% for small group plans.
As is the case with far too many states these days, most of the rate filing memorandums are heavily redacted in New Jersey, making it nearly impossible to get ahold of the actual enrollment numbers, which means I have no way of running a weighted average on either market.
While nearly 16.4 million Americans selected Qualified Health Plans (QHPs) via the federal and state ACA exchanges/marketplaces during the official 2023 Open Enrollment Period (along with an additional 1.2 million signing up for a Basic Health Plan (BHP) program in New York & Minnesota, which CMS continues to inexplicably treat as an afterthought in such reports), not all of them actually pay their first monthly premium (for January) for various reasons:
The good news about New Hampshire's health insurance market is that they're the only state without its own ACA exchange which produces publicly-accessible monthly reports on individual on-exchange market enrollment. The bad news is that they don't seem to publish the actual rate filings in an easy-to-read format, which means I'm left with the federal rate review website, which sometimes posts average rate requests which don't match up with the actual filings...but it's gonna have to do here.
With these two data sources in hand, New Hampshire's individual market carriers are asking for a weighted average increase of 3.1%. It's important to note that Anthem Health Plans and Matthew Thornton Health Plan are listed as separate carriers on the federal Rate Review website (with separate average rate requests), but on the state's monthly report, they're merged into a single listing.
Nevada used to be a state where the annual individual & small group rate filings were fairly transparent. They have a pretty easy-to-use searchable filing database which clearly lists the carriers, market, maximum & minimum rate changes and even includes the SERFF Tracking numbers for every filing.
Unfortunately, this year at least, most of that proves useless for my purposes. The average rate changes are posted, but the enrollment data is still hidden from public view--entering the SERFF Tracking Numbers still brings up nothing in the SERFF database, and the actuarial memos posted at RateReview.HealthCare.Gov are mostly redacted. As a result, I'm only able to enter enrollment data for one of the nine carriers on the Nevada individual market, and none on the small group market.
Interestingly, the one I have enrollment data for (Aetna Health of Utah) also has a curious discrepancy: The filing itself lists the average requested rate increase as being 6.97%, but on the RR.HC.gov site it only shows up as 1.36%. The other eight carriers all match up (or are within a tenth of a percentage point, anyway).
Nebraska doesn't even bother listing indy/small group plan rate filings on their own insurance department website...the link goes directly to the federal Rate Review database. The problem with this is that very few filings here are unredacted, which means it's difficult to acquire the policy enrollees for many carriers needed to run a weighted average.
Nebraska has 4 carriers on the individual market for 2024: BCBS, Medica, NE Total Care and Oscar Health. The unweighted average rate increase being requested is around 2.9%.
I also don't have the enrollment for any of the 4 Small Group market carriers. It also looks like Aetna is pulling out of the NE sm. group market, but it might just be that the federal database doesn't have them listed yet The unweighted average rate change being requested there is a 7.9% increase.
The good news about the Montana Insurance Dept. is that once the final, approved annual rate changes for the individual and small group markets are released, they're pretty good about posting them in a clear, transparent manner.
The bad news is that they only do so for the final rates, not the preliminary/requested rate filings.
For that, I have to yet again rely on an unweighted average of the rate filings from the federal Rate Review website.
Montana only has three carriers on the indy market and four on the small group market. Of these, Montana Health Co-Op is providing their actual enrollment numbers for both, although one is in a roundabout way. For their individual market filing they state that:
Unfortunately, Mississippi is another state which provides zero useful rate filing data for my purposes (preliminary or final) prior to the Open Enrollment Period launching. The only data I have is from the federal Rate Review website, and even the filing forms there are heavily redacted, so all I can put together are unweighted averages for the 2024 calendar year.
It's worth noting that one of the three UnitedHealthcare divisions appears to be dropping out of Mississippi's small group market, as is Humana (which seems to be pulling out of a lot of small group markets nationally).
With that in mind, unsubsidized individual market enrollees are looking for unweighted average increases of around 2.3%, while small group carriers are hoping to increase rates by around 4.5% (again, unweighted).
Massachusetts, which is arguably the original birthplace of the ACA depending on your point of view (the general "3-legged stool" structure originated here, but the ACA itself also has a lot of other provisions which are quite different), has 10 different carriers participating in the individual market.
One thing which sets Massachusetts (along with Vermont) apart from every other state is that their Individual and Small Group risk pools are merged for premium setting purposes.
Normally you would think this would make my job easier, since I only have to run one set of analysis instead of two...but until recently, it was surprisingly difficult to get ahold of exact enrollment data for each carrier on the merged Massachusetts market (and even more difficult to break out how many are enrolled in each market since they're merged...not that that's relevant to the actual rate changes).
They break out the filings not between Individual and small group markets or on- vs. off-exchange policies, but between rate increases over and under 10%. Normally that would be fine, but they also have multiple listings within each market for several carriers; HMO Louisiana, in fact, has 11 entries, each for a different product line, making it tedious and difficult to piece together the weighted average rate change and current enrollment for the carrier as a whole.
Not that any of that matters this year, as they don't appear to have posted any of the ACA-compliant individual market filings there anyway. I had to rely entirely on the federal Rate Review site, and the filings there still don't include enrollment data for most carriers, so the averages below are all unweighted only:
Individual Market: Around 1.7% higher
Small Group Market: 9.4% higher
It's worth noting, however that Humana is, once again, dropping out of the states' small group market, while Vantage Health Plan appears to be pulling out of both the individual and small group markets in Louisiana.
Kentucky is yet another state where the actuarial memos are heavily redacted, making it difficult to acquire information such as the number of enrollees...which in turn makes it impossible to run a weighted average requested rate change for the individual or small group markets.
There are four carriers offering policies on the KY individual market (Anthem, CareSource, Molina and WellCare), with an unweighted average rate change request of 4.1%. Molina has provided an unredacted actuarial memo which includes their enrollment...but it's only 505 people, while KY's total indy market is likely closer to 75,000 or so including the off-exchange market.
Kansas is yet another state where the actuarial memos are heavily redacted, making it extremely difficult to get ahold of the actual enrollment numbers for the individual or small group markets. Once again, without knowing how many Kansans are enrolled in each carriers insurance policies, I have no way of running a weighted average, and therefore can only provide an unweighted average.
With that in mind, for 2024 Kansas individual market carriers are requesting an unweighted average rate increase of 4.5%. One carrier (US Health & Life) does provide an unredacted summary with enrollment, but they're a tiny part of the market which doesn't help much. The small group market carriers are likewise asking for a 4.7% unweighted average rate hike.
It's worth noting that Cigna appears to be leaving the states individual market, while Humana is leaving the small group market...which I've noticed is happening in several other states that Humana currently offers small group plans in as well.
Here's the preliminary 2024 rate filings for Iowa's individual & small-group markets. Unfortunately, I only have the enrollment data for the two smaller carriers on the individual market (and for only one carrier on the small group market). Oddly, while the Iowa Insurance Dept. has detailed rate filings for Medica and Oscar, it doesn't have one for Wellmark posted...and on the small group market, they only have publicly-available filing documentation for two of the eleven carriers.
Interestingly, CareSource Iowa, which only joined the state's individual market this year, appears to be dropping out of it again in 2024...or at least they don't have a listing showing up at RateReview.HealthCare.Gov as of this writing. Similarly, Aetna seems to be dropping out of the small group market as well.
In any event, based on my estimate of Iowa's total ACA-compliant individual market, I can make an educated guess as to the former's weighted average, which should be roughly a 5.7% drop in premiums.
Unfortunately I can't do the same for the small group market; for that, the unweighted average rate increase is around a 6.4% increase.
While numerous other states have already done the same thing (and several more are in the process of doing so as well), Georgia's move to their own enrollment platform was especially noteworthy for two reasons:
First, because it represents as complete 180-degree policy turn from their prior attempts (over the course of several years) to eliminate any formal ACA exchange (federal or state-based) in favor of outsourcing it to private insurance carriers & 3rd-party web brokers.
