2015 ACA Premium Increases

[pb4uski]

+1

 

[2B]

Pragmatic perhaps, but warped as well. I'm trying to think of any other business that "ability to pay" affects prices as much as medical services and I'm coming up blank.

Sex trade? Nah, they have better ethics.

 

[2B]

Unfortunately, I don't think we'll have a clue what policies will be priced at until open enrollment begins. Right now states have a vested interest in predicting low price increases especially if they invested heavily in the process. Even after open enrollment begins we could have adjustments if the computer glitches haven't been fully resolved (still an open question). Then to make things more interesting, there are the law suits that will eventully find their way to SCOTUS on whether the law is what it says (subsidies require state exchanges) or what some people want it to mean (subsidies through HealthCare.gov also apply). Throw that in with all our usual political pot stirring and who knows what will happen. It certainly appears that so far the ACA hasn't contained health care costs. Transparency in plans, networks, coverage and costs certainly doesn't exist now but one can only hope.

 

[pb4uski]

In most states the process of setting premium rates is subject to regulatory approval and the 2015 rates have been submitted by the insurers, so in many states one can get a good idea of 2015 rates with a little googling. Also, I suspect that in some states that premiums have already been approved.

I think the medal designations (platinum/gold/silver/bronze) was a good first step in providing more transparency in that they provide insight as to how much of your health care costs will be covered by health insurance.

I concede that there is a lot of room for improvement, but IMO ACA hasn't been the disaster that some pundits predicted and health insurance increases for 2015 seem to be about the same as they were in the last few years.

 

[explanade]

Have most ER members who got ACA gone for Bronze?

 

[ERhoosier]

.....Even if you are already a customer and you price out a prescription, for instance, you are getting the information from the formulary associated with your current policy. Next year you may or may not have that same formulary list, or the list could change......

One might also call local big box pharmacies and ask for their best prices. Some participate in various non-HI drug discount programs. Most such programs do not seem to care whether you have other HI or not. For some lower cost meds it can be cheaper to pay the best 'no-insurance' discount price rather than the ever-increasing HI policy co-pay. Only down side is that these 'off-insurance' buys (i.e. not using your HI's pharm program) do not appear to count towards deductibles/OOPmax. I think this is rather unfair, particularly when your policy's pharm network happens to be out-of-stock for a med you need quickly (unusual, but has happened to relatives).

And just to add to the bureaucratic fun, formulary lists & even the pharmaceutical vendors your HI plan contracts with can change DURING your plan-year. Hard to keep up sometimes, but it can save some $$.

 

[ERhoosier]

.....IMO ACA hasn't been the disaster that some pundits predicted........

Guess that depends upon one's perspective. All data (inc. Fed's) show that since ACA's passage HC costs have continued to rise well above inflation. Against Obama's own oft-repeated benchmark of saving families, employers, and the country $2500/family/yr in HI premiums and costs, ACA has been a disastrous failure.

Obama Promises To Lower Health Insurance Premiums by $2,500 Per Year - YouTube

Many felt that the HI rates for 2014 were artificially set a bit high by the HI companies for CYA reasons ('fudge factor' while adjusting to new system). According to this view, cost containment efforts implemented in 2014 (narrower networks, improved efficiencies of care delivery, negotiation of better prices from providers/hospitals/suppliers, etc.) would begin to pay off and 2015 would see a broad premium DEcrease to what would be more "normal" levels. Unfortunately, the premium increases many are predicted to see for 2015 show the fiscal monster of HC inflation marches on. This does not bode well for the years to come.

 

[sengsational]

Another interesting measure that might be empowering is a "two price only" mandate. Providers can bill to all comers - insurers, Medicare, cash customers - one price for insurance reimbursement and a second price for immediate cash payment. When everyone has access to the same price and that price is publicly available, insurers and patients alike can begin to make more positive choices.

That would go a long way to making shopping easier. We might need to make a three price mandate...need to add the rich saudi price, hehe.

Have most ER members who got ACA gone for Bronze?

Bronze is common, I think (that's what I did). But depending on your normal usage of medical services, the cost sharing available on Silver if your income is in a specific range, can be a better deal. Low utilizers that can't get a subsidy have jumped through hoops get catestrophic ("over age 30" "cheapest bronze is >8% of O-MAGI"). So it just depends on your income and how much medical you think you'll need.

One might also call local big box pharmacies and ask for their best prices. Some participate in various non-HI drug discount programs.
...

I do ask about the best non-HI price, then check goodrx.com.

 

[pb4uski]

Guess that depends upon one's perspective. All data (inc. Fed's) show that since ACA's passage HC costs have continued to rise well above inflation. Against Obama's own oft-repeated benchmark of saving families, employers, and the country $2500/family/yr in HI premiums and costs, ACA has been a disastrous failure. ......

