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What to Expect for ACA Premiums?

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An Actuary Opens the Black Box

This essay looks at the factors involved in setting premiums for health plans offered on the health insurance exchanges [HIEs].


NIHCM – What to Expect for 2015 ACA Premiums: An Actuary Opens the Black Box


So, were the actuaries correct?


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13 Responses

  1. Group Insurers Earned a 2.5% Profit in 2014

    The Commonwealth Fund recently conducted an analysis comparing projected and actual financial performance for health insurance companies under the ACA in 2014. Here are some key findings from the report:

    • Medical claims were 2% higher in 2014 than insurers first projected.
    • Within the individual market, health insurers incurred losses of 4% of premiums.
    • Group insurers earned a profit of almost 2.5% in 2014.
    • More than a third of insurance companies improved/remained profitable from 2013 to 2014.
    • For individual coverage, medical claims were 5.7% higher than projected ($429 vs. $406 pmpm).
    • Most underestimated claims were offset by $7.9 billion in reinsurance payments from the government.

    Source: Commonwealth Fund, July 20, 2016


  2. ACA

    Three of the major players in Tennessee — Cigna Health Insurance, Humana and Blue Cross Blue Shield — were just granted huge double-digit premium increases for the 2017 season beginning in January amid a warning from the state’s insurance commissioner that the Obamacare markets were “very near collapse.”



  3. Changes to ACA Exchanges May be Enough to Keep Them Afloat for Now

    Proposed changes to help stabilize the Affordable Care Act health insurance exchange markets should be enough to stop the bleeding, but further changes will likely be needed next year. The rule, which was released a couple of months earlier than expected includes changes in 2018 to the ACA risk-adjustment program as well as changes to plan requirements.

    The rule changes are a response to tumult in the exchanges as Aetna, Humana, and UnitedHealth Group have all said they will be significantly scaling back their plan offerings in 2017. That and overall low enrollment from consumers has led some to question whether the exchanges can remain viable. There have also been concerns about double-digit premium increases in some states, although the HHS released an analysis stating that coverage would still be affordable for most consumers who receive premium subsidies.

    Source: Shannon Muchmore, Modern Healthcare [8/30/16]


  4. PP-ACA Penalty Update

    Getting insurance is required by law for many people.

    The penalty for noncompliance is the greater of 2.5 percent of your adjusted gross income, or $695 per adult and $347.50 per child in tax year 2016. The amount for a household is capped at $2,085. The fee called the “individual shared responsibility payment” on healthcare.gov will be the same in 2017 and beyond, with adjustments for inflation.

    If you lack coverage for only part of the year, the fee is prorated. For example, an individual who goes without health insurance for three months will be assessed 25 percent of the fee.

    Those who owe the fee this year will have it assessed as part of their income taxes. Exemptions are available in certain situations, such as if you were without health insurance less than three months or the cost of the cheapest plan in your area exceeds 8 percent of your income.




  5. 2 in 3 Plans on the Marketplace are Silver Plans

    The Robert Wood Johnson Foundation recently released a study on the differences between health plans on and off the exchanges. Here are some key findings from the report:

    • On the marketplace, silver plans comprise about two-thirds of all plans.
    • Off the marketplace, only about a third of plans available are silver.
    • The average off-exchange silver premium was $314, vs. $279 for exchange plans.
    • Off-exchange silver plan deductibles were $1,200 higher on average.
    • One third of off-exchange plans are bronze and 25% are gold or platinum plans.
    • Bronze make up 16% and gold or platinum plans 12% of marketplace offerings.

    Kaiser Health News, October 28, 2016


  6. Family Premiums Have Increased 140% Since 2013

    eHealth recently released an analysis of premium costs for 2017. Here are some key findings from the report:

    • The average individual premium in 2017 is $393 per month.
    • In 2013 the average individual premium was $197 per month.
    • Between 2013 and 2017, average individual premiums have increased 99%.
    • The average family premium is $1,021 per month in 2017.
    • In 2013 the average family’s premium was $426 per month.
    • Family premiums have increased 140% between 2013 and 2017.



  7. Half of Payers Plan to Increase Rates 10-20% in 2018

    Oliver Wyman recently released results from a survey on the 2018 ACA exchanges. Here are some key findings from the report:

    • Of the payers that intend to participate in 2018, 70% are not changing strategy.
    • 30% of payers are making adjustments to stabilize their ACA lines of business.
    • 1 in 4 are adjusting strategy within current geographic footprint.
    • Half the payers surveyed plan on a rate increase of 10- 20%.
    • 25% are planning a rate increase less than 10% for 2018.
    • The average premium rate increase for 2017 was 22%.

    Oliver Wyman Health, April 17, 2017


  8. Subsidies For People Under Age 65 Will Total $705 Billion in 2017

    The Congressional Budget Office recently released projections for federal government spending on health insurance subsidies for people under age 65. Here are some key findings from the report:

    • In 2017, net subsidies for people under age 65 will total $705 billion.
    • 244 million civilians under age 65 will have health insurance in 2017.
    • 28 million people will be uninsured in 2017.
    • From 2018-2027, the number with coverage will grow from 242 to 247 million.
    • The number of uninsured people is expected to grow from 30 million to 31 million.
    • For the entire 2018–2027 period, the projected net subsidy is $9.2 trillion.

    Source: Congressional Budget Office, September 2017


  9. 24% of Adults Said Their Healthcare Was Harder to Afford Over the Past Year

    The Commonwealth Fund recently released results from their Affordable Care Act Tracking Survey. Here are some key findings from the report:

    • In 2018, 62.4% of adults said they were confident they could afford their health care.
    • 2 in 3 adults said there was no change in care affordability over the past year.
    • 1 in 4 adults said their healthcare was harder to afford over the past year.
    • 46% said they would not have the money to cover an unexpected $1000 medical bill.

    Source: Commonwealth Fund, May 10, 2018


  10. Pfizer to Pay $24 Million to Settle Probe Into Copay Assistance Charities

    The allegations follow a federal probe into charities that accept money from pharmaceutical companies and help sick patients pay for prescription drugs.




  11. 2019

    A health care expert predicts 2019 will be marked by a backlash against high deductibles as consumers fear accessing health care because of rising out-of-pocket costs.




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