Nearly all carriers that sold 2015 coverage through federally facilitated and state-based exchanges have applied to sell qualified health plans (QHPs) for the 2016 plan year, based on a survey of selected states conducted by AIS.
Publicly traded firms Aetna, Inc., Humana Inc. and UnitedHealth Group applied to enter a few new markets. Many carriers are seeking substantial rate increases.
In the spring, Assurant Health applied to continue offering coverage in 16 states, but on April 28, it announced that it was getting out of the health insurance and employee benefits businesses. The company had sought substantial rate increases in most states where it sold 2015 coverage.
Below is a snapshot of carriers that have applied to sell coverage — and their proposed rate increases — for 2016, based on data provided by state regulators and CMS, which recently posted only proposed rate increases above 10%.
Alabama: In the individual market, Blue Cross Blue Shield of Alabama and UnitedHealth Group will offer statewide coverage through the state’s federally run exchange. No new carriers have applied to sell coverage through the exchange, says Mark Fowler, chief of staff for the Alabama Dept. of Insurance. According to CMS, the Alabama Blues plan requested a 27% rate increase for its Value Silver individual plan and a 54% increase for its Blue Access Gold plan. The insurer also requested a 71% increase for its platinum-tiered plan. For its small-group plans, the Blues plan requested an average increase of 14%. Rate increases will affect 175,000 members, according to the filing. UnitedHealth Group requested a 24.5% average rate hike for its off-exchange individual plans, according to CMS data.
Alaska: Moda Health Plan, Inc. and Premera Blue Cross Blue Shield of Alaska, which were the state’s only exchange participants for 2015, are the only carriers that applied to sell coverage for the 2016 plan year, says Lori Wing-Heier, director of the Alaska Division of Insurance. Moda requested a 23.5% rate increase for its individual gold- and silver-tier plans. Premera requested 40% increases for its Preferred Plus and Preferred Plus health savings account (HSA)-qualified individual plans.
Delaware: For the 2016 plan year, Aetna and Pennsylvania-based Blues plan Highmark Inc. will remain the only two health plan operators on the state’s federally run exchange, says Jerry Grant, a spokesperson for the Delaware Dept. of Insurance. Aetna proposed rate increases of about 16% for its individual HMO and PPO plans. Highmark is seeking rate hikes of about 22% for its HSA-qualified plans, 24% for a PPO and 26% for its exclusive provider organization (EPO), according to CMS data.
Georgia: All carriers that sold individual coverage through HealthCare.gov for 2015 have re-applied. They are: Alliant Health Plans, Blue Cross Blue Shield Health Care Plan of Georgia (Anthem, Inc.), Coventry Health Care (Aetna), Cigna Corp., Humana Inc., Kaiser Foundation Health Plan of Georgia, Peach State Health Plan (Ambetter/Centene) and United HealthCare of Georgia. Two health plan operators — Humana and UnitedHealth — applied to sell coverage through the Small Business Health Options Program (SHOP), according to Georgia Dept. of Insurance spokesperson Laura Wright. The Blues plan is seeking rate increases of 12.4% and 15.8% for two individual plans. Coventry applied to boost rates by 15.3% and 16.2% for two plans.
Indiana: All 12 carriers that sold coverage in the state through HealthCare.gov for 2015 applied to continue for 2016. Humana is seeking a 19.2% average increase, which would bring the average cost of an individual plan to $574 a month (excluding premium subsidies). MDwise Marketplace, Inc., by contrast, requested a 19% average reduction, according to the Indiana Dept. of Insurance.
Kansas: UnitedHealth of the Midwest, an HMO, applied to join five existing health plans for the 2016 plan year. The incumbent plans are Blue Cross and Blue Shield of Kansas, Blue Cross and Blue Shield of Kansas Blue Solutions (HMO), Blue Cross and Blue Shield of Kansas City and Aetna subsidiaries Coventry Health and Life and Coventry Health Care of Kansas (HMO), according to the Kansas Insurance Dept. BCBS of Kansas requested rate increases of 36% for several individual products, while Aetna’s Coventry subsidiary is seeking increases of 30% and 35% for two PPOs and a 20% jump for an HMO.
Kentucky: Three new carriers will sell individual coverage in Kentucky for 2016. UnitedHealth will offer statewide coverage, Aetna will sell products in 10 counties and Bluegrass Family Health will sell coverage in 79 counties, says Gwenda Bond, spokesperson for the Cabinet for Health and Family Services. Carriers that have reapplied to sell QHPs are Anthem, Humana, Kentucky Health Cooperative, CareSource and WellCare Health. Anthem and Kentucky Health offer statewide coverage. CareSource proposed expanding its market from 16 to 67 counties. Anthem requested an average 14.6% rate increase and CareSource proposed a 12% hike. Humana is seeking to increase rates by a modest 5.2% and WellCare requested a 9.3% decrease. Companies seeking to participate in the small-group market for 2016 are Anthem, Kentucky Health, UnitedHealth and Bluegrass Family Health.
Maine: If approved, Aetna would be the only new carrier selling coverage to Mainers via HealthCare.gov for 2016. It will join Anthem, Harvard Pilgrim Health Care and Maine Community Health Options, a Consumer Operated and Oriented Plan (CO-OP). For the 2016 plan year, the CO-OP proposed an average 0.5% rate increase with a maximum of 6.2%. Anthem proposed an average 5.7% jump with a maximum 17.8% increase, according to the Maine Dept. of Professional and Financial Regulation.
