ACA premium changes for 2015 (some way up, others way down)

[FUEGO]

NY Times summary of where Exchange health insurance rates will increase or decrease:

http://www.nytimes.com/interactive/2014/11/14/us/Where-Federal-Health-Exchange-Rates-Will-Rise.html

Looks like my county's rates will go up 8% while the county just to the south will see a 16% drop in rates. I have to imagine there was some guesswork going in to the actuarial assumptions for 2014's premiums, and they are truing up the numbers for 2015's premiums.

It looks like the price for the cheapest silver plan went up 5% on average:

The data, released by the Centers for Medicare and Medicaid Services, indicates that price increases will be modest for many people willing to change plans. In a typical county, the price will rise 5 percent for the cheapest silver plan and 4 percent for the second cheapest.

From this NY Times article, that provides a more detailed overview of premium changes for 2015: http://www.nytimes.com/2014/11/15/u...-affordable-care-act-to-increase-in-2015.html

 

[FUEGO]

Out of curiosity, I pulled up 2014 and 2015 plans to do an apples to apples comparison.

My subsidy with a $40,000 AGI for a family of 5 increased from $395 to $466 (partly due to the FPL increasing).

The cheapest unsubsidized bronze plan increased by 10%.

The cheapest unsubsidized silver plan increased by 8%.

After factoring in the 18% higher subsidy for 2015, the cheapest silver plan decreased in price by 24% (from $125/month in 2014 to $95/month in 2015). That's coverage for 2 of us (with a HH size of 5). The 3 kids qualify for the state's Children's Health Insurance Program (free or a max of $100 to enroll per family per year, depending on income).

The cheapest silver plan is POS limited network, $1000 deductible, $5/10 copays at PCP/Specialist.

So far, so good. DW is quitting work and joining me in early retirement some time in 2015 (that's the current plan anyway). Seeing an 18% price decrease (for us) in year 2 of ACA is reassuring considering the typical 9-10% increases pre-ACA. I know the subsidy is mixed up in the numbers, but the out of pocket premium cost is what I'm referring to here (my "affordability").

 

[MooreBonds]

NY Times summary of where Exchange health insurance rates will increase or decrease:

http://www.nytimes.com/interactive/2014/11/14/us/Where-Federal-Health-Exchange-Rates-Will-Rise.html

Looks like my county's rates will go up 8% while the county just to the south will see a 16% drop in rates. I have to imagine there was some guesswork going in to the actuarial assumptions for 2014's premiums, and they are truing up the numbers for 2015's premiums.

It looks like the price for the cheapest silver plan went up 5% on average:



From this NY Times article, that provides a more detailed overview of premium changes for 2015: http://www.nytimes.com/2014/11/15/u...-affordable-care-act-to-increase-in-2015.html

The problem I have with all of these stories about "X% increase/decrease in HI premiums" is that it appears they aren't truly comparing apples to apples. Whether it's a new plan/company this year that wasn't available last year, or the lowest price plan last year not available this year, or the same plan for both years changing networks, IMO there's too much potential for massive changes in the fine details to simply compare the lowest or 2nd lowest plan between two years and proclaim that there is a certain increase/decrease.

I realize that it could be very difficult to compare them, and that you have to have some form of comparison....but if car models/manufacturers changed their vehicle lines and availabilities by as much as the health insurance plans/networks are changing, you would laugh at the press for saying that car prices in Missouri "decreased by 10%" (because they only had BMWs available last year but have Hyundais available now), or saying that "prices increased 30%", because last year a Ford Escort was available as the cheapest car, and this year the Ford Escort isn't sold anymore, but last year's 2nd cheapest car (a Buick) is still available, but for a slightly higher price than last year.

 

[bamsphd]

The problem I have with all of these stories about "X% increase/decrease in HI premiums" is that it appears they aren't truly comparing apples to apples.

According to our "Getting ready for Open Enrollment" letter from Anthem (BC/BS) our unsubsidized Anthem Silver HSA plan’s premium is changing from $725.18 to $736.27 if we stay in the same plan (despite both being a year older).

