Pennsylvania Market Remains Competitive As Review Process Begins For Health Plans In 2017

May 25, 2016, HARRISBURG, Pa. /PRNewswire-USNewswire/ -- Insurance Commissioner Teresa Miller today announced that Pennsylvania's individual and small group health care market remains competitive, as her department begins its review of 20 health plans that have filed to provide coverage for small groups and 18 health plans that have filed to provide coverage for individuals under the Affordable Care Act for 2017.

"As we did last year, my department is thoroughly reviewing the premiums requested by insurers for each of these health plans, to ensure that each is offering the comprehensive coverage required by the Affordable Care Act, to benefit Pennsylvania health care consumers," Commissioner Miller said. 

Currently, 509,000 Pennsylvanians are covered through individual health plans and 375,000 are covered through small group plans under the ACA.

Insurers' proposed premium increases average 7.9 percent for small group plans and 23.6 percent for individual plans. The rate requests and summaries of these requests by health plan are posted on the Insurance Department website, www.insurance.pa.gov, on the home page, under "Top Pages."

Commissioner Miller noted that these insurers' rate requests vary widely depending on the health plan.

"While proposed rate increases this year are a concern, there are several factors that are driving these rate proposals that may not be there in future years. These factors include provisions of the Affordable Care Act that end in 2016, such as those which help to cover bills for rare patients who require extremely expensive medical care, and those that help to recover some costs for insurers who made incorrect estimates on how sick their overall pool of customers, including new, previously uninsured customers, would be," Said Commissioner Miller. "In addition, some insurers in the ACA's first few years priced their plans to attract new customers, and now are correcting these rates to better reflect the anticipated costs of covering the people who bought coverage. It's important to note that these factors may have less impact on rates in future years."

Commissioner Miller reminded consumers that these are only proposed rates by insurers. The Insurance Department will conduct a thorough review of the requested rates. Last October, Commissioner Miller reduced proposed rates by nearly $81 million before approving final rates for 2016.

"During our review process, I maintain as my top priority the impact that rates may have on consumers," Commissioner Miller said.  "At the same time, I will continue to work to ensure that Pennsylvania's health insurance market remains competitive and sustainable."

A national study by GoBankingRate.com found Pennsylvania's total 2016 costs for silver plans to be the most popular plans under the ACA, as premiums, deductibles, co-pays, and co-insurance, were found to be the fifth lowest in the country.

"The GoBankingRate.com study found competition in states was a factor in keeping total costs down, so I am pleased Pennsylvania residents will continue to have a competitive health care market and a choice of health plans," Commissioner Miller said.

Shopping among health plans is an important way for consumers to find lower premiums.  A study by the Kaiser Family Foundation found consumers who switched from the lowest cost silver plan in 2015, to the lowest cost silver plan in 2016, saved an average of $322 in annual premiums, as opposed to staying with the same plan they had in 2015. The Insurance Department encourages consumers to shop among these plans, to find the one which best meets their needs, at the best price.  Every Pennsylvanian will have at least eight plans from which to choose in 2017.

The Insurance Department today released a third video to help consumers make the best use of their health insurance plans. This video explains the health insurance rate review process and what factors the department considers when evaluating whether or not to approve a requested rate. The video is on the department website, www.insurance.pa.gov, under the Consumers tab, by clicking on "Health", and then on the video, "How Are Health Insurance Rates Decided", under "Resources."

Most Pennsylvanians who get health insurance through the ACA receive subsidies to help pay their monthly premiums. The federal Department of Health and Human Services, which oversees the ACA, reported that approximately 75 percent of Pennsylvanians who chose health coverage through individual plans purchased under the ACA on the federal government's exchange site receive subsidies which help pay part of their premiums.  Therefore while many health plans are offering coverage through healthcare.gov and directly through a company, consumer subsidies are available only for plans bought through healthcare.gov.

Subsidies are available depending on the individual's income. However, Commissioner Miller urged all consumers to look into whether they may qualify for subsidies, as the income guidelines are higher than some consumers may think: 

• In 2016, individuals with incomes up to $47,520 a year qualify for subsidies. 
• The income limit for a family of four to receive subsidies is $97,200.
• On average, Pennsylvanians who chose individual plans on healthcare.gov qualified for subsidies that reduced their monthly premium by nearly two-thirds. These subsidies are pegged to the price of plans available on healthcare.gov, so if rates increase, the amount of subsidy available usually also increases. 

Monthly premiums are only one part of a health plan's cost, and Commissioner Miller encouraged consumers to look at their entire out-of-pocket cost when choosing coverage.  Other consumer costs include:

• Deductibles, or how much a consumer pays annually for care before insurance kicks in;
• Co-pays, or the fixed amount a consumer pays at the time of each specific service, after insurance kicks in;
• Co-insurance, or the percentage a consumer pays of the total payment to a provider for certain services, after insurance kicks in.

The full rate filing information for each health plan will be posted on the Insurance Department website in mid-June.  Final rates will be approved in October.

MEDIA CONTACT: Ron Ruman, 717-787-3289

SOURCE Pennsylvania Insurance Department

Related Links

http://www.insurance.pa.gov