Close Close

Life Health > Health Insurance

Florida regulators tell Humana to raise PPACA individual plan rates

Your article was successfully shared with the contacts you provided.

(Bloomberg) — No. Take more. Really.

While most states have been pushing health insurers to curb proposed price increases, Florida is telling some of them they can charge more.

The state on Wednesday approved an average premium increase of 9.5 percent for Patient Protection and Affordable Care Act (PPACA) plans sold to individuals for next year. Insurers had asked to boost rates 8.6 percent on average.

See also: Florida unveils 2016 individual health chessboard

Humana Inc. (NYSE:HUM) and Blue Cross & Blue Shield of Florida (Florida Blue) were among those whose final rates were higher than they’d first sought. Alex Kepnes, a Humana spokesman, said the approved increase incorporated updated information from the U.S. government on PPACA programs designed to spread cost, known as reinsurance and risk adjustments.

See also: What if CMS risk-adjustment bill collectors fail?

Kepnes said it’s routine for rates to be adjusted between initial submission and final approval. Calls to a BCBS media line weren’t answered.

Florida Blue doubled

Regulators can push insurers to raise rates if they think companies aren’t charging enough to cover costs, which could raise the prospect of a company failing. They also have the power in some states to force insurers to lower rates.

“In most cases, when a state changes a rate in the rate review process, it’s to lower it, not to increase it,” said Cynthia Cox, who studies private health plans at the Kaiser Family Foundation.

Humana had asked to raise rates 7.4 percent in one set of plans it’s selling in Florida. Instead, the Florida Office of Insurance Regulation told it to boost rates 16.3 percent. For the Florida Blue plan, the final rate increase was 8.9 percent, more than double the 4.3 percent request.

The rate increases were determined by a review that included risk adjustment amounts and other factors, Amy Bogner, a spokeswoman for the Florida regulator, said by e-mail.

Florida also pushed down rate requests for some insurers, including Aetna Inc. (NYSE:AET). Aetna’s premium increase was limited to 13.9 percent, down from a requested 21 percent.

Sicker patients

Humana, which is being acquired by Aetna, has faced higher-than-expected costs for some policies it sold under PPACA. In Georgia, for instance, the company said its customers were sicker than expected, and it had to cover more out-of-network doctor visits than it planned for.

The insurer ran into that problem in Florida as well, and told regulators it expects more customers to stay in network next year.

See also: Analysts: Traditional health players pricing more defensively

The rates are averages, weighted by 2015 enrollment, and don’t take into account subsidies that individuals with low incomes get to buy coverage. More than 93 percent of enrollees in Florida are getting those subsidies this year, receiving $294 a month on average. Rates can vary by age and geographic area.

Florida isn’t the only state that made insurers raise their charges. In Oregon, Kaiser Foundation Health Plan asked to cut rates by 2 percent and ended up increasing premiums by 8.3 percent.

See also: Vermont official: Keep health insurer solvent