The medical benefit comparison chart indicates only two changes.

"Tier 4 Mail Order Pharmacy" goes from "Not Covered" to "10% In Network Coinsurance" (the same 10% status as all the other Pharmacy tiers).

Under "additional changes for 2015" it also says "Your Mental Health and Substance Abuse benefits have been expanded to comply with the Federal Mental Health Parity mandate."

What the letter does not mention is that last year the only HealthCare.gov insurance company in NH was Anthem. This year there are other alternatives, some offering lower costs, some offering wider provider networks. As a result the 2nd lowest cost Silver plan on the exchange is cheaper for 2015, which means subsidies will go down. Though so will the cost of the cheapest plans.

 

[ERhoosier]

The problem I have with all of these stories about "X% increase/decrease in HI premiums" is that it appears they aren't truly comparing apples to apples. Whether it's a new plan/company this year that wasn't available last year, or the lowest price plan last year not available this year, or the same plan for both years changing networks, IMO there's too much potential for massive changes in the fine details to simply compare the lowest or 2nd lowest plan between two years and proclaim that there is a certain increase/decrease.

I realize that it could be very difficult to compare them, and that you have to have some form of comparison....but if car models/manufacturers changed their vehicle lines and availabilities by as much as the health insurance plans/networks are changing, you would laugh at the press for saying that car prices in Missouri "decreased by 10%" (because they only had BMWs available last year but have Hyundais available now), or saying that "prices increased 30%", because last year a Ford Escort was available as the cheapest car, and this year the Ford Escort isn't sold anymore, but last year's 2nd cheapest car (a Buick) is still available, but for a slightly higher price than last year.

Absolutely true! In my region, KFF (and some other sources) claim HI premiums are DEcreasing ave 7%. They make that claim based upon the gov't's '2nd lowest Silver' plan pricing used to calc subsidies. Reality is that the '2nd Silver' is not an accurate view of the overall market. My region had some new carriers enter the market for '15 with lower Silver premiums but worse coverage (i.e. less benefits (drugs/rehab/ambulance/etc) & much narrower networks). Comparing same actual plans from same carriers which continued on from '14 to '15, rates INcreased by ave 6-8%. Shop those plans & I think you'll agree there are some BIG differences in real-life coverages between various Silver plans.

 

[FUEGO]

Absolutely true! In my region, KFF (and some other sources) claim HI premiums are DEcreasing ave 7%. They make that claim based upon the gov't's '2nd lowest Silver' plan pricing used to calc subsidies. Reality is that the '2nd Silver' is not an accurate view of the overall market. My region had some new carriers enter the market for '15 with lower Silver premiums but worse coverage (i.e. less benefits (drugs/rehab/ambulance/etc) & much narrower networks). Comparing same actual plans from same carriers which continued on from '14 to '15, rates INcreased by ave 6-8%. Shop those plans & I think you'll agree there are some BIG differences in real-life coverages between various Silver plans.

But in the context of "what kind of affordable coverage can I get?", maybe those new plans are lower priced and more affordable even though they cover less.

I don't mind a limited network since we rarely use medical services. Others might want unlimited choice. I'm glad there's a ford escort plan available while others want Cadillac plans (do people still drive those cars?).

 

[aaronc879]

Took 3 hours over 2 days but I got my insurance renewed. My premium(subsidized) will go up from $32/mo to $62/mo. That's because I increased my expected income from $15,000 in 2014 to $17,000 in 2015. That's a big % increase but I guess I can handle that even on my income. Without a subsidy it would cost $298/mo and I would not have health insurance at that price at my age(35).

 

[ziggy29]

Mine is up by more than 26% (bronze PPO with $6K deductible), from $272 to $344 (unsubsidized).

I also live in an area where the Marketplace has no competition (one insurer only, BCBSTX, though there are 17 different plans). I wonder if others in the state saw similar increases if they live in an area where there are multiple insurers competing for business. Of course, this isn't a terribly consumer-friendly state when it comes to insurance regulation, either.

