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%.

A couple of weeks ago, my post on Indiana's average 2016 rate increases on the individual market would likely be very close to flat, based on partial enrollment data (i.e., they provided the rate data for every insurance company, but enrollment data for only one of them). The one company they provided enrollment information for, Physicians Health Plan, also happens to have the highest average rate hike, 13.5%.

However, I noted that since a) Physicians only holds around 4% of Indiana's market, and b) several of the other companies were approved for rate decreases (up to -19% for Mdwise Marketplace), it's entirely possible that the state could be looking at an overall rate decrease, or a very low increase at worst. I decided to split the difference and go with a flat zero percent change until further notice.

Today, Louise Norris has come through again:

Louise Norris has again done some of the heavy lifting for me over at healthinsurance.org, this time for New Hampshire:

In 2015, New Hampshire’s exchange had five carriers, up from just one in 2014.  There will still be five carriers in 2016, although there’s one swap:  Assurant/Time is exiting the market (nationwide), but Ambetter (offered by Celtic) is joining the exchange in New Hampshire.

...Two carriers in the exchange – Minuteman Health and Community Health Options – have requested double digit rate increases, although they have not yet been approved.  Both carriers are CO-OPs created under the ACA, and both expanded into New Hampshire at the start of 2015, so their claims data for the state is very limited. 

As we head into the final batch of states, it looks like the national weighted average rate increases, which had been hovering in the 11-12% range up until a week or so ago, are unfortunately starting to inch upwards, slammed by 20%+ averages out of South Dakota, Montana, West Virginia, Oklahoma and Utah. Lower average rate hikes out of Connecticut and Wyoming have also been announced, but the other 5 states more than cancelled those two out.

And now you can add Tennessee to the mix. Starting with Louise Norris' exchange-only data (which comes in at a 33% average hike), I've also plugged in additional off-exchange individual market numbers to come up with what looks like an overall average rate hike of around 28.3%:

Wyoming's total individual health insurance market in 2014 was just 27,000 people. While the total market likely increased somewhat this year, those gains are likely offset by perhaps 15% being either "grandfathered" or "transitional" policies.

Just over 18,000 were enrolled in effectuated exchange-based policies as of June 30 of this year, leaving perhaps 9,000 more enrolled in off-exchange plans.

According to Louise Norris of HealthInsurance.org, there's only two companies operating on the exchange in Wyoming this year: WINhealth Partners and BCBS of WY. WINhealth is asking for a 13.37% average rate hike; Blue Cross is asking for an uknown increase...except that it's under 10%.

Over at HealthInsurance.org, Louise Norris has done her usual excellent job of summarizing the enrollment/rate/exchange participation situation for another state, Utah. As she notes, in addition to the companies which operated on the Utah ACA exchange this year, one more "mystery" company is expected to join in 2016. Of course, Louise only focuses on the companies actually operating on the exchange, while I'm looking at the entire ACA-compliant individual market state-wide (because the risk pool includes off-exchange policies as well).

Fortunately, Utah has a fairly comprehensive rate review database with an easy-to-use lookup feature. Unfortunately, a few of the entries don't quite jibe with HHS's RateReview website. Most notably, the HHS site claims that Arches Mutual Insurance has 2 filings from the same date: One requesting a jaw-dropping 58% hike, the other for a slightly less-insane 46.65% increase, neither of which includes the actual number of covered lives:

The Kaiser Family Foundation has posted an updated analysis of the average rate hikes for the benchmark Silver plans (ie, the 2nd-lowest cost policies) and the lowest-cost Silver plans in each market.

"Benchmark" in this case refers to the plans which are used as the basis for the ACA's Advance Premium Tax Credit (APTC) formula. How much/little these particular rates change is even more important than the change in other policy rates, because these are the ones which the federal tax credit amounts are based on.

This is really important, because if the benchmark policy rate in your area changes, it can seriously impact how you receive in tax credits...even if nothing has changed at your end.

Maryland was one of the first states to release their list of requested 2016 rate hikes, and caused quite a stir at the time due to the largest player in the state, CareFirst, asking for a whopping 30% rate hike. At the time, I didn't have much to go on in terms of hard enrollment numbers, but it looked like the weighted average request would be somewhat lower, perhaps around 22-23%.

Today, the Maryland Dept. of Insurance has released the final, approved rate changes, and while 5 of the 8 companies on the individual exchange saw reductions in their rate change (2 others were approved as is, and one, Kaiser Health Plan was actually increased from 4.8% to 10%), it's still difficult to lock down a fully weighted average due to some crucial enrollment data missing.

I was able to track down the "covered lives" data for 5 of the eight companies.