Provides that beginning before or on May 1, 2026, and each May 1 thereafter, the Department of Insurance shall report to the Governor and the General Assembly on health insurance coverage, affordability, and cost trends.
Amends the Illinois Insurance Code.
Provides that any forms and rates filed for large employer group accident and health insurance shall be automatically deemed approved after 90 days after filing.
Provides that beginning plan year 2026, rate increases for all individual and small group accident and health insurance policies must be filed with the Department for approval.
Provides that unreasonable rate increases or inadequate rates shall be modified or disapproved.
Provides that beginning plan year 2025, the Department shall post all insurers' rate filings and summaries on the Department's website.
Hawaii only has two health insurance carriers serving the individual market, Hawaii Medical Service Assocation and Kaiser Foundation Health Plan. Both of them have submitted their proposed premium rate filings for 2024; HMSA is asking for a dramatic 12.2% rate hike while Kaiser Foundation is seeking a more modest 3% increase.
Our requested rates include only the amounts needed to cover the expected health care benefits of our members, the cost of administering their benefits, expected Affordable Care Act (ACA) fees, a small charge to help manage the risk of offering benefits to this population, and a small margin that will allow us to continue replenishing HMSA’s reserves.
Florida state law gives private corporations wide berth as to what sort of information, which is easily available in some other states, they get to hide from the public under the guise of it being a "trade secret."
In the case of health insurance premium rate filing data, that even extends to basic information like "how many customers they have."
The good news is that the federal Rate Review database has now posted the preliminary avg. 2024 rate filings for the individual and small group markets for every state. This makes it very easy to plug in the average requested rate changes in 2024 for every carrier participating in both markets.
The bad news is that most of the underlying filing forms are heavily redacted, meaning I can't use the RR database to acquire the other critical data I need in order to run a proper weighted average: The number of people actually enrolled in the policies for each carrier.
This means that in cases where this data isn't available elsewhere (either the state's insurance department website, the SERFF database or otherwise), I'm limited to running an unweighted average. This can make a huge difference...if one carrier is requesting a 10% increase and the other is keeping prices flat, that's a 5.0% unweighted average rate hike...but if the first carrier has 99,000 enrollees and the second only has 1,000, that means the weighted average is actually 9.9%.
Alaska is a sparsely populated state with only two carriers on their individual market and four on their small group market. Alaska's insurance department website is useless when it comes to getting rate filings or enrollment data; I had to use the federal Rate Review site to even get the requested rate changes.
Fortunately, Premera Blue Cross includes a summary which lists their enrollment numbers, and with Moda being the only other carrier on the market, I was able to estimate a weighted average (assuming Moda has around 4,000 enrollees, which seems about right given Alaska's total on-exchange enrollment of roughly 25,500 people during Open Enrollment; effectuated enrollment as of last spring is almost certainly a couple thousand lower overall).
The good news is that RateReview.HealthCare.Gov has posted the preliminary 2024 rate filing summaries for every state, making it much easier to pin down which carriers are actually participating in the individual & small group markets next year, as well as what the carriers average requested rate changes are in states which don't publish that data publicly (or which make it difficult to track down if they do).
The bad news is that in many of those states, acquiring the actual enrollment data is even more difficult, as their rate filings tend to be heavily redacted. Alabama falls into this category.
Back in late 2021, Colorado launched their own new, state-based ACA financial subsidies on top of federal subsidies which have already been enhanced (at least through the end of 2025) via the American Rescue Plan and Inflation Reduction Act:
The financial help you can get to lower your out-of-pocket costs are healthcare discounts called Cost-Sharing Reductions. Connect for Health Colorado is the only place you can apply for financial help to lower the cost of private health insurance. Due to the American Rescue Plan, Coloradans are now eligible for more savings than ever before.
Consider a Silver plan if your Health First Colorado (Medicaid) coverage recently ended or your income is over the limit to qualify
Connect for Health Colorado launched a new state-funded program recently to provide even more healthcare savings to people shopping on the Marketplace for 2022 whose income is just over the limit to receive Health First Colorado (Medicaid) and who enroll in a Silver-level plan.
