Medical Costs Drive New Health Plan Increases Above 10 Percent

Rising medical costs were the primary driver of recent rate increases by health insurers, accounting for three-quarters or more of the larger premium hikes requested between July 2012 and June 2013, a new Commonwealth Fund study finds.

The analysis takes a national look at the explanations insurers file with federal and state authorities to justify rate increases of 10 percent or more, as required by the Affordable Care Act (ACA). Currently, insurers are only required to submit rate increase explanations for non-grandfathered plans — those plans that became available after the enactment of the health reform law.

Researchers reviewed 311 filings from insurance plans covering 150 or more people in the individual and small-group markets for their study, What’s Behind Health Insurance Rate Increases? An Examination of What Insurers Reported to the Federal Government in 2012–2013. The review found that only about half the filings — 155 — attributed any portion of rate increases to provisions of the Affordable Care Act (ACA) that had gone into effect by 2013.

Overall, those effects accounted for a small part of insurers’ increases. Specifically, insurers reporting that these early insurance reforms in the law had an effect on their decisions to raise premiums said that new preventive and contraceptive services for women were responsible, on average, for 0.8 percent of the increases, while taxes and fees related to the law were responsible for 1.5 percent.

The researchers found that among insurers with large rate increases, nonprofit companies sought lower increases than publicly traded companies, by an average of $121 in the individual market and $180 in the small-group market. Nonprofit plans’ premiums increased at lower rates because they had smaller increases in administrative costs and profits, according to the study.

Filings for premium cost increases also revealed that:

  • The average annual premium increases among carriers with increases of 10 percent or more were $648 in the individual market and $729 in the small-group market.
  • Rising prices were a larger driver of medical expense increases than enrollees’ greater use of services.
  • Increases in administrative costs and profits accounted for 28 percent of premium increases, on average, among insurers with high rate increases in the small-group market.
  • Insurers in the individual market with large rate increases reduced overhead costs and profits in response to medical cost increases by an average of $25 annually per member.

According to the study, between 4 and 5 percent of consumers in the individual and small-group markets were affected by rate increases of 10 percent or more nationally between July 2012 and June 2013. Of the 311 filings reviewed, 115 had been resolved. State regulators were somewhat more likely to approve increases than federal regulators, who reviewed filings for states that did not review filings themselves, approving 83 percent of all resolved filings. Connecticut, Idaho, Maine, Maryland, Ohio, Indiana, Washington, and West Virginia will see larger shares of their small-group and individual markets affected by large rate increases.

Starting in 2014, major changes to the small-group and individual health insurance marketplaces will take place. These include essential health benefits, the minimum package of benefits that plans must cover, such as prescription drugs and maternity and newborn care; community rating, or charging everyone the same price regardless of gender or health condition; and provisions requiring insurers to provide coverage to anyone who applies.

Moreover, insurers will be required to report all premium increases in non-grandfathered plans—those offered after the ACA was signed into law—in addition to submitting for approval rate increases of over 10 percent. It will be crucial, say the researchers, to closely monitor those filings to assess the impact the new rules have on health insurance premiums.

Source: The Commonwealth Fund , December 19, 2013

Healthcare Trends & Forecasts in 2014: A Strategic Planning Session, a 60 minute-webinar available for replay

Healthcare Trends & Forecasts in 2014: A Strategic Planning Session, a 60 minute-webinar on October 30, 2013 webinar presents Steven Valentine, president, The Camden Group, and Catherine Sreckovich, managing director, healthcare, Navigant, who provide a roadmap to the key issues, challenges and opportunities for healthcare providers and payors in 2014, including the strategic importance of health insurance exchanges for health plans and providers even if they’re not participating in the initial enrollment period.

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