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CMS posts 2016 health rate filings

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The issuer of a typical individual or small-group major medical plan that’s going through a Patient Protection and Affordable Care Act (PPACA) rate review process may be asking for a rate increase of about 15 percent to 20 percent for 2016.

About half of the hundreds of 2016 PPACA-compliant plans in the health rate filing database around 3 p.m. on Monday, June 1, were asking for a bigger increase, and about half were asking for smaller increases. 

See also: Feds firm up health rate filing calendar

The range of proposed 2016 rate changes for real plans seems to be a decrease of 25.82 percent, for a plan sold by a unit of Aetna Inc. (NYSE:AET) in Nebraska, up to some for more than 70 percent for new products filed by a unit of Assurant Inc. (NYSE:AIZ). Assurant had to classify the new rates as increases based on comparisons with PPACA-compliant “metal level” plans that are available this year. Assurant has said it will withdraw from the major medical market in 2017.

The Centers for Medicare & Medicaid Services (CMS) made 2016 rate filing information public on Monday, June 1, 2015. The 2016 data now available includes information from states with PPACA rate review programs administered by CMS and some states with state-based review programs.

PPACA requires health insurers to have large rate increase proposals reviewed for reasonableness. The U.S. Department of Health and Human Services (HHS) has adopted regulations requiring proposals for increases over 10 percent to go through rate reviews.

Many states posted complete, or nearly complete, versions of the rate filings insurers submitted through the official System for Electronic Rate and Form Filing (SERFF).

The CMS rate review database redacts, or blacks out, many tables and financial numbers that state SERFF public viewing systems leave in plain sight.

But the CMS rate review database is easier to search than many state SERFF public viewing systems, and, earlier Monday, users could sort all of the filings for the entire United States by variables such as proposed rate change percentage.

Later in the day, CMS limited users to sorting the database one state at a time.

See also: HHS: Health rates climbed in 2013

In one typical Aetna individual exchange plan near the middle of the nationwide rankings, in Georgia, the company is asking for an average premium rate increase of 17.4 percent. The increase, which will affect 51,000 enrollees, is necessary partly because costs for pharmacy prescriptions have increased 6 percent, the cost of an inpatient hospital admission has increased 9 percent, and the use of outpatient hospital services has increased 9 percent, Aetna says.

An Aetna unit is asking for a 27.14 percent increase for an individual exchange plan in Missouri that has 55,300 enrollees. That increase is necessary in part because outpatient utilization is up 104 percent and inpatient care utilization is up 730 percent, the company says.

An actuary notes that he cannot certify the rate filing because of the uncertainty about the effects the King vs. Burwell Supreme Court ruling might have on pricing assumptions. The actuary asks for permission to change the rate filing if the court finds that the use of PPACA premium subsidies in states with exchanges set up by HHS is not lawful.

See also: Will King vs. Burwell kill the 2016 individual health market?

Many of the states now in the rate review database are subject to state rate negotiation and approval processes. Some states are still reviewing rates. Final rates for all states are supposed to be published by Nov. 1, 2015, CMS officials say.


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