4 FAQs about 2019 Medicare rates

Some high-income enrollees of Medicare Part B may experience premium increases of 7.4 percent. According to Medicare managers, Medicare Part B premium increases will be held to about 1.1 percent for most enrollees in 2019. Read on to learn more.


Medicare managers announced last week that they will hold increases in Medicare Part B premiums to about 1.1 percent for most enrollees in 2019. For some high-income enrollees, however, premiums will rise 7.4 percent.

Medicare Part B is the component of the traditional Medicare program that covers physician services and hospital outpatient care.

Here’s a look at how the monthly Part B premiums will change, by annual income level:

  • Individuals earning less than $85,000, and couples earning less than $170,000:$135.50 in 2019, from $134 this year.
  • Individuals earnings $160,000 to $500,000, and couples earning $320,000 to $750,000: $433.40 in 2019, from $428.60 this year.
  • Individuals earning $500,000 or more, and couples earning $750,000 or more: $460.50 in 2019, from $428.60 this year.

The annual Medicare Part B deductible will increase by 1.1 percent, to $185.

Another component of the traditional Medicare program, Medicare Part A, covers inpatient hospital bills.

Medicare managers use payroll taxes to cover most of the cost of running the Medicare Part A program. Few Medicare Part A enrollees pay premiums for that coverage. But, for the enrollees who do have to pay premiums for Medicare Part A coverage, the full premium will increase 3.6 percent, to $437 per month.

The Medicare Part A deductible for inpatient hospital care will increase 1.8 percent, to $1,340.

Why are high earners paying so much more for Medicare Part B?

Congress has been increasing the share of Medicare costs that high earners pay in recent years.

For 2018, the top annual income category for Medicare Part B rate-setting purposes was for $160,000 and over for individuals, and for $320,000 and over for couples. Premiums from those Medicare Part B enrollees are supposed to cover 80 percent of their Part B claims.

In the Balanced Budget Act of 2018, Congress added a new annual income category: for individuals earning $500,000 or more and couples earning $750,000 or more. Premiums from Part B enrollees in that income category are supposed to cover 85 percent of those enrollees’ Part B claims.

Who do these rate increases actually affect?

Medicare now has about 60 million enrollees of all kinds, according to the CMS Medicare Enrollment Dashboard.

About 21 million are in Medicare Advantage plans and other plans with separate premium-setting processes.

About 38 million are in the traditional Medicare Part A, the Medicare Part B program, or both the Medicare Part A and the Medicare Part B programs. CMS refers to the traditional Medicare Part A-Medicare Part B program as Original Medicare. The rate increases have a direct effect on the Original Medicare enrollees’ costs.

How do the Medicare increases compare with the Social Security cost-of-living adjustment (COLA)?

The Social Security Administration recently announced that the 2019 Social Security COLA will be 2.8 percent.

That means the size of the COLA will be greater than the increase in Medicare premiums for all Medicare enrollees other than the highest-income Medicare Part B enrollees and the enrollees who pay the full cost of the Medicare Part A premiums.

Why should financial professionals care about Original Medicare premiums?

For consumers who already have traditional Medicare coverage, the Part A and Part B premiums may affect how much they have to spend on other insurance products and related products, such as Medicare supplement insurance coverage.

For retirement income planning clients, Medicare costs are something to factor into income needs calculations.

Because access to Medicare coverage is critical to all but the very wealthiest retirees, knowledge about how to get and keep eligibility for Medicare coverage on the most favorable possible terms is of keen interest to many consumers ages 50 and older. Some consumers may like to get information about that topic from their insurance agents, financial planners and other advisors.

Resources

Officials at the Centers for Medicare and Medicaid Services, the agency that runs Medicare, are preparing to publish the official 2019 Medicare rate notices in the Federal Register on Wednesday. A preview copy of the Part A notice is available here, and a preview copy of the Part B notice is available here.

SOURCE: Bell, A. (16 October 2018) "4 FAQs about 2019 Medicare rates" (Web Blog Post). Retrieved from https://www.benefitspro.com/2018/10/16/medicare-posts-2019-rates-pinches-high-earners-412/


An Early Look at 2018 Premium Changes and Insurer Participation on ACA Exchanges


Each year insurers submit filings to state regulators detailing their plans to participate on the Affordable Care Act marketplaces (also called exchanges). These filings include information on the premiums insurers plan to charge in the coming year and which areas they plan to serve. Each state or the federal government reviews premiums to ensure they are accurate and justifiable before the rate goes into effect, though regulators have varying types of authority and states make varying amounts of information public.

In this analysis, we look at preliminary premiums and insurer participation in the 20 states and the District of Columbia where publicly available rate filings include enough detail to be able to show the premium for a specific enrollee. As in previous years, we focus on the second-lowest cost silver plan in the major city in each state. This plan serves as the benchmark for premium tax credits. Enrollees must also enroll in a silver plan to obtain reduced cost sharing tied to their incomes. About 71% of marketplace enrollees are in silver plans this year.

