Executive announcement to end cost sharing reductions

[FIREd]

Good points.

Do all BCBS plans (bronze, silver, gold, platinum) go up 25-90%? And is the entire increase attributable to the end of the subsidy?

How much would the plans have gone up if the CSR subsidy did not get eliminated?

Healthcare is generally good, it's the pricing that is a problem.

In my state, BCBS requested premium increases based on the assumption that the CSR would not be federally funded in 2018.

They requested increases for Bronze and Gold plans in the 0-5% range and ~20% for Silver plans (no Platinum plans available). This is a non-expansion market.

 

[LARS]

Seems to me the biggest concern is in poor counties and how the impact of uncertainty will play out for insurers. Will we see more insurers pulling out of individual markets? Feel reasonably confident, notwithstanding uncertainty, more viable insurance markets (read: more income levels) will continue to limp along.

Anyone disagree? For me, biggest fear is not having any plans offered, which some counties in US are facing...

 

[scrabbler1]

The regulators no longer have any teeth. The insurance companies threaten to leave the state and regulators simply let them have their way..This is fact not a political comment

It depends on which state you live in. My state, New York, has a competitive market and the state's toothed insurance department frequently reduces rate increases. If a company wants to pull out because of that, they pull out.

 

[SecondCor521]

So, to summarize what we knew, and still know.

- The cost sharing reduction has been eliminated.
- Insurance companies are still required to offer a silver plan with reduced cost sharing / higher actuarial values (94/87/73)
- The premium tax credit continues as before.
- The "expected contribution", otherwise know as the amount each individual is expected to pay for health insurance, continues unchanged, and is still based on MAGI.
- The actual subsidy an individual receives will continue to be the difference between the second lowest cost silver plan and the expected contribution for their income level.

What matters now is how insurers price their 2018 policies. What matters most is the difference in premium between the SLCSP and the plan with reduced cost sharing, because it looks to me as if that amount will not be eligible for premium assistance.

It is too early to say "nothing to worry about here". We know states are taking different approaches, and without actual prices, we should not assume a specific outcome. Am I reading this wrong?

Emphases added by me.

I think it is more accurate to say that the cost sharing reduction payments from the government to the insurers have been eliminated. I'm pretty sure that's what you meant, but some people might misunderstand from your wording.

In my state at least - and maybe my understanding is wrong, but the premium assistance is simply, as you say, the difference between the expected contribution (which is a formula based on ACA MAGI) and the SLCSP, and that one can apply that premium assistance to any marketplace plan, including bronze, silver, silver with CSR, gold, or platinum. So I am a little confused by the second phrase I bolded in your post.

Finally, my state has had prices for 2018 on the website published for a week or two now. The state discussed CSRs ending with the insurance companies during the rate setting process, so they don't have to go back. I can see some states revisiting the issue and possibly revising/amending rates given the recent actions. But I was under the impression that final participation and rates from the insurers were due by 9/27 or so, so aren't all the rates already available for people to review?

I did find out that in my state for my insurer, part of the ~40% increase in Silver plans for 2018 is loss recovery from 2017. The premiums collected covered about 3/4 of the benefit payments, and I believe that the CSR payments from the federal government were not enough to cover the remaining 1/4 gap.

Idaho is a non-expansion state and has/had a high percentage of people on silver CSR plans.

 

[Senator]

The regulators no longer have any teeth. The insurance companies threaten to leave the state and regulators simply let them have their way..This is fact not a political comment

I think it is 100% a political comment.

 

[MichaelB]

How ‘bout we just stay on the thread topic, eh?

 

[teejayevans]

Good points.



Do all BCBS plans (bronze, silver, gold, platinum) go up 25-90%? And is the entire increase attributable to the end of the subsidy?



How much would the plans have gone up if the CSR subsidy did not get eliminated?



Healthcare is generally good, it's the pricing that is a problem.

Florida BCBS plans have gone up about 17% per year consistently since beginning (bronze plans). Clearly this can't go on.

 

[RetiredGypsy]

Florida BCBS plans have gone up about 17% per year consistently since beginning (bronze plans). Clearly this can't go on.

I don't know if they plan on making any last minute changes, but our Silver Florida BCBS plan is only going up by about $2 a month for 2018, about a 1.3% increase. Dental doesn't seem to be going up at all.

 

[rodi]

Folks the topic is the CSR funding elimination.

Please keep the discussion of any bipartisan *proposal* out of this thread. And definitely don't talk about tweets regarding proposed policy. Regardless of who is tweeting. That stuff is politics, not legislation, law, or executive orders.

Thank you.

 

[GTFan]

CSRs were what allowed me and DW to have a $0 deductible for 2016 and 2017. TOOP was $2500 each for 2016 and $2000 each for 2017. My agent says as a result of this order a deductible (TBA) will apply and TOOP will Triple. But the overall monthly payment "Should" be comparable.

Once again, your agent is wrong. CSR'd plans have mandated cost-sharing regardless of how the government pays for it.

EDIT: saw your later post with the BCBS email confirming CSRs. Don't know why agents can't understand the law behind the policies though, it's not like CSR mandates were anything new.

 

[GTFan]

It is too early to say "nothing to worry about here". We know states are taking different approaches, and without actual prices, we should not assume a specific outcome.

For those reporting over 400% FPL there is a LOT to worry about here because they are repeatedly (this year and especially next year) taking it on the chin with premium increases. And for everyone else the CSR decision could possibly result in a lot fewer insurers staying in the market beyond 2018.