Delaware's 2016 rate hike analysis is about as simple and straightforward as it gets: Two companies (Aetna and Highmark BCBS) for both the individual and small group market, both on- and off-exchange, period...and their website includes the actual affected enrollee tallies for each, giving weighted totals:

Ugh. Nearly 25% requested for the individual market, just under 10% for the small group market. Of course these are requests only, so they might be slashed somewhat by regulators yet.

Louisiana's Insurance Dept. website is refreshingly complete: It includes every company on the individual & small group market, lists both the requested and approved rate hikes, and includes direct links to the filings which list the actual total enrollment in a clear-cut, consistent fashion.

In fact, the only data missing is some of the approved rate hikes; they've only posted the approved numbers for 3 of the 5 small group listings and 1 of the 10 individual listings, making it impossible to plug in the approved weighted average. However, the requested average is complete: About 15.4% for the individual market and 9.4% for the small group market.

Last year, while most state-wide average premium rates increased somewhat (averaging around 5.5% overall nationally, give or take), there were a few states which actually saw rate decreases from the year before: Arkansas, Mississippi and New Mexico saw overall decreases on their individual markets, while the District of Columbia and Hawaii saw decreases on their Small Business markets.

Last week I estimated the overall weighted average rate increases for the Arkansas individual market at "between 4-5%", with a rough estimate of around 4.6%.

Today, Arkansas Times reporter David Ramsey has provided the exact market share numbers for Arkansas. When I plug these in, the weighted average comes in a bit higher, at 4.98%:

HOWEVER, according to Ramsey, the Arkansas Insurance Division says that the actual weighted average is only 4.4% overall.

There could be any number of reasons for the discrepancy; it's possible that there's a few additional minor off-exchange carriers who I've missed, or there could be rounding errors/etc. In any event, these are all just estimates anyway, so I'll go with AID's official 4.4% figure.

Nevada's insurance dept. rate filing website has an extremely user-friendly, interactive website which lets you drill down and find exactly what you're looking for: Individual or Small Group policies, HMO or PPO, Under Review or Reviewed. From what I can tell, there are 12 companies offering individual policies in 2016 (a 13th, the Nevada Health COOP, just announced that they've gone belly-up and are being dissolved, meaning a minimum of 16,000 Nevadans will have to switch to a different insurance carrier).

The requested rates were approved for 8 of the companies, but were reduced significantly for Aetna (from 21-24% down to 15%). Here's what it looks like in the end:

The Small Group market is faring somewhat better, with just a 5.3% overall weighted average increase:

When I last checked in on Rhode Island's 2016 rate increase status, the three companies operating in the state (BCBSRI, Neighborhood and UnitedHealthcare) had requested hikes of 7%, 8.6% and 11% respectively. There was no off-exchange enrollment data, but the exchange-based market share breakdown was roughly 48.5% / 48.5% / 3%. This meant a requested average hike of around 7.9%.

A week or so ago, the approved rate hikes were released for Neighborhood and UHC, along with total enrollments (on+off exchange) for BCBS:

Still unresolved is how much Blue Cross and Blue Shield of Rhode Island may raise rates for its individual plans, which cover about 25,000 people. The nonprofit insurer initially requested an 18-percent increase, but no decision has yet been made because, by law, its rate hike requests are reviewed in a separate process that reserves a key role for the state's attorney general.

NOTE: THIS POST HAS BEEN UPDATED WITH ALL 50 STATES HERE.

  • 10/15/15: Added Pennsylvania with approved rate average
  • 10/12/15: Updated South Carolina with approved rate average
  • 10/8/15: Added Nebraska (approved rates)

I spent most of July and August simply overwriting/updating the original version of this entry, but now that the approved 2016 premium rates are starting to pop up all over (the deadline for approval of exchange policy rates was a few days ago), I figured it was time to start fresh.

When I last checked in on the ongoing saga between the New Mexico Insurance Commissioner and Blue Cross Blue Shield of New Mexico, BCBS was threatening to take their ball and go home if NM Insurance Commish John Franchini didn't cave and agree to let them jack rates up by 51% on the individual market (Franchini had agreed to a 24% hike instead).

Well, Franchini called BCBS's bluff...but they weren't bluffing:

Thousands of New Mexicans will need to shop for new health insurance plans later this year after a decision by Blue Cross Blue Shield to stop offering individual insurance plans through the state health exchange beginning Jan. 1.

...The letter said Blue Cross Blue Shield of New Mexico lost $19.2 million in 2015 on the 35,000 individuals covered by plans they purchased on and off the exchange.

...Blue Cross will offer a basic-level insurance plan outside the exchange in 2016, which will be available to all consumers at the same rate as in 2015.

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