 

[photoguy]

I don't mind a limited network since we rarely use medical services. Others might want unlimited choice. I'm glad there's a ford escort plan available while others want Cadillac plans (do people still drive those cars?).

I wonder how limited are the limited networks. Is it a matter of having to drive an extra 30 minutes to find the specialist you need? wait an extra week for non urgent care? have to pick a different (but still competent) doctor? or is it more serious?

 

[ziggy29]

I wonder how limited are the limited networks. Is it a matter of having to drive an extra 30 minutes to find the specialist you need? wait an extra week for non urgent care? have to pick a different (but still competent) doctor? or is it more serious?

It can vary quite a bit. In my case I could shave off almost $100 a month if I took the HMO option instead of a PPO, but I want nothing to do with an HMO for that primary reason -- a more limited network (when I use the "find a provider" function to look for all providers within 50 miles of our zip code, the HMO has about half the in-network providers as the PPO) and more limited access to specialists. Most of our specialists are in Victoria, about a 45 minute drive away, in any event. But they are "gated" by a primary care physician in an HMO.

 

[photoguy]

Most of our specialists are in Victoria, about a 50 minute drive away, in any event. But they are "gated" by a primary care physician in an HMO.

We went with a PPO as well to (hopefully) get the best network. But the practice of gating which requires a referral from a primary care physician is ridiculous i think. Every time we've had to see a primary care doc first, they've just told us what we already knew (you need to see physician in speciality X).

Also, in some cases the primary care doc has given us wrong information (said the condition was normal / not serious etc).

 

[MichaelB]

I wonder how limited are the limited networks. Is it a matter of having to drive an extra 30 minutes to find the specialist you need? wait an extra week for non urgent care? have to pick a different (but still competent) doctor? or is it more serious?

The insurers aren't making it easy to answer this question, but this is nothing new for them and they've had lots of practice. The only real way to figure this out is to browse the insurer's "find a doctor" search tool, which they are now required to make available.

 

[Texas Proud]

It is interesting that if I had stayed on the ACA my premiums would have increased 28% for the same plan....


BUT, since I am on a company plan.... it increased 80%!!! I think I lost my company subsidy due to not getting enough time... still, a MUCH better plan for not a lot more money.... even though the plan is worse next year than this year (from $300 deductible to $500).....

 

[FUEGO]

I wonder how limited are the limited networks. Is it a matter of having to drive an extra 30 minutes to find the specialist you need? wait an extra week for non urgent care? have to pick a different (but still competent) doctor? or is it more serious?

I was curious too, so I took a look at the gold plated silver plan we'll probably end up on.

My current PCP is in network. So are 64 other PCP physicians that accept new patients within 5 miles (and 355 if I look within 25 miles).

Hospitals - the one 2 miles away isn't in network, but the two bigger hospitals 5 miles away are in network (and those are the 2 big hospitals in town anyway, not that bigger = better necessarily). This is actually the exact same as our current employer provided coverage, except swap the closer hospital with one of the other hospitals 5 miles away. So not really "limited" compared to our status quo.

Specialists within 5 miles - 14 dermatologists, 85 OBGYNs, 73 orthopedists, 37 gastroenterologists, 2 general oncologists, 6 cardiovascular surgeons, 11 neurosurgeons.

Seems like a pretty good range of choices except for the oncologists, but maybe I'm not looking at the right specialty or they are farther than 5 miles away.

And it doesn't feel any more limited than our current employer provided coverage (and the different employer provided plans we have had over the years that required DW to switch OBGYN's occasionally).

YMMV of course. I'd take a look at the actual networks from healthcare.gov.

 

[Animorph]

I bought my insurance (HSA, $5500 each deductible, for a couple) directly from the insurer last October, but the same plan was listed on the ACA exchange for exactly the same amount when I bought it. No subsidies, of course. I don't have to do anything to renew it. The cost went down by 2% for the same plan, with what looks like slightly increased benefits (no penalties if an in-network provider sends me to an out-of-network provider, for example).