That's my real fear given that we're going to keep playing the MAGI game - there won't be anyone left to buy insurance from.

 

[MichaelB]

I don't know if they plan on making any last minute changes, but our Silver Florida BCBS plan is only going up by about $2 a month for 2018, about a 1.3% increase. Dental doesn't seem to be going up at all.

If you don’t mind my asking, is this the increase after accounting for premium assistance?

 

[jim584672]

I was reading that since the SLCSP is going up that it makes the bronze and gold plans cheaper after the subsidy is applied. Talk about unintended consequences.

 

[Senator]

You are correct that premiums will increase probably, with or without any CSR changes.

The problem, is determining how much the premium changes are that can be attributed to the lack of a CSR.

There are many reasons for the premium increase.

 

[scrabbler1]

I was reading that since the SLCSP is going up that it makes the bronze and gold plans cheaper after the subsidy is applied. Talk about unintended consequences.

The way the subsidy is determined, I see the opposite result. When the SLCSP rises, the Silver plan's subsidy also rises, making it more attractive than the Bronze and Gold plans. I created a small spreadsheet which mimics the subsidy calculation from Form 8962 and entered higher numbers for the SLCSP, keeping everything else the same. The Silver plan's subsidy rises.

 

[jim584672]

The way the subsidy is determined, I see the opposite result. When the SLCSP rises, the Silver plan's subsidy also rises, making it more attractive than the Bronze and Gold plans. I created a small spreadsheet which mimics the subsidy calculation from Form 8962 and entered higher numbers for the SLCSP, keeping everything else the same. The Silver plan's subsidy rises.

The subsidy can be applied to any metal plan. The subsidy is hinged to the SLCSP which rises due to the CSR issue. Presuming only the Silvers are rising (depends on the state), then the Bronze/Gold/Platinums get cheaper (after subsidy) due to the higher subsidy induced by the Silver's rise.

 

[scrabbler1]

The subsidy can be applied to any metal plan. The subsidy is hinged to the SLCSP which rises due to the CSR issue. Presuming only the Silvers are rising (depends on the state), then the Bronze/Gold/Platinums get cheaper (after subsidy) due to the higher subsidy induced by the Silver's rise.

Ack, you are right about the subsidies applicable to any metal plan. I stand corrected.

In my state's (NY) marketplace website, I tried getting a list of all the applicable Silver plans so I could try to figure out the second lowest one and get a better idea now of what it will be when I complete Form 8962, instead of having to wait until next January when I get Form 1095-A. Looks like the SLCSP is rising quite a bit for 2017, which is great news for calculated subsidy.

Switching to Bronze for 2018, at least within my current company, is out of the question because my prescription drug costs would rise a lot, far more than any savings on premiums.

 

[jim584672]

NY is a special case since it has the BHP Essential plans. These plans are for the 138-200 FPL range. These have prevented the SLCSP from rising as much as in other states.

 

[BeachOrCity]

One piece of news, which came out in the last 24 hours is the IRS announced they will not take TY2017 returns without filers checking the box on whether the purchased insurance or not. Basically this means stronger enforcement of the individual mandate.

This piece of news will help (for policy year 2019) as insurers are leery of their risk pool if the individual mandate / penalties are not enforced and if they think it won't be enforced, they adjust premiums upward in anticipation of a worse risk pool of insured people.

 

[RetiredGypsy]

If you don’t mind my asking, is this the increase after accounting for premium assistance?

It is. Without that, it's increased somewhere between $5-50 for the year. I remember how many of hundreds it costs, but fail when it comes to the tens of dollars to the right of that. It's within that range, though.

 

[MBSC]

Maryland just approved higher rates for 2018 on-exchange Silver Plans.

The state's insurance administration also noted that carriers will not be changing premium rates for their off-exchange silver plans, so consumers could avoid the rate increase entirely by moving off of the state's health care exchange.

Reference: https://www.nbcwashington.com/news/...-Higher-Health-Insurance-Rates-453271593.html

 

[Senator]

Maryland just approved higher rates for 2018 on-exchange Silver Plans.

so consumers could avoid the rate increase entirely by moving off of the state's health care exchange.

Reference: https://www.nbcwashington.com/news/l...453271593.html

That seems logical. I wonder how many premium horror stories can just be avoided by switching plans or companies.

 

[MichaelB]

That seems logical. I wonder how many premium horror stories can just be avoided by switching plans or companies.

My guess is none. Health insurance is incredibly expensive because health care is incredibly expensive. There is no such thing as inexpensive comprehensive health insurance. If a health insurance policy is inexpensive, it’s coverage is limited or compromised in some way.

 

[Senator]

My guess is none. Health insurance is incredibly expensive because health care is incredibly expensive. There is no such thing as inexpensive comprehensive health insurance. If a health insurance policy is inexpensive, it’s coverage is limited or compromised in some way.

That is interesting. Most products cannot go beyond the ability of the consumers to buy it. I cannot raise rents beyond what my customers can afford, if I do, I wind up with payment or vacancy issues.

 

[Mr._Graybeard]

That is interesting. Most products cannot go beyond the ability of the consumers to buy it. I cannot raise rents beyond what my customers can afford, if I do, I wind up with payment or vacancy issues.

Health care can make the difference between living and dying. And, as a rule the market is structured so you rarely know the cost of the service going in. It's like renting an apartment with no idea what the rent is going to be. You can only guess.

In the case of health care, though, your guess is generally too low.