States are still reviewing premiums and participation, so the data in this report are preliminary and could very well change. Rates and participation are not locked in until late summer or early fall (insurers must sign an annual contract by September 27 in states using Healthcare.gov).

Insurers in this market face new uncertainty in the current political environment and in some cases have factored this into their premium increases for the coming year. Specifically, insurers have been unsure whether the individual mandate (which brings down premiums by compelling healthy people to buy coverage) will be repealed by Congress or to what degree it will be enforced by the Trump Administration. Additionally, insurers in this market do not know whether the Trump Administration will continue to make payments to compensate insurers for cost-sharing reductions (CSRs), which are the subject of a lawsuit, or whether Congress will appropriate these funds. (More on these subsidies can be found here).

The vast majority of insurers included in this analysis cite uncertainty surrounding the individual mandate and/or cost sharing subsidies as a factor in their 2018 rates filings. Some insurers explicitly factor this uncertainty into their initial premium requests, while other companies say if they do not receive more clarity or if cost-sharing payments stop, they plan to either refile with higher premiums or withdraw from the market. We include a table in this analysis highlighting examples of companies that have factored this uncertainty into their initial premium increases and specified the amount by which the uncertainty is increasing rates.

Changes in the Second-Lowest Cost Silver Premium

The second-lowest silver plan is one of the most popular plan choices on the marketplace and is also the benchmark that is used to determine the amount of financial assistance individuals and families receive. The table below shows these premiums for a major city in each state with available data. (Our analyses from 201720162015, and 2014 examined changes in premiums and participation in these states and major cities since the exchange markets opened nearly four years ago.)

Across these 21 major cities, based on preliminary 2018 rate filings, the second-lowest silver premium for a 40-year-old non-smoker will range from $244 in Detroit, MI to $631 in Wilmington, DE, before accounting for the tax credit that most enrollees in this market receive.

Of these major cities, the steepest proposed increases in the unsubsidized second-lowest silver plan are in Wilmington, DE (up 49% from $423 to $631 per month for a 40-year-old non-smoker), Albuquerque, NM (up 34% from $258 to $346), and Richmond, VA (up 33% from $296 to $394). Meanwhile, unsubsidized premiums for the second-lowest silver premiums will decrease in Providence, RI (down -5% from $261 to $248 for a 40-year-old non-smoker) and remain essentially unchanged in Burlington, VT ($492 to $491).

As discussed in more detail below, this year’s preliminary rate requests are subject to much more uncertainty than in past years. An additional factor driving rates this year is the return of the ACA’s health insurance tax, which adds an estimated 2 to 3 percentage points to premiums.

Most enrollees in the marketplaces (84%) receive a tax credit to lower their premium and these enrollees will be protected from premium increases, though they may need to switch plans in order to take full advantage of the tax credit. The premium tax credit caps how much a person or family must spend on the benchmark plan in their area at a certain percentage of their income. For this reason, in 2017, a single adult making $30,000 per year would pay about $207 per month for the second-lowest-silver plan, regardless of the sticker price (unless their unsubsidized premium was less than $207 per month). If this person enrolls in the second lowest-cost silver plan is in 2018 as well, he or she will pay slightly less (the after-tax credit payment for a similar person in 2018 will be $201 per month, or a decrease of 2.9%). Enrollees can use their tax credits in any marketplace plan. So, because tax credits rise with the increase in benchmark premiums, enrollees are cushioned from the effect of premium hikes.

Table 1: Monthly Silver Premiums and Financial Assistance for a 40 Year Old Non-Smoker Making $30,000 / Year
State  Major City 2nd Lowest Cost Silver
Before Tax Credit
2nd Lowest Cost Silver
After Tax Credit
Amount of Premium Tax Credit
2017 2018 % Change
from 2017
2017 2018 % Change
from 2017
2017 2018 % Change
from 2017
California* Los Angeles $258 $289 12% $207 $201 -3% $51 $88 71%
Colorado Denver $313 $352 12% $207 $201 -3% $106 $150 42%
Connecticut Hartford $369 $417 13% $207 $201 -3% $162 $216 33%
DC Washington $298 $324 9% $207 $201 -3% $91 $122 35%
Delaware Wilmington $423 $631 49% $207 $201 -3% $216 $430 99%
Georgia Atlanta $286 $308 7% $207 $201 -3% $79 $106 34%
Idaho Boise $348 $442 27% $207 $201 -3% $141 $241 70%
Indiana Indianapolis $286 $337 18% $207 $201 -3% $79 $135 72%
Maine Portland $341 $397 17% $207 $201 -3% $134 $196 46%
Maryland Baltimore $313 $392 25% $207 $201 -3% $106 $191 81%
Michigan* Detroit $237 $244 3% $207 $201 -3% $29 $42 44%
Minnesota** Minneapolis $366 $383 5% $207 $201 -3% $159 $181 14%
New Mexico Albuquerque $258 $346 34% $207 $201 -3% $51 $144 183%
New York*** New York City $456 $504 10% $207 $201 -3% $249 $303 21%
Oregon Portland $312 $350 12% $207 $201 -3% $105 $149 42%
Pennsylvania Philadelphia $418 $515 23% $207 $201 -3% $211 $313 49%
Rhode Island Providence $261 $248 -5% $207 $201 -3% $54 $47 -13%
Tennessee Nashville $419 $507 21% $207 $201 -3% $212 $306 44%
Vermont Burlington $492 $491 0% $207 $201 -3% $285 $289 2%
Virginia Richmond $296 $394 33% $207 $201 -3% $89 $193 117%
Washington Seattle $238 $306 29% $207 $201 -3% $31 $105 239%
NOTES: *The 2018 premiums for MI and CA reflect the assumption that CSR payments will continue. **The 2018 premium for MN assumes no reinsurance. ***Empire has filed to offer on the individual market in New York in 2018 but has not made its rates public.
SOURCE:  Kaiser Family Foundation analysis of premium data from Healthcare.gov and insurer rate filings to state regulators.

