The federal government released a trove of public files Friday, the day before Obamacare's second open-enrollment period begins, outlining the premiums, cost-sharing requirements, provider networks and other pertinent details of every plan that will be sold on the health insurance exchanges next year.
“CMS just dropped the mother lode of data,” said Katherine Hempstead, a director at the Robert Wood Johnson Foundation who oversees health insurance research. “It's like the rumors are totally true. Transparency has increased a lot.”
An early analysis of the individual rates by consulting firm Avalere Health found that the average premium of the lowest-cost silver plan for a 50-year-old nonsmoker will be $381 next year, an increase of 4%. The average premium of the lowest-cost bronze plan for the same type of person will be $307, or about 3% higher than in 2014.
One of the most important benchmarks of the exchanges is the second lowest-cost silver plan, the benchmark the government uses to determine premium subsidies. Avalere found the average premium of the second-lowest silver plan for a nonsmoking 50-year-old in 2015 will rise 3% next year to $395, before factoring in the premium subsidy. However, that figure varies greatly. In Mississippi, the benchmark premium will drop 19%, and in Alaska, it will soar 28%.
Premium subsidies are issued to consumers in the form of tax credits to help offset the cost of insurance. About 85% of people received financial assistance for their exchange plans last year, but those subsidies will soon face the judgment of the U.S. Supreme Court, which agreed to take a case determining the legality of the subsidies in states that are relying on the federal government to run their exchange.
The early analysis of next year's ACA exchange plans reiterates experts' preliminary findings that premium increases will generally remain modest in 2015, but premium rates are also greatly dependent on where insurers and consumers live and the competition of plans in a given exchange. For example, the average premium for a 40-year-old nonsmoker before tax credits are applied ranges from a low of $121.95, which is a catastrophic-level plan in Arizona, to a high of $791.34, a platinum plan in Illinois, according to the CMS data released Friday. For 27-year-olds, premiums range from $100 a month to $648.92 a month before subsidies, depending on the coverage level.
“The bottom line is that exchange enrollees' 2015 premiums will vary widely based on geography,” Elizabeth Carpenter, a director at Avalere, said in a statement. “Consumers should be wary of reports detailing national or statewide premium changes and should instead focus on the details of their particular plan.”
But for the most part, premiums will not be rising heavily as some initially feared would happen under the Patient Protection and Affordable Care Act. “There seems to be a good indication that a robust rate review process does appear to reduce premium increases,” said Ceci Connolly, managing director at PricewaterhouseCoopers' Health Research Institute. “I think that's worthy of additional scrutiny and discussion as sort of the how and why of that.”
The CMS' Center for Consumer Information and Insurance Oversight also posted files of more granular health plan data, such as coverage limits, what cost-sharing requirements are, links to provider networks for each plan and how premium rates vary by different qualifiers like age and tobacco use.
Overall, the CMS said the number of health insurers participating in an Affordable Care Act exchange is 25% higher than last year. In addition, more than nine in 10 people will be able to pick a plan from at least three competing insurers, up from 75% last year.
“There is much broader participation from insurers,” Connolly said. “We were expecting that, and the early filings suggested it. This is confirmation that the health insurance industry sees the new ACA exchanges as a business opportunity and business worth pursuing.”
The health plan information release is similar to other measures HHS and the CMS have taken to give providers, insurers and consumers more data upfront. For instance, the government most recently listed a partial dataset of payments between providers and medical-device and pharmaceutical companies, called the Open Payments database. Similarly, data have been dropped related to Medicare payments to physicians, as well as inpatient and outpatient rates paid to hospitals.
“We are committed to transparency and providing consumers with the information they need to choose the right health plan for them,” CMS Administrator Marilyn Tavenner said in a statement. “Today's data provide further evidence that the Affordable Care Act is working to improve competition and choice among marketplace plans in 2015. Consumers should shop around, with new options available this year they're likely to find a better deal.”
“To me it started with the hospital charge data,” Hempstead said. “Since then it's been one release after another … it's just more than I was expecting.”
But like those other data dumps, most see the health plan information as a way for others in the industry to create tools to help consumers make sense of their coverage options. “I don't know the average consumer is going to be downloading these files on a Friday night,” Connolly said. “The average consumer is still going to be focused more on doing that window shopping on HealthCare.gov.”
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