Many felt that the HI rates for 2014 were artificially set a bit high by the HI companies for CYA reasons ('fudge factor' while adjusting to new system). According to this view, cost containment efforts implemented in 2014 (narrower networks, improved efficiencies of care delivery, negotiation of better prices from providers/hospitals/suppliers, etc.) would begin to pay off and 2015 would see a broad premium DEcrease to what would be more "normal" levels. Unfortunately, the premium increases many are predicted to see for 2015 show the fiscal monster of HC inflation marches on. This does not bode well for the years to come.

Health care and health insurance costs were increasing at much more than the general rate of inflation before ACA as well, so I guess then we'll agree to disagree. Note that I said that it wasn't the disaster that some predicted - costs and insurance costs have been relatively stable all things considered.

I'm actually paying 35% less than I was last year because I now qualify for catastrophic coverage that was not previously available. My current HDHI premiums are less than half of my COBRA when I retired in 2011. Same network by the way.

 

[pb4uski]

Have most ER members who got ACA gone for Bronze?

Was bronze for the first half of the year but now have a catastrophic policy that is a bit less coverage then bronze for 40% less. If one is healthy and not on any expensive prescriptions, I think bronze or cat is the way to go.

 

[explanade]

Was bronze for the first half of the year but now have a catastrophic policy that is a bit less coverage then bronze for 40% less. If one is healthy and not on any expensive prescriptions, I think bronze or cat is the way to go.

Does your catastrophic policy include any preventive, like once a year physicals?

Do you pay the full doctor's bill until you meet the physical or is there also a high copay.

The Bronze copays I've seen are like $75 for a doctor's visit IIRC.

 

[M Paquette]

My costs are down. Weird, huh?

For next year, after factoring out the age change in the rates, I'm looking at a rise of less than 3% in the insurance premiums. How very un-disasterish...

If I manage to qualify for the premium subsidy tax credit, I'll see a tremendous drop in my out of pocket cost. Curious how that works...

It is a puzzlement...

 

[ejman]

Guess that depends upon one's perspective. All data (inc. Fed's) show that since ACA's passage HC costs have continued to rise well above inflation. Against Obama's own oft-repeated benchmark of saving families, employers, and the country $2500/family/yr in HI premiums and costs, ACA has been a disastrous failure.

Obama Promises To Lower Health Insurance Premiums by $2,500 Per Year - YouTube

Many felt that the HI rates for 2014 were artificially set a bit high by the HI companies for CYA reasons ('fudge factor' while adjusting to new system). According to this view, cost containment efforts implemented in 2014 (narrower networks, improved efficiencies of care delivery, negotiation of better prices from providers/hospitals/suppliers, etc.) would begin to pay off and 2015 would see a broad premium DEcrease to what would be more "normal" levels. Unfortunately, the premium increases many are predicted to see for 2015 show the fiscal monster of HC inflation marches on. This does not bode well for the years to come.

I'm not really much into the politics of this thing and my measurement stick is really short - how does this thing impact me? It looks like for the first time in history health insurance rates in Oregon will actually decrease from the prior year. Amazing! State releases Oregon's 2015 health insurance rates for individuals, small businesses | OregonLive.com

 

[ERhoosier]

The Saudi sheikh with a suitcase full of cash is a fantasy. The practice is [-]morally repugnant [/-] distasteful and creates a significant obstacle to health care reform in the US.

Agree 100% that the Saudi sheikh issue is pure, unadulterated fantasy for the vast majority of US hospitals. Very few hospitals ever see ANY patients with a huge net worth. And for those hospitals that do, the REAL $$$ sure as heck is NOT coming from the $5k vs $2k ER visit. It comes from the multi-million$$ donations/endowments given in appreciation of the (presumably) outstanding care received.
IMHO- The real reason behind this hyper-billing is historical. For many years both providers and insurers wanted/needed to show they got 'results' in annual contract negotiations. The insurer had to show they got increasing discounts from billed prices, and the providers continually & artificially raised prices to maintain or increase net income after granting these big artificial discounts. Over time the billed amounts grew progressively more ridiculous. In some ways it's become a profitable game of liar's poker. For most providers/hospitals, relatively few uninsured actually pay anywhere near these fantasy prices after renegotiations, bankruptcies, or simple refusals to pay. FWIW- I do not see this charade as any legitimate obstacle to serious HC reform. The charade becomes irrelevant if we do what is done in many other developed countries and simply set (negotiate) defined market prices for specific services and publish them. Full market transparency. Like everyone paying the same menu price for their BigMac Value Meal. Medicare basically does this (with some regional differences) by setting max allowable charges for specific HC services. These fantasy billings are now essentially irrelevant to the Medicare marketplace.

 

[pb4uski]

Does your catastrophic policy include any preventive, like once a year physicals?

Do you pay the full doctor's bill until you meet the physical or is there also a high copay.

The Bronze copays I've seen are like $75 for a doctor's visit IIRC.

Yes, annual physicals are covered/free and paid directly by the insurer. For other services it works the same as the bronze policy (same carrier). Generally speaking just a high deductible policy with slightly higher deductibles than the bronze ($6,350 vs $5,000) but actually a lower maximum cost since the premiums are $1,500 a year lower. Since we are relatively healthy it works out cheaper for us and gives us access to negotiated rates for medical services and protects us from the financial coat of a catastrophic illness.

 

[rbmrtn]

Does your catastrophic policy include any preventive, like once a year physicals?

Do you pay the full doctor's bill until you meet the physical or is there also a high copay.

The Bronze copays I've seen are like $75 for a doctor's visit IIRC.

This article compares bronze to catastrophic, ACA Bronze Tier Health Insurance vs. Catastrophic Plans - US News

Mostly the same, Catastrophic has additional eligibility requirements and no subsidy support.

There was thread last year where someone posted a spreadsheet to compare plans. Generally if you don't use a lot of medical services the bronze came out ahead. If you have ongoing conditions and always meet your deductibles a silver might be better.

And it depends what is offered in your area. There are no catastrophic plans in my area.

 

[MichaelB]

The spreadsheet, by Animorph, which many found very helpful, is here, and was added to the PPACA FAQ last year

 

[AllDone]

I'm not really much into the politics of this thing and my measurement stick is really short - how does this thing impact me? It looks like for the first time in history health insurance rates in Oregon will actually decrease from the prior year. Amazing! State releases Oregon's 2015 health insurance rates for individuals, small businesses | OregonLive.com

Arkansas and Connecticut will also be seeing lower prices.

 

[ERhoosier]

Arkansas and Connecticut will also be seeing lower prices.

Not according to data from OP's link.
As of Aug 15 update, ave 2015 rates AR +11.7% and CT +5.4%

ACA state exchanges

 

[steelhead]

Not according to data from OP's link.
As of Aug 15 update, ave 2015 rates AR +11.7% and CT +5.4%

ACA state exchanges

The 11.7% increase for Arkansas in that PWC graph is not consistent with more recent reports. Looks like the Arkansas exchange rates will decrease by 2% for 2015. Good for the folks of Arkansas.

Arkansas, home to key Senate race, announces rate decreases on Obamacare exchange - Washington Times

I'm very happy with how the rates for 2015 are shaping up in California where I am.

 

[steelhead]

Connecticut

Not according to data from OP's link.
As of Aug 15 update, ave 2015 rates AR +11.7% and CT +5.4%

ACA state exchanges

Connecticut rejected Anthem's (the state's largest insurer) 12%+ initial proposed rate hike and the revised number was an average decrease of .1%. I don't think the PWC graph includes that update, but I couldn't find any links to the source material on the PWC graph.

After rate hike rejected, Anthem to decrease premiums next year | The CT Mirror

Prior to the ACA, even a 5.4% increase would be pretty good news. But that was then...and I was promised...etc. etc.

 

[ERhoosier]

Connecticut rejected Anthem's (the state's largest insurer) 12%+ initial proposed rate hike and the revised number was an average decrease of .1%. I don't think the PWC graph includes that update, but I couldn't find any links to the source material on the PWC graph.

After rate hike rejected, Anthem to decrease premiums next year | The CT Mirror

Prior to the ACA, even a 5.4% increase would be pretty good news. But that was then...and I was promised...etc. etc.

I could not find source material for PWC link either. IIRC, PWC only lists it's own research as source material so we do not know precisely how they calc their figures.
As is the case for some other states/regions, the rate change analysis in CT is complicated by the fact that important features are changing in 2015 for some of the more popular Plans. For example deductibles and OOP max are rising significantly for Bronze Plans. Bronze 1 deductibles will rise from $3200indiv/$6500 family to $5,000/$10,000. Other features are changing as well. Exchange actuaries estimated that net effect of these Bronze Plan design changes for 2015 (EXcluding inflation) would decrease premiums by 2.9% vs 2014. Considering that the CT Ins Dept approved a decrease of 0.1%, these rates are actually a net ~2.8% INcrease when corrected for changes in coverage features (e.g. increased deductibles/OOPmax's). CT's Gold Plans had no coverage design changes, but rates still increased 1.5-4.2%. So not a real 'apples-to-apples' rate decrease in CT, but still better than the figures PWC has posted on their site.