Looking back to 2014, when changes to the individual insurance market under the ACA first took effect, reveals a wide range of premium changes. In many of these cities, average annual premium growth over the 2014-2018 period has been modest, and in two cites (Indianapolis and Providence), benchmark premiums have actually decreased. In other cities, premiums have risen rapidly over the period, though in some cases this rapid growth was because premiums were initially quite low (e.g., in Nashville and Minneapolis).

Table 2: Monthly Benchmark Silver Premiums
for a 40 Year Old Non-Smoker, 2014-2018
State Major City 2014 2015 2016 2017 2018 Average Annual % Change from 2014 to 2018 Average Annual % Change After Tax Credit, $30K Income
California Los Angeles $255 $257 $245 $258 $289 3% -1%
Colorado Denver $250 $211 $278 $313 $352 9%  -1%
Connecticut Hartford $328 $312 $318 $369 $417 6%  -1%
DC Washington $242 $242 $244 $298 $324 8%  -1%
Delaware Wilmington $289 $301 $356 $423 $631 22%  -1%
Georgia Atlanta $250 $255 $254 $286 $308 5%  -1%
Idaho Boise $231 $210 $273 $348 $442 18%  -1%
Indiana Indianapolis $341 $329 $298 $286 $337 0%  -1%
Maine Portland $295 $282 $288 $341 $397 8%  -1%
Maryland Baltimore $228 $235 $249 $313 $392 15%  -1%
Michigan* Detroit $224 $230 $226 $237 $244 2%  -1%
Minnesota** Minneapolis $162 $183 $235 $366 $383 24%  6%
New Mexico Albuquerque $194 $171 $186 $258 $346 16%  1%
New York*** New York City $365 $372 $369 $456 $504 8%  -1%
Oregon Portland $213 $213 $261 $312 $350 13%  -1%
Pennsylvania Philadelphia $300 $268 $276 $418 $515 14%  -1%
Rhode Island Providence $293 $260 $263 $261 $248 -4%  -1%
Tennessee Nashville $188 $203 $281 $419 $507 28%  2%
Vermont Burlington $413 $436 $468 $492 $491 4%  -1%
Virginia Richmond $253 $260 $276 $296 $394 12%  -1%
Washington Seattle $281 $254 $227 $238 $306 2% -1%
NOTES: *The 2018 premiums for MI and CA reflect the assumption that CSR payments will continue. **The 2018 premium for MN assumes no reinsurance. ***Empire has filed to offer on the individual market in New York in 2018 but has not made its rates public.
SOURCE:  Kaiser Family Foundation analysis of premium data from Healthcare.gov and insurer rate filings to state regulators.

Changes in Insurer Participation

Across these 20 states and DC, an average of 4.6 insurers have indicated they intend to participate in 2018, compared to an average of 5.1 insurers per state in 2017, 6.2 in 2016, 6.7 in 2015, and 5.7 in 2014. In states using Healthcare.gov, insurers have until September 27 to sign final contracts to participate in 2018. Insurers often do not serve an entire state, so the number of choices available to consumers in a particular area will typically be less than these figures.

Table 3: Total Number of Insurers by State, 2014 – 2018
State Total Number of Issuers in the Marketplace
2014 2015 2016 2017 2018 (Preliminary)
California 11 10 12 11 11
Colorado 10 10 8 7 7
Connecticut 3 4 4 2 2
DC 3 3 2 2 2
Delaware 2 2 2 2 1 (Aetna exiting)
Georgia 5 9 8 5 4 (Humana exiting)
Idaho 4 5 5 5 4 (Cambia exiting)
Indiana 4 8 7 4 2 (Anthem and MDwise exiting)
Maine 2 3 3 3 3
Maryland 4 5 5 3 3 (Cigna exiting, Evergreen1 filed to reenter)
Michigan 9 13 11 9 8 (Humana exiting)
Minnesota 5 4 4 4 4
New Mexico 4 5 4 4 4
New York 16 16 15 14 14
Oregon 11 10 10 6 5 (Atrio exiting)
Pennsylvania 7 8 7 5 5
Rhode Island 2 3 3 2 2
Tennessee 4 5 4 3 3 (Humana exiting, Oscar entering)
Vermont 2 2 2 2 2
Virginia 5 6 7 8 6 (UnitedHealthcare and Aetna exiting)
Washington 7 9 8 6 5 (Community Health Plan of WA exiting)
Average (20 states + DC) 5.7 6.7 6.2 5.1 4.6
NOTES: Insurers are grouped by parent company or group affiliation, which we obtained from HHS Medical Loss Ratio public use files and supplemented with additional research.
1The number of preliminary 2018 insurers in Maryland includes Evergreen, which submitted a filing but has been placed in receivership.
SOURCE:  Kaiser Family Foundation analysis of premium data from Healthcare.gov and insurer rate filings to state regulators.

