The average premiums of popular health insurance plans sold on HealthCare.gov will rise much more rapidly next year than in 2015. HHS maintains that people will still have plenty of affordable options, but some locales will see higher prices and less competition than others.
“As with all markets, health insurance marketplaces will ebb and flow,” Richard Frank, HHS' assistant secretary for planning and evaluation, said on a call with reporters Friday. “But (the federal exchange) is strong and stable.”
The Affordable Care Act's third open enrollment begins Nov. 1 and runs for three months. The federal government released troves of data Friday for every health plan and dental plan being offered in the 34 states that are fully relying on HealthCare.gov. A separate link on HealthCare.gov has additional files on Hawaii, New Mexico, Nevada and Oregon.
The data include the premiums for various age groups, full summaries of benefits, lists of covered drugs, links to provider networks, out-of-pocket maximums, coinsurance rates, deductibles and many other categories. The CMS released this level of data for the first time last year. State-based exchange data was not collected. The data also do not include current enrollment in each plan.
Some of the most important and common health plans will have significantly higher premiums next year, the CMS said earlier this week. The benchmark plans, or the second-lowest-cost silver plans that determine a person's premium subsidy, will rise by 7.5% on average in 2016. People qualify for the premium tax credits if they make less than 400% of the federal poverty level and don't have access to employer-based insurance.
The Health Research Institute at PricewaterhouseCoopers has also been studying rate filings and found that the median increase in benchmark premiums between 2015 and 2016 is 7%. That's much higher than the first two years of the exchange operations, when the median increase was 1.6%, PwC found. Experts said carriers finally had a full year of claims data to base their prices and needed to adjust for the high-cost exchange population. Many insurers also may be setting higher rates to offset two of the ACA's three risk programs that are sunsetting in 2017.
As in previous years, prices vary widely depending on where someone lives and how many insurers are competing in the market. HHS also downplayed the higher premium rates, saying they were “relatively modest compared to those in the individual market before the Affordable Care Act, when consumers in the individual market regularly experienced double-digit rate increases on average.”
Overall, there are roughly 10 health insurers offering plans per state, HHS said. However, that's a very rough figure. Some states have little competition. For example, West Virginia has only two insurers offering health plans, and the average premium of a benchmark plan in there is going up by 18.5%. Further, the average number of individual plans per county across the country will drop from 58 to 50, although it's not a dip that HHS viewed as concerning, Frank said.
HHS said about 90% of exchange enrollees will be able to choose from three or more companies next year. The data do not incorporate the rash of co-op closures since Oct. 19.
Exchange consumers will mostly be shielded from price hikes if they shop around and keep their subsidies. However, that still means more taxpayer money is going to health insurance companies to offer public exchange plans.
The average exchange member across all metal tiers can save $51 a month by choosing a cheaper option, HHS said. But that comes with trade-offs. People may enter narrow-network plans as a result of their shopping, and those plans could exclude their preferred doctor. And many ACA plans don't have in-network care for some specialists.
The data shows how wide the spectrum of options is. For example, in Florida, Aetna's Coventry subsidiary offers the cheapest bronze plan with a monthly premium of $217.38 for a 40-year-old before premium tax credits. Blue Cross and Blue Shield of Florida has the most expensive plan for a 40-year-old at $871.81 before subsidies. However, that's a platinum plan, and a vast majority of people enroll in bronze or silver plans.
A Modern Healthcare analysis of 2014 and 2015 data found that the average premiums for a 40-year-old went down year over year in most plans, although that—as with most of the variables—depends where someone lives.
However, experts view out-of-pocket costs as just as important as the monthly premiums. The average deductibles went up from 2014 to 2015 and averaged more than $2,800 for a 40-year-old with a silver plan and more than $5,100 for a bronze plan. A look at a limited set of 2016 data suggested high-deductible options again will be the most common offering.
—Data analysis by Art Golab