Access Health CT’s 2015 plans: See what’s changing | The CT Mirror
After rate hike rejected, Anthem to decrease premiums next year | The CT Mirror

 

[M Paquette]

Note that the Standard Connecticut Bronze plan continues to be HSA eligible, with maximum deductibles and max out of pocket amounts for individuals and families meeting the nationwide 2015 HSA eligibility limits.

ERhoosier's numbers are for Access Health CT Bronze Non-Standard Plans, specialty low rate plans.


http://www.irs.gov/pub/irs-drop/rp-14-30.pdf

• HSA Contribution Limits. The 2015 annual HSA contribution limit for individuals with self-only HDHP coverage is $3,350 (a $50 increase from 2014), and the limit for individuals with family HDHP coverage is $6,650 (a $100 increase from 2014).
• HDHP Minimum Required Deductibles. The 2015 minimum annual deductible for self-only HDHP coverage remains $1,300 and for family HDHP coverage remains $2,600.
• HDHP Out-of-Pocket Maximum. The 2015 maximum limit on out-of-pocket expenses (including items such as deductibles, co-payments, and co-insurance, but not premiums) for self-only HDHP coverage is $6,450 (a $100 increase from 2014), and the limit for family HDHP coverage is $12,900 (a $200 increase from 2014).

 

[steelhead]

As is the case for some other states/regions, the rate change analysis in CT is complicated by the fact that important features are changing in 2015 for some of the more popular Plans. For example deductibles and OOP max are rising significantly for Bronze Plans. Bronze 1 deductibles will rise from $3200indiv/$6500 family to $5,000/$10,000. Other features are changing as well. Exchange actuaries estimated that net effect of these Bronze Plan design changes for 2015 (EXcluding inflation) would decrease premiums by 2.9% vs 2014. Considering that the CT Ins Dept approved a decrease of 0.1%, these rates are actually a net ~2.8% INcrease when corrected for changes in coverage features (e.g. increased deductibles/OOPmax's). CT's Gold Plans had no coverage design changes, but rates still increased 1.5-4.2%. So not a real 'apples-to-apples' rate decrease in CT, but still better than the figures PWC has posted on their site.

Access Health CT’s 2015 plans: See what’s changing | The CT Mirror
After rate hike rejected, Anthem to decrease premiums next year | The CT Mirror

I don't think you can fairly use the .1% decrease across the Anthem plans (all medals) to conclude that the expected 2.9% decline for a Bronze Plan shows that there's a net increase of 2.8% in the cost of that Bronze Plan. The Standard Bronze $5,000 deductible plan that you've highlighted has an approved decrease of 7.3% (not .1%). Using your methodology, 2015 will bring a net 4.4% decrease in the cost of that bronze plan accounting for benefit changes. For standard Silver, the decrease is 1.67% (2.7% expected increase versus 1.03% increase). There is a increase for Gold of less than 1% (.7% expected versus 1.5 approved).

 

[pb4uski]

I could not find source material for PWC link either. IIRC, PWC only lists it's own research as source material so we do not know precisely how they calc their figures.
As is the case for some other states/regions, the rate change analysis in CT is complicated by the fact that important features are changing in 2015 for some of the more popular Plans. For example deductibles and OOP max are rising significantly for Bronze Plans. Bronze 1 deductibles will rise from $3200indiv/$6500 family to $5,000/$10,000. Other features are changing as well. Exchange actuaries estimated that net effect of these Bronze Plan design changes for 2015 (EXcluding inflation) would decrease premiums by 2.9% vs 2014. Considering that the CT Ins Dept approved a decrease of 0.1%, these rates are actually a net ~2.8% INcrease when corrected for changes in coverage features (e.g. increased deductibles/OOPmax's). CT's Gold Plans had no coverage design changes, but rates still increased 1.5-4.2%. So not a real 'apples-to-apples' rate decrease in CT, but still better than the figures PWC has posted on their site. .....

IMO even if we accept your point, annual rate changes of 1.5-4.2% are not something to complain about.

I suspect that the PwC data was based on year-to-year comparisons of total premium from insurer filings available at the date the analysis was done and has not been updated for subsequent filings and changes.

While I see your point on the change in benefits. I wonder if there are other changes in benefits that offset the increase in deductible because an extreme change in benefits would cause a plan to no longer be able to be in its medal category. In any event, at least in my state, a good portion of the increase in 2014 related to ACA changes (and IIRC the same could be said for a significant portion of the increases in 2014 and 2013).

Significant medical price increases were partially offset by favorable membership assumptions and reductions in ... administrative expenses. Combined, these factors produced a 3.3 percent increase in rates. The remainder of the 9.8 percent increase was driven by changes related to federal and state health care reforms, including an increase in the federal fee that is included in Exchange pricing, a reduction in federal subsidies of the premiums on (the) new Exchange, and a modest expansion of dental benefits for children.