Uncertainty Surrounding ACA Provisions

Insurers in the individual market must submit filings with their premiums and service areas to states and/or the federal government for review well in advance of these rates going into effect. States vary in their deadlines and processes, but generally, insurers were required to submit their initial rate requests in May or June of 2017 for products that go into effect in January 2018. Once insurers set their premiums for 2018 and sign final contacts at the end of September, those premiums are locked in for the entire calendar year and insurers do not have an opportunity to revise their rates or service areas until the following year.

Meanwhile, over the course of this summer, the debate in Congress over repealing and replacing the Affordable Care Act has carried on as insurers set their rates for next year. Both the House and Senate bills included provisions that would have made significant changes to the law effective in 2018 or even retroactively, including repeal of the individual mandate penalty. Additionally, the Trump administration has sent mixed signals over whether it would continue to enforce the individual mandate or make payments to insurers to reimburse them for the cost of providing legally required cost-sharing assistance to low-income enrollees.

Because this policy uncertainty is far outside the norm, insurers are making varying assumptions about how this uncertainty will play out and affect premiums. Some states have attempted to standardize the process by requesting rate submissions under multiple scenarios, while other states appear to have left the decision up to each individual company. There is no standard place in the filings where insurers across all states can explain this type of assumption, and some states do not post complete filings to allow the public to examine which assumptions insurers are making.

In the 20 states and DC with detailed rate filings included in the previous sections of this analysis, the vast majority of insurers cite policy uncertainty in their rate filings. Some insurers make an explicit assumption about the individual mandate not being enforced or cost-sharing subsidies not being paid and specify how much each assumption contributes to the overall rate increase. Other insurers state that if they do not get clarity by the time final rates must be submitted – which has now been delayed to September 5 for the federal marketplace – they may either increase their premiums further or withdraw from the market.

Table 4 highlights examples of insurers that have explicitly factored into their premiums an assumption that either the individual mandate will not be enforced or cost-sharing subsidy payments will not be made and have specified the degree to which that assumption is influencing their initial rate request. As mentioned above, the vast majority of companies in states with detailed rate filings have included some language around the uncertainty, so it is likely that more companies will revise their premiums to reflect uncertainty in the absence of clear answers from Congress or the Administration.

Insurers assuming the individual mandate will not be enforced have factored in to their rate increases an additional 1.2% to 20%. Those assuming cost-sharing subsidy payments will not continue and factoring this into their initial rate requests have applied an additional rate increase ranging from 2% to 23%. Because cost-sharing reductions are only available in silver plans, insurers may seek to raise premiums just in those plans if the payments end. We estimate that silver premiums would have to increase by 19% on average to compensate for the loss of CSR payments, with the amount varying substantially by state.

Several insurers assumed in their initial rate filing that payment of the cost-sharing subsidies would continue, but indicated the degree to which rates would increase if they are discontinued. These insurers are not included in the Table 4. If CSR payments end or there is continued uncertainty, these insurers say they would raise their rates an additional 3% to 10% beyond their initial request – or ranging from 9% to 38% in cases when the rate increases would only apply to silver plans. Some states have instructed insurers to submit two sets of rates to account for the possibility of discontinued cost-sharing subsidies. In California, for example, a surcharge would be added to silver plans on the exchange, increasing proposed rates an additional 12.4% on average across all 11 carriers, ranging from 8% to 27%.