Maryland: CareFirst BlueCross BlueShield, which has dominated Maryland’s state-based exchange for the past two years, is seeking a 26.7% rate increase. CareFirst of Maryland Inc. and Group Hospitalization and Medical Services Inc. — both CareFirst companies — requested an average 30.4% increase in the state. All Savers Insurance, a UnitedHealth company, is seeking an average 3.2% reduction. Cigna Health and Life Insurance Co. also asked for a 2.9% premium reduction. Evergreen Health Cooperative proposed a 9.7% increase and Kaiser Foundation Health Plan of the Mid-Atlantic States is seeking a 4.8% rate increase, according to the state’s Dept. of Insurance.
Nebraska: Blue Cross Blue Shield of Nebraska and Aetna’s Coventry subsidiary applied to participate again in the individual market. If approved, Minnesota-based Medica and United HealthCare of the Midlands would be new players on the exchange for 2016, says Martin Swanson, administrator for Health Policy at the Nebraska Dept. of Insurance Exchange Planning Division. Requested rate increases posted by CMS range from 12.4% to 15.8%, while Coventry is seeking increases of 14.5% and 16.02% for two of its plans.
Nevada: For the 2016 plan year, seven carriers applied to sell QHPs on the state’s exchange and nine intend to sell individual coverage outside of it, according to the Nevada Division of Insurance. HMOs from Humana and PPO plans from Anthem would be new to the market. Collectively, the carriers proposed nearly 300 product offerings, 99 of which will be offered on the exchange. The average proposed rate increase for the individual market is 10.5%. For the small-group market, 15 carriers intend to sell coverage outside of the exchange, while just one has applied to sell on the exchange. The average proposed rate change for the small group market is 5.12%.
New Hampshire: The five carriers that sold individual coverage on the federal exchange for 2015 — Anthem, Harvard Pilgrim Health Care of New England, Community Health Options, Minuteman Health, and Ambetter Health offered by Centene Corp.’s Celtic Insurance subsidiary — applied to participate in 2016, according to the New Hampshire Insurance Dept. Minuteman Health Inc., a CO-OP that had among the lowest-priced QHPs for 2015, is seeking rate increases of between 42% and 51%. Maine Community Health Options, also a CO-OP, asked for premium increases between 19% and 22%. Both companies attributed their proposed increases in part to a Medicaid expansion program slated to begin on Jan. 1, 2016, The New Hampshire Union Leader reported June 3. The program will send Medicaid recipients to the exchange and give them Medicaid dollars to pay for their coverage.
*North Carolina: *The state’s largest carrier, Blue Cross and Blue Shield of North Carolina, requested a 26.2% increase for its Blue Advantage individual policy and a 26.7% for its Blue Value product. The average rate increase averaged 25.7%. In a statement issued June 1, the health plan operator explained that “ACA customers continue to use a great deal of expensive health care – and that drives rates higher.” The Blues plan says it enrolled 397,000 people during the most recent open-enrollment period.
Pennsylvania: Aetna did not apply to sell coverage for the 2016 plan year, and Highmark Select Resources applied to sell coverage for the first time in the state. For its existing QHPs, Highmark requested rate increases of between 23% and 39% depending on the plan. Aetna is requesting a 6.1% rate increase for individual products sold outside of the exchange. Geisinger Health Plan is seeking an average rate increase of between 15% and 40% for its individual HMO exchange plans. For its PPO, the company has projected a proposed increase up to 58%. First Priority, a joint venture owned by Highmark and Blue Cross of Northeastern Pennsylvania, requested rate hikes of between 21% and 35%. Several carriers requested rate increases below 10%: Capital Advantage Assurance Co. is seeking a 2.3% average increase for its individual exchange plans and a 1% decrease for products sold outside of the exchange. Keystone Health Plan is seeking increases of less than 3% and UPMC Health plan applied for rate increases of between zero and 9.75%.
Utah: All carriers that sold coverage for 2015 — Altius Health Plans, Inc. (Aetna), Arches Mutual Insurance Co., BridgeSpan Health Co. (Cambia Health Solutions), Humana, Molina, SelectHealth, Inc. and UnitedHealth — applied to participate again for 2016, says Utah State Insurance Dept. spokesperson Steve Gooch. Two new carriers, HSA Health Insurance Co. LLC and University of Utah Health Plans, applied to join them for 2016, according to the Utah Insurance Dept. Arches, HSA Health and SelectHealth applied to sell individual coverage through HealthCare.gov and small-group coverage through Utah’s state-operated SHOP. UnitedHealth applied to sell only small-group coverage. For its individual PPO, Arches Mutual requested an average 45.3% rate increase, with a range of 27% to 63%.
The CO-OP, which had 26,662 members at the end of February, noted that it brought in $39.7 million in premiums for the 2014 plan year and incurred claims of more than $56 million.
For the 2016 plan year, the state mandates autism coverage, which contributed about 2% to the overall rates, says Shaun Greene, chief operating officer at Arches. He tells AIS that the risk across all QHPs in Utah “was grossly underpriced.”
Excerpted from the 6/1/2015 issue of AIS’s Inside Health Insurance Exchanges
© 2015 by Atlantic Information Services, Inc.