The Affordable Care Act individual major medical rules and public exchange system are supposed to help consumers compare health plans on an apples-to-apples basis.
One challenge for agents, brokers and other market watchers is figuring out some way to make meaningful year-over-year coverage price comparisons.
The U.S. Department of Health and Human Services recently posted a huge set of 2017 individual exchange health plan price data on the web, right above a huge set of 2016 individual exchange health plan price data.
Anyone with the patience to get the online filters to work, or the ability to download the files and pull them into a spreadsheet program, can learn what silver plans cost for 21-year-olds in specific counties in Alabama, or what the median cost of platinum coverage is for children with child-only plans.
Analysts at HealthPocket, a Mountain View, California-based unit of Health Insurance Innovations, have crunched the data and reported that a 30-year-old, for example, will spend an average of $364.91 on monthly premiums for mid-level silver-level coverage in 2017, up 17 percent from the average for 2016.
The average cost of richer, gold-level coverage will rise 22 percent, and the average cost of skimpier, bronze-level coverage will rise 21 percent.
The average 30-year-old will pay $311.17 for bronze coverage in 2017 and $464.19 for gold coverage.
Silver plan premiums tend to rise slowly, because ACA system managers base ACA subsidy levels to silver plan prices. In theory, silver plans might appeal more to healthy people who are buying coverage simply because they get rich subsidies, rather than to people who know they need health coverage because they expect to need expensive medical care.
Analysts at other organizations have crunched the data other ways and come up with somewhat different kinds of results.
Fruit v. fruit
Agents and brokers know that issuers have made many changes that interfere with clear apples-to-apples health coverage price comparisons.
For one thing, many issuers have reduced or eliminated agent commissions. That may lower the odds that consumers who sign up for coverage will get help from licensed, trained professionals with choosing and using their coverage.
Traditionally, lowering or eliminating commissions has also been a way for insurers to communicate the message that, for some reason, they are stuck with offering a product they do not really want to sell. A policy sold by an issuer that must sell it, through gritted corporate teeth, may work much differently than a seemingly identical policy sold by a company that’s happy to have the business.
Another challenge is that, in spite of ACA drafters’ efforts to ease product comparisons, by defining an “essential health benefits” core benefits package, and by requiring most ACA-compliant individual and small-group plans to cover about 60 percent, 70 percent, 80 percent or 90 percent of the actuarial value of the essential health benefits package, differences between plan co-payment, medical deductible, medical coinsurance and prescription drug cost-sharing rules make comparing two plans that seem as if they ought to cover the same things difficult.
Some state-based exchanges and managers of HealthCare.gov encourage or require issuers to offer more standardized benefits packages, with easier-to-compare cost-sharing rules, but no one has come up with a good value summary indicator for the non-standardized plans.
Health policymakers have been dreaming about making consumers better health care shoppers by “giving them more skin in the game,” or increasing their out-of-pocket costs, for more than a decade. But, at this point, there are signs the popularity of increasing skin in the game might be starting to backfire by discouraging people from getting medical care they need to maintain their health and hold down their overall health care costs.
Analysts in the New York office of GfK S.E., a market research firm, recently reported that about 36 percent of the ACA exchange plan enrollees it surveyed in August said they were going without physician care when they were sick to hold down their out-of-pocket costs. Many of the ACA plan enrollees who did go in for sick care got it from the kinds of urgent care clinics that may have only a limited ability to coordinate patients’ care and get patients with underlying chronic conditions into condition management programs.
The overall individual health coverage price picture, and plan menu appeal, may also depend on the nature of a state’s regulatory climate and the nature of the issuers choosing to do business in a state.
Charles Gaba, the editor of the ACASignups.net blog, recently reported, based on state insurance regulators’ reports and other sources of information, that individual exchange plan rates seem to be rising more slowly in the states that have done the most to embrace Affordable Care Act programs and rules.
Individual rates are on track to rise about 30 percent in 2017 in states that have resisted most or all ACA provisions, about 26 percent in states that have embraced some ACA provisions, and about 18 percent in states that have state-based exchanges and have adopted ACA rules as fully and as quickly as they could.
The situation is not perfect even in the states that fully embraced the ACA, Gaba concedes.
In Minnesota, for example, a state that has been enthusiastic about the ACA and its state-based exchange, individual health rates are on track to rise more than 55 percent in 2017.
In Connecticut, one of the cradles of the modern American insurance industry, rates are set to rise about 25 percent, and regulators in that state had to plead with Farmington, Connecticut-based ConnectiCare to have two carriers selling coverage through its on-exchange individual health market.
But California appears to be holding its 2017 individual health exchange rate increases to less than 15 percent partly because it has a state-based individual health exchange, Covered California, that has attracted about 1.3 million relatively young, healthy users.
Another homegrown LifeHealthPro.com analysis of the HHS individual health plan price data shows that two of the most enthusiastic exchange plan issuers, St. Louis-based Centene and Long Beach, California-based Molina Healthcare, are on track to be raising their silver plan prices an average of only about 10 percent in 2017.
Those companies, which have deep roots in the government plan market, sell what some call “Medicaid plus” plans, or plans that offer the kinds of provider networks that a typical Medicaid plan might offer.
In the markets those Molina and Centene’s Ambetter exchange unit serve, a 21-year-old might be able to get silver coverage for an average monthly premium of about $242.
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