Table 4: Examples of Preliminary Insurer Assumptions Regarding Individual Mandate Enforcement and
Cost-Sharing Reduction (CSR) Payments
State Insurer Average Rate Increase  Requested Individual Mandate Assumption CSR Payments Assumption Requested Rate Increase Due to Mandate or CSR Uncertainty
CT ConnectiCare 17.5% Weakly enforced1 Not specified Mandate: 2.4%
DE Highmark BCBSD 33.6% Not enforced Not paid Mandate and CSR: 12.8% combined impact
GA Alliant Health Plans 34.5% Not enforced Not paid Mandate: 5.0%
CSR: Unspecified
ID Mountain Health CO-OP 25.0% Not specified Not paid CSR: 17.0%
ID PacificSource Health Plans 45.6% Not specified Not paid CSR: 23.2%
ID SelectHealth 45.0% Not specified Not paid CSR: 20.0%
MD CareFirst BlueChoice 45.6% Not enforced Potentially not paid Mandate: 20.0%
ME Harvard PilgrimHealth Care 39.7% Weakly enforced Potentially not paid Mandate: 15.9%
MI BCBS of MI 26.9% Weakly enforced Potentially not paid (two rate submissions) Mandate: 5.0%
MI Blue Care Network of MI 13.8% Weakly enforced Potentially not paid (two rate submissions) Mandate: 5.0%
MI Molina Healthcare of MI 19.3% Weakly enforced Potentially not paid (two rate submissions) Mandate: 9.5%
NM CHRISTUS Health Plan 49.2% Not enforced Potentially not paid Mandate: 9.0%, combined impact of individual mandate non-enforcement and reduced advertising and outreach
NM Molina Healthcare of NM 21.2% Weakly enforced Paid Mandate: 11.0%
NM New Mexico Health Connections 32.8% Not enforced Potentially not paid Mandate: 20.0%
OR* BridgeSpan 17.2% Weakly enforced Potentially not paid Mandate: 11.0%
OR* Moda Health 13.1% Not enforced Potentially not paid Mandate: 1.2%
OR* Providence Health Plan 20.7% Not enforced Potentially not paid Mandate: 9.7%, largely due to individual mandate non-enforcement
TN BCBS of TN 21.4% Not enforced Not paid Mandate: 7.0%
CSR:  14.0%
TN Cigna 42.1% Weakly enforced Not paid CSR: 14.1%
TN Oscar Insurance  NA (New to state) Not enforced Not paid Mandate: 0%, despite non-enforcement
CSR: 17.0%, applied only to silver plans
VA CareFirst BlueChoice 21.5% Not enforced Potentially not paid Mandate: 20.0%
VA CareFirst GHMSI 54.3% Not enforced Potentially not paid Mandate: 20.0%
WA LifeWise Health Plan of Washington 21.6% Weakly enforced Not paid Mandate: 5.2%
CSR: 2.3%
WA Premera Blue Cross 27.7% Weakly enforced Not paid Mandate: 4.0%
CSR: 3.1%
WA Molina Healthcare of WA 38.5% Weakly enforced Paid Mandate: 5.4%
NOTES: The CSR assumption “Potentially not paid” refers to insurers that filed initial rates assuming CSR payments are made and indicated that uncertainty over CSR funding would change their initial rate requests. In Michigan, insurers were instructed to submit a second set of filings showing rate increases without CSR payments; the rates shown above assume continued CSR payments. *The Oregon Division of Financial Regulation reviewed insurer filings and advised adjustment of the impact of individual mandate uncertainty to between 2.4% and 5.1%. Although rates have since been finalized, the increases shown here are based on initial insurer requests. 1Connecticare assumes a public perception that the mandate will not be enforced.
SOURCE:  Kaiser Family Foundation analysis of premium data from Healthcare.gov and insurer rate filings to state regulators.

Discussion

A number of insurers have requested double-digit premium increases for 2018. Based on initial filings, the change in benchmark silver premiums will likely range from -5% to 49% across these 21 major cities. These rates are still being reviewed by regulators and may change.

In the past, requested premiums have been similar, if not equal to, the rates insurers ultimately charge. This year, because of the uncertainty insurers face over whether the individual mandate will be enforced or cost-sharing subsidy payments will be made, some companies have included an additional rate increase in their initial rate requests, while other companies have said they may revise their premiums late in the process. It is therefore quite possible that the requested rates in this analysis will change between now and open enrollment.

Insurers attempting to price their plans and determine which states and counties they will service next year face a great deal of uncertainty. They must soon sign contracts locking in their premiums for the entire year of 2018, yet Congress or the Administration could make significant changes in the coming months to the law – or its implementation – that could lead to significant losses if companies have not appropriately priced for these changes. Insurers vary in the assumptions they make regarding the individual mandate and cost-sharing subsidies and the degree to which they are factoring this uncertainty into their rate requests.

Because most enrollees on the exchange receive subsidies, they will generally be protected from premium increases. Ultimately, most of the burden of higher premiums on exchanges falls on taxpayers. Middle and upper-middle income people purchasing their own coverage off-exchange, however, are not protected by subsidies and will pay the full premium increase, switch to a lower level plan, or drop their coverage. Although the individual market on average has been stabilizing, the concern remains that another year of steep premium increases could cause healthy people (particularly those buying off-exchange) to drop their coverage, potentially leading to further rate hikes or insurer exits.

Methods

Data were collected from health insurer rate filing submitted to state regulators. These submissions are publicly available for the states we analyzed. Most rate information is available in the form of a SERFF filing (System for Electronic Rate and Form Filing) that includes a base rate and other factors that build up to an individual rate. In states where filings were unavailable, we gathered data from tables released by state insurance departments. Premium data are current as of August 7, 2017; however, filings in most states are still preliminary and will likely change before open enrollment. All premiums in this analysis are at the rating area level, and some plans may not be available in all cities or counties within the rating area. Rating areas are typically groups of neighboring counties, so a major city in the area was chosen for identification purposes.


ACA premiums to rise 25 percent in biggest jump yet

Zachary Tracer clarifies on ACA premiums rising yet again.

Originally posted on BenefitsPRO.com

Posted October 25, 2016

 

 

Premiums for mid-level Obamacare health plans sold on the federal exchanges will see their biggest jump yet next year, another speed bump in the administration’s push for enrollment in the final months of the U.S. president’s term.

Monthly premiums for benchmark silver-level plans are going up by an average of 25 percent in the 38 states using the federal HealthCare.gov website, the U.S. Department of Health and Human Services said in a report today. Last year, premiums for the second-lowest-cost silver plans went up by 7.5 percent on average across 37 states.

Individuals signing up for plans this year are facing not only rising premiums, but also fewer options to choose from after several big insurers pulled out from some of the markets created under the Affordable Care Act, known as Obamacare. While the ACA has brought uninsured numbers to record lows in the U.S., millions remain uninsured. To attract more people, the government has emphasized that subsidies are available for many people to help cushion the premium increases.

Protecting consumers

About 77 percent of current enrollees would still be able to find ACA plans for less than $100 a month, once subsidies are taken into account, according to the report. Subsidies are calculated based on the cost of the second-lowest-premium silver plan in a given area. Silver plans typically cover about 70 percent of an individual’s medical expenses, though additional subsidies can help make the coverage more generous for lower-income individuals.

“Even in places of high rate increases this year, consumers will be protected,” Kathryn Martin, assistant secretary for planning and evaluation at the health department, said on a conference call with reporters. Her message to consumers is to check if they are entitled to subsidies and shop for options: “The odds are good you’ll find plans more affordable than what the public debate about the ACA might lead you to expect.”

Changes in the cost of the benchmark silver plans varied widely among regions, and the median benchmark premium increase was 16 percent. Premiums actually declined about 3 percent in Indiana, to $229 a month. In Arizona, on the other hand, the benchmark premium more than doubled, from $196 a month to $422, the report shows.

The data released Monday confirm reports based on state regulatory filings that have been accumulating for months, showing much higher premiums for 2017. ACASignups.net, which tracks the health law, had also estimated a 25 percent rise in premiums on average, weighted by membership.

Silver plans are mid-level on Obamacare’s marketplaces, with other plans including bronze, gold and platinum.

The government data show that some people may be able to find lower-cost plans by switching from their current coverage. The U.S. said that if all people who currently have ACA plans switched into the cheapest option of the same “metal” level, they could cut their premiums by 20 percent. Some people will have to switch because their plan will no longer be offered.

See the original article Here.

Source:

Tracer, Z. (2016 October 25). ACA Premiums to rise 25 percent in biggest jump yet. [Web blog post]. Retrieved from address http://www.benefitspro.com/2016/10/25/aca-premiums-to-rise-25-percent-in-biggest-jump-ye?kw=ACA%20premiums%20to%20rise%2025%20percent%20in%20biggest%20jump%20yet&et=editorial&bu=BenefitsPRO&cn=20161025&src=EMC-Email_editorial&pt=News%20Alert

 


Does out-of-pocket delay actually apply to you?

Originally posted September 3, 2013 by Tristan Lejeune on http://ebn.benefitnews.com

Yet another Affordable Care Act delay is in the spotlight: limits on out-of-pocket spending.

According to the law, starting in 2014, health plan participants will be spending no more than $6,350 in total out-of-pocket costs for individuals and $12,700 for family plans. That cap on out-of-pocket spending has been delayed until 2015, however, if an employer is using two separate vendors for its medical and pharmacy benefits. Sandy Ageloff, southwest health & group benefits leader for Towers Watson, says the rule only applies “to nongrandfathered plans” and emphasizes that the delay only applies to those who split their services.

“So the biggest piece of the legislation,” Ageloff says, “is that compliance is still required for Jan. 1, 2014 if the benefit plan – whether it’s a self-funded employer plan or a fully insured carrier program – is using a single vendor for the administration of both medical and pharmacy. The nuance comes in when you have multiple vendors, you get a one-year deferral in total compliance. You still have to comply in pieces, but you don’t have to comply in total.”

The number of plans that maintain their grandfathered status in the face of ACA continues to shrink, but Ageloff estimates that 35% or 40% of large employers use different vendors and thus have the extra year. Complicating things, she says, is that “a number of carriers actually have, behind the scenes, carved out that relationship with a pharmacy vendor,” so two can masquerade as one. Figuring out compliance may require more than just a phone call to your provider.

“For example, if you look at Anthem Blue Cross Blue Shield, they have a subcontracted relationship with ESI to manage their pharmacy benefits,” Ageloff says. “Same is true of a lot of other broad-based medical insurance carriers. So the health plans themselves are taking different interpretations on whether the full mandate for 2014 applies to them, or if they get the deferral. So that’s complicating this. As an employer, if I say, I use Anthem BCBS as either my [third-party administrator] or I’m buying an insured product from them, I’m relying on them to tell me how they interpret their own program. So that’s creating some challenges, particularly for self-funded employers who control their own plan design.”

