Charles Gaba's blog

Louisiana's rate filing database is frustrating, because it's both highly-detailed and confusing at the same time.

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.

Back in February, I wrote about how the state of Georgia, in an eyebrow-raising move, announced that they were moving from the federal ACA exchange (HealthCare.Gov) onto their own state-based ACA exchange.

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.

Secondly, because of the timeframe involved:

A few months ago, the Illinois legislature passed, and IL Gov. Pritzker signed, a new law which made my healthcare wonk heart sing, including:

  • 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.

From the HMSA filing summary:

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."

If you think I'm being sarcastic, this is literally a screenshot of what you get if you attempt to use the Florida Office of Insurance Regulation's filing search:


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).

From Premera's summary: