Exchange Premiums to Rise 13%: State

Aug 4, 2014

Premiums for Floridians buying insurance on the Affordable Care Act marketplace will rise an average of 13 percent for next year, the Florida Office of Insurance Regulation said Monday.

Eight insurers with existing plans filed for premium increases for 2015, while three filed for rate cuts for individual plans purchased on Healthcare.gov.  There are three new carriers participating, the OIR said in a news release.

Nearly 1 million Floridians signed up for insurance on the federal health exchange in 2014. Most state residents get insurance in other ways: through the workplace, or through a government program, such as Medicare.

The state's report shows that two insurers have proposed average rate increases of 20 percent or more over the past year: a Health First Insurance Inc. PPO and an HMO from Health Options Inc.

However, these plans are not the most expensive monthly premium rates. Blue Cross Blue Shield of Florida, or Florida Blue, lists a $503 monthly premium for its PPO, before any possible subsidies for people with low or middle incomes. Cigna Health and Life Insurance Company is not far behind: its PPO rate for next year is $497 a month, before subsidies are considered.

Three insurers decreased their HMO rates for 2015, according to OIR data. Molina Healthcare has the largest premium decrease, 12 percent, while Sunshine State Health Plans Inc. dropped its monthly premium 10 percent. Aetna Health Inc. reduced its rate by 5 percent.

Florida is one of 36 states that offer policies through the federal health care marketplace.  Health economists note that some states are seeing the marketplace rates go down, and in others they’re going up. This depends in part on how tightly the state regulated the market before the ACA was passed.

In the market for individuals buying their own plans, Florida had allowed insurers to screen out sick applicants. When the ACA went into effect, insurers were supposed to take all comers. But at the last minute, President Obama allowed states to “grandfather in” some of the old plans with low rates.  That prevented a lot of healthy people from joining the less-healthy people in Healthcare.gov plans.

Also, actuaries who determine the premiums insurers should propose still don’t have enough experience with the new enrollees to tell how expensive they will be to cover. The plans had to come up with bids for 2015 only a few weeks after this year’s open enrollment closed.

“They know a little bit more about who they enrolled as far as demographics, but they still don’t know much about their health,” said Gary Claxton, a vice president with the Kaiser Family Foundation, an independent non-partisan research organization.

And as it was last year, premiums in 2015 will vary by income and county.

For example, in Hillsborough County, a single 28-year-old with an income of $27,000 will pay about $18 a month more next year, or around $238 a month.  This price includes a federal subsidy to help pay for the premium.

In Pinellas County, the average premium for an individual will rise by $30 a month, to $245.

See these price comparisons for 2015 and  2014, as provided by the state.

The OIR analysis of the rates is again being criticized by Florida CHAIN, a consumer group and staunch advocate for the Affordable Care Act. In a statement, CHAIN said the state's political opposition to the ACA translates to "misleading" information about the new proposed rates.

More than 90 percent of Floridians who bought plans on the exchange this year received subsidies, according to the U.S. Department of Health and Human Services. The average premium they paid was $68 a month, far lower than the hundreds of dollars listed in the OIR report, according to CHAIN Policy Director Greg Mellowe.

"It’s essential that Floridians understand that the numbers in these scenarios tell them very little or nothing about the premiums that they will actually pay next year," he said in a statement. "Rather, what nearly all of the almost 1 million Floridians who purchased coverage in the Marketplace will continue to pay is a price that is based mainly on their income and on the specific plan they choose.” 

The three insurers offering new plans on the 2015 Florida exchange include UnitedHealthCare of Florida Inc.  which proposed an average monthly premium of $404, before tax credits. An Assurant Health subsidiary, Time Insurance Company, also has filed a PPO plan with a $457-a-month premium, before subsidies.

The third additional plan is Brevard County’s Health First, which is offering an HMO in addition to a PPO plan it sold on the exchange in 2014. Before it was a commercial insurer, Health First was better known as the owner of four Space Coast hospitals and a physician’s group.

--Health News Florida is part of WUSF Public Media. Contact Carol Gentry at cgentry@wusf.org and Mary Shedden at shedden@wusf.org. For more health news, visit HealthNewsFlorida.org.