The National Business Group on Health Vice President of Public Policy Steve Wojcik says, like the employer mandate delay, the out-of-pocket postponement was done to allow systems to catch up to what is required of them in terms of processing and accounting. And, like the employer mandate delay, he says it’s good news.

“It means that employers and their plans have another year to consolidate and coordinate,” Wojcik says. “In many cases the issue is that the PBM handles the pharmacy benefit separately and the medical expenses are handled through the health plan, so a lot of times their systems don’t talk with one another, and then the patient or plan member doesn’t have up-to-the-minute information on where they stand toward their out-of-pocket limit.”

Wojcik says “by and large, most people don’t approach their out-of-pocket limits in a year, so for most people, it’s not going to affect them.” For those who do – usually those with chronic conditions or highly expensive pharmacy needs or both – “it will just be another year before they get relief.”


Companies can tie worker health premium cost to wellness

Original article from eba.benefitnews.com

By Alex Nussbaum

Businesses in the U.S. won more freedom to charge higher insurance premiums to workers who don’t meet health goals, or reward those who shape up, under rules released by the Obama administration.

Three years in the making, the regulations also require employers to offer a “reasonable alternative” for workers who can’t meet standards on weight, cholesterol or other measures, the U.S. Department of Health and Human Services said yesterday in a statement. That’s meant to protect employees from discrimination, although the agency rejected calls by consumer groups that companies provide medical evidence for claims that wellness programs improve health.

“The final rules support workplace health promotion and prevention,” the department said, “while ensuring that individuals are protected from unfair underwriting.”

Conditions such as obesity and diabetes account for three-quarters of U.S. health spending, and wellness programs have been gaining in popularity as businesses grapple with rising costs. The regulations, mandated by the Affordable Care Act, let employers charge workers as much as 30% of their medical-plan premiums if they fail to meet goals, an increase from the current 20%. The rules take effect Jan. 1.

Incentive programs

Almost half of U.S. companies with more than 200 employees now have wellness programs, according to the Kaiser Family Foundation, a nonprofit health research group based in Menlo Park, California. The incentives can be tied to activities such as joining a gym or getting a blood-pressure test or specific targets such as body-mass index.

While the administration eased some proposals, the regulations will still complicate wellness efforts, says Helen Darling, president of the National Business Group on Health. The Washington-based nonprofit represents large employers including Dell Inc., American Express Co. and PepsiCo Inc.

The rules give workers more leeway to seek changes in wellness targets they can’t meet due to health conditions and to have their doctors suggest alternative measures. There’s a danger that could tie up employers in protracted negotiations over health goals, Darling says.

“The more you put in terms of requirements and the more risk you make for employers, the more likely they are to say, ‘we don’t need this hassle,’” she says. “It’s making a lot more work for employers, and therefore, more expense.”

Consumer protections

Families USA, a Washington-based consumer group, welcomed the consumer protections.

“These rules will help ensure that wellness programs are designed to actually promote wellness, and that they are not just used as a backdoor way to shift health care costs to those struggling with health problems,” says Ron Pollack, the group’s executive director.

The health agency today also released a study of workplace wellness efforts, also mandated by the health care law. The report by the Rand Corp. found small yet promising changes in worker behavior and costs from programs at 600 businesses.

The measures “can reduce risk factors, such as smoking and increase healthy behaviors, such as exercise,” the Santa Monica, California-based research institute said in the report. Its analysis “confirms that workplace wellness programs can help contain the current epidemic of lifestyle-related diseases.”

The move to tie workers’ costs to their health is being examined by the U.S. Equal Employment Opportunity Commission to see whether such programs violate anti-discrimination laws. And California’s legislature is considering a bill that would bar linking financial rewards to a worker’s health status.

While some studies suggest $3 or more is saved for every $1 spent on wellness programs, the gains may come from shifting costs to less-healthy employees rather than changing behavior, according to a March analysis in Health Affairs.

 


Are You Ready for PPACA? Employers Count the Days

Original article from forbes.com

As the full enactment of PPACA approaches, there are many factors that business owners know to look out for.

  • Do I need to provide health insurance to my employees?
  • Should I go to an exchange?
  • How will the mandate impact my business and profitability?
  • How much are my health insurance premiums going to go up?

These are all questions that many business owners are starting to look. Below are some points that you may not have thought of that should go into your business planning.

We all know that health insurance premiums are expected to go up, but do you know how much? Small groups (2-99 employees) can expect to see price increases between 20% and 50% upon the full enactment of reform. When factoring in medical trend, taxes and fees, carrier and product changes and the introduction of community rating, your premiums will jump significantly. As a small business owner, asking your existing broker for a quote is not going to solve this problem as it will require a new method behind providing employees with health insurance. The objective of a health insurance plan should not be to carry you over to the next year with as little pain as possible, but to address your company’s healthcare expenses for the long term. You need a road map that will allow you to offer affordable coverage to employees while keeping costs in line.

