It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
After last year's near-chaos on Virginia's individual market, things seem to be much calmer & less interesting this year. The premium increases for 2025 being requested by individual market carriers have a weighted average of 4.0%, while small group market carriers are asking for 6.8% increases on average.
The most noteworthy news for 2025 is that Aetna Life Insurance (their EPO division) is exiting the Virginia market, although Aetna Health (HMOs) is sticking around.
UPDATE: I thought Piedmont was also pulling out in 2025, but it turns out they left Virginia's individual market last fall at the very last minute.
In addition, it looks like Aetna is pulling completely out of the small group market, as is Innovation Health and, again, Piedmont Community.
Friday is the last day for Virginia residents to apply for health care coverage that starts on January 1, 2024.
Any healthcare coveragesecured after December 15 and before Open Enrollment ends on January 15 will begin on February 1, 2024.
The Virginia Insurance Marketplace reminds Virginians to apply now for 2024.
After the Open Enrollment period ends January 15, Virginians experiencing a Qualifying Life Event such as having a baby or losing health insurance coverage may be eligible to enroll during a Special Enrollment Period.
Virginia’s Insurance Marketplace replaced HealthCare.gov for all Virginians and launched on November 1, 2023. Marketplace provides a wealth of resources for residents to find affordable health care coverage. Hundreds of thousands of Virginians have accessed the Marketplace this Open Enrollment Period to find coverage that meets their needs.
A week or so ago, when the Centers for Medicare & Medicaid Services (CMS) issued their first official "snapshot report" of the 2024 Open Enrollment Period, I noted that unlike most states which have seen dramatically higher initial enrollment numbers, Virginia saw a dramatic drop in initial 2-week enrollment:
At the opposite end of the spectrum, Virginia is running a whopping 64% behind their 2023 OEP enrollment at this point, almost certainly due to the state moving off of the federal exchange onto their own platform; since current enrollees have to actively log into a whole new account and go through a different interface to enroll for 2024, there's no doubt a lot of confusion at the moment. Hopefully this will straighten itself out by the time OEP ends, however.
[In 2017], Virginia residents experienced massive amounts of heartburn and ulcers as two major insurance carriers, Optima (Sentara Health) and Anthem (HealthKeepers) played musical chairs with both their 2018 rate filings and which areas of the state they offered plans on.
In May 2017, things didn't look too bad: Both Anthem and Optima were available in fairly large chunks of the state, and while Anthem wanted to raise rates an ugly 38% on average, Optima was only looking to increase rates by around 10-11%.
Virginia is slated to become the nation’s 19th state-based exchange now that CMS has given officials the greenlight to fully transition away from healthcare.gov starting Nov. 1 for the 2024 plan year. Meanwhile, the State Corporation Commission (SCC), which administers the exchange, has suspended the state’s reinsurance program that had lowered premiums by about 20% for 2023, so individual plan rates are set to increase by an average 28.4%, according to a presentation made during an Aug. 9 hearing on the 2024 rates.
As I noted a month ago, Virginia insurance carriers participating in the ACA individual market submitted preliminary 2024 rate filings which averaged over a 20% hike, almost entirely due to the prospect of the states reinsurance program (which had only been implemented one year earlier) possibly not being funded for the second year.
In 2023, average unsubsidized indy market premiums in Virginia had dropped by around 13% thanks to the new reinsurance program, which offloads a portion of high-cost enrollee care to the federal government in return for reducing the amount of subsidies received by low/moderate-income enrollees.
Fortunately, cooler heads eventually prevailed, and in the end the state legislature passed a budget which did indeed properly fund the program. This allowed insurance carriers to file modified rates for 2024 which include the reinsurance program being in place.
Virginia is slated to become the nation’s 19th state-based exchange now that CMS has given officials the greenlight to fully transition away from healthcare.gov starting Nov. 1 for the 2024 plan year. Meanwhile, the State Corporation Commission (SCC), which administers the exchange, has suspended the state’s reinsurance program that had lowered premiums by about 20% for 2023, so individual plan rates are set to increase by an average 28.4%, according to a presentation made during an Aug. 9 hearing on the 2024 rates.
Virginia’s Health Benefit Exchange (VHBE) was enacted in 2020 by former Gov. Ralph Northam (D) and has been operating as a state-based exchange reliant on the federal platform (SBE-FP) since plan year 2021. The state paused the transition activity in 2021 after the enhanced premium tax credits were enacted but restarted it the following year.
CMS Approves Added Benefits to Essential Health Benefits (EHB) Benchmark Plans in North Dakota and Virginia
September 6: CMS approved added benefits to the Essential Health Benefits (EHB) benchmark plans for North Dakota and Virginia for the 2025 plan year. The Affordable Care Act requires non-grandfathered health plans in the individual and small group markets to cover essential health benefits (EHB), which include items and services in ten benefit categories. For plan year 2020 and after, the Final 2019 HHS Notice of Benefits and Payment Parameters provides states with greater flexibility by establishing new standards for states to update their EHB-benchmark plans, and for tailoring them to fit the health care needs of their states.
Here's the best summaries I could find of the additional benefits for each state:
A few weeks ago, I noted that Virginia's average 2023 unsubsidized ACA individual market premiums dropped by nearly 13% thanks to the newly-implemented state-based reinsurance program...but that they were at risk of skyrocketing by as much as 25% in 2024 due to that same reinsurance program being at risk of not continuing for a second year because of a budget standoff:
During 2021, the Virginia General Assembly passed HB 2332, the Commonwealth Health Reinsurance Program, which was signed into law on March 31, 2021 as Chapter 480, of the 2021 Virginia Acts of Assembly. This bill requires the State Corporation Commission to submit a waiver request for federal approval to establish a reinsurance program beginning January 1, 2023.