Some employers are looking to drop plans in order to remain profitable. Unfortunately, this is not the answer either and can cause more pain than gain. With the Supreme Court upholding the individual mandate, all Americans will be required to obtain health insurance or pay a penalty. The cost of obtaining coverage for individuals is expected to jump 100% – 200% with an average increase of 116%. This is going to push many employees who either have individual plans or would ordinarily look at obtaining individual plans to go to their employer to obtain coverage. By not obtaining small group coverage, you risk losing your talent to other companies who are willing to absorb the cost. This can result in the loss of business and inevitably impact the bottom line more then not offering coverage at all.

The federal funding for health care reform is already facing challenges that will impact all small business owners. In the deal that was reached in the fiscal cliff debate, an agreement was made to cut the remaining $1.9 billion dollars that was set to fund Consumer Oriented Operated Plans (CO-OP’s) through the Affordable Care Act. $1.9 billion was already spent to fund the creation of CO-OP’s. These will remain in place; however no more federal money will be used to create any additional CO-OP’s at this time. This is another example of where PPACA has been modified in order to maintain its functionality. This will lead to higher costs in term of premium and taxes for small business owners and individuals seeking health insurance in the short term, to cover the high costs of implementing the systems and covering up all other budget shortfalls that would have ordinarily paid for these costs.

 


Putting off PPACA with early plan renewals

Original article from benefitspro.com

By Allen Greenberg

Why wait?

That’s the attitude a growing number of employers are expected to adopt this year when it comes to renewing their health plans and, as a result, putting off the day when they have to deal with the many provisions of the Patient Protection and Affordable Care Act.

“It’s actually not anything new,” said Cheryl Randolph, a spokeswoman for United HealthCare Group. “Employers have always had this option.”

Of course, that’s true. But this year’s different.

With the PPACA going into full effect Jan. 1, a number of employers are expected to pull the trigger on renewals in November and December. Just how many, no one knows right now.

But UnitedHealth, Humana and Aetna, among others, are all expected to offer early renewals, health insurance brokers say.

There’s plenty of incentive for employers to renew early.

Health insurance premiums on average could rise by 40 percent under the Patient Protection and Affordable Care Act, according to a study by Milliman, the consulting firm. The study was done on behalf of Center Forward, a bipartisan organization. It focused on premiums for individual and group comprehensive medical insurance plans in Arizona, Florida, Illinois, New Jersey, Ohio and Wisconsin.

Individual premiums, on average, will increase 25 percent to 40 percent due to PPACA, the firm said, while small market group premiums could increase by 6 percent to 12 percent.

Karen Harrison, a broker with Lakewood, Colo.-based Braddock Harrison Agency, said she expected to receive renewal packages from carriers in late August and was letting her clients know now they should consider early renewals this year.

“There are pros and cons to doing this,” Harrison said.

One con? Any employer renewing early this year would not be able to move their renewal date again.

The big pro? For companies with younger, healthier employees, renewing early could limit their rate increase to 15 percent or less, according to an estimated projection Humana shared with brokers.

Whether renewing early will work as a strategy is unclear.

The Illinois Department of Insurance recently warned health insurers it wouldn't approve policies with "arbitrary" renewal dates meant to "delay compliance with the reforms." Also, Rhode Island said it wouldn't approve early renewals of health plans for small businesses.

Harrison, for one, said she didn’t think regulators would have much choice.

“So long as everyone follows the rules, I think it would be very hard” to fight this, she said.

 


Premium Blues

The cost of employer-sponsored health coverage increased faster than wages in every state between 2003 and 2011, a new Commonwealth Fund analysis found. Employees' share of premiums of family coverage hit $3,962 in 2011, a 74 percent jump from 2003. The total average premium cost for family coverage reached $15,022 in 2011, an increase of 62 percent from 2003.


Younger buyers buying asset-based LTC

By Marli D. Riggs

The sale of asset-based long-term care insurance protection continues to grow significantly, reveals research by the American Association for Long-Term Care Insurance.

More than half (53%) of male LTC buyers were under age 65, up from 48% in a prior year’s study, while women buyers under age 65 also increased to 50%, up from 44%, according to data gathered from  insurers.

Meanwhile, premiums increased nearly 20% and the number of covered lives increased 13.5%.

"We expect the sale of asset-based or linked LTC products will continue to grow as they offer some highly attractive benefits to a category of buyers looking to protect their retirement savings," says Jesse Slome, AALTCI's director. "The growth of sales will only continue as more large players enter the marketplace.”

In 2011 the study finds that the initial single premium face amount of policies purchased was $100,000 or greater for 73% of new policies. Meanwhile, 96% of new life and LTC policies issued did not include a benefit increase option that bumped up available benefits to keep pace with inflationary growth of costs. Additionally the study of traditional individual LTC insurance policy sales finds that in 2011 some 96% included a growth option.

“At a time when long-term care is increasingly top of mind, these life insurance-based solutions avoid the ‘use it or lose it’ risk associated with traditional long term care insurance,” says Chris Coudret, vice president of OneAmerica. “In most cases, people make a single payment, effectively removing the risk of future premium increases.”