The two insurers selling plans to Maine consumers under the Affordable Care Act want to raise rates in 2015, but well below the double-digit average hikes cropping up in some other states.
The proposed rates offer a tentative first look at how much insurers seek to charge during the second year of Healthcare.gov, a cornerstone of the Affordable Care Act. The rates remain subject to change and regulatory approval.
If they become final, some Maine consumers could pay slightly more, with increases ranging from an average of 0.1 to 3.1 percent. Others could see their rates drop.
The proposed rates would affect the relatively small population of Maine consumers who buy their health coverage in the “individual market,” rather than get insurance through work or government programs such as Medicaid and Medicare. Many gained coverage over the last six months through Healthcare.gov, the federal government’s gateway for health insurance marketplaces in Maine and 35 other states.
During the first year of enrollment under Healthcare.gov, more than 44,000 Mainers signed up for private health insurance, according to federal data. Health advocates expect even more of Maine’s population to sign up for plans taking effect in 2015, with the next open enrollment period kicking off on Nov. 15.
If approved, the new rate increases may not translate into noticeably higher bills for many policyholders, particularly the 90 percent of Maine enrollees who qualified for financial subsidies that could help absorb an increase. Those who didn’t qualify for subsidies may feel the pinch more.
In Maine, two insurers sold plans through Healthcare.gov. Both plan to continue selling policies in 2015. They’ll be joined by a third, the nonprofit Harvard Pilgrim Health Care, which has sold individual policies in Maine previously but will market plans through Healthcare.gov for the first time next year.
Yet another insurer, Aetna, will bring more competition to Maine in 2015. The company has offered plans to Maine businesses, and now plans to sell individual policies.
“We have built a new product offering that we think is going to be a very highly competitive offering in Maine,” said Susan Millerick, a spokeswoman for the company.
The new insurance product, which will also be available to small and large businesses, is expected to hit the market in January 2015, pending regulatory approval, she said.
New proposed prices
Maine Community Health Options, a startup insurer based in Lewiston that captured 80 percent of all Healthcare.gov enrollment in Maine, has proposed an average 0.1 percent increase next year, an uptick that would affect an estimated 38,300 people, according to a preliminary analysis provided by the Maine Bureau of Insurance.
The actual rate changes vary by plan, from a 1.1 percent hike to a 3.3 percent decrease.
Kevin Lewis, CEO of MCHO, said the proposed rate changes were a “testament to a number of factors,” including the insurer’s solid market position in 2014 and its commitment to keeping costs low and “returning value back to our members.”
The nonprofit, member-run insurer plans to expand into New Hampshire.
Anthem Blue Cross and Blue Shield, the other player that sold plans to Maine consumers through Healthcare.gov, has proposed an average 3.1 percent increase in 2015. Some policyholders could get hit with as high as a 10.3 percent increase, while others would experience an 8.7 percent decrease, according to the analysis. The number of affected policyholders was not available.
Individual member’s rates may vary from the overall average, based on the plan chosen and other factors, such as age and tobacco use, Anthem said in a statement.
“These new rates help ensure that our affiliated plans can pay doctors, hospitals and other health care professionals to provide the care our customers need and deserve,” said Rory Sheehan, an Anthem spokesman. “Once our rates and products are approved, we’ll be working with members and consumers during the next open enrollment period to help them navigate through their options, including subsidies for qualified individuals and tax credits for small employers.”
Anthem and MCHO sell policies both through Healthcare.gov and outside of the federal marketplace, through insurance brokers and directly to consumers. Their proposed rate changes, which would take effect Jan. 1, 2015, reflect plans sold on and off the marketplace.
Aetna plans to sell individual policies off the marketplace, but may join Healthcare.gov in 2016, said Maine Insurance Superintendent Eric Cioppa, addressing the state’s health exchange advisory committee Tuesday.
Mega Life, a health insurer that served as Anthem’s main competitor before MCHO’s establishment, will withdraw from Maine’s individual market, Cioppa said.
Insurers had to meet a May 30 state deadline to file their proposed rates for 2015. The bureau cautioned that its review has just begun, and that the preliminary rate analysis released Tuesday remains subject to change. Regulators still must approve the rates, a process that could stretch into July or August.
Details about the health insurance plans, including benefits and out-of-pocket costs, won’t become public until regulators issue final approval.
Cioppa described the proposed average rate increases as a “pretty narrow, small range.”
In some states, including Connecticut and Arizona, insurers are seeking average rate increases of more than 10 percent. Many other states have seen more modest proposed increases and in some cases, falling rates.
Advocates of the health reform law have pointed out that health insurance premiums routinely increase every year, beginning long before the Affordable Care Act passed in 2010.
“While the numbers released [Tuesday] are preliminary, they put to bed the lies being spread by the law’s opponents of double digit increases,” Mitchell Stein, a health policy consultant and member of the state health exchange advisory committee, wrote in an email Tuesday. “These rate filings show that the law is helping to moderate the unsustainable increases we used to see.”
Rep. Michael McLellan, a Raymond Republican who also serves on the panel, credited the modest rate increases to PL 90, a 2011 state health reform law championed by his party that allowed consumers to buy health insurance across state lines, among other provisions.
“It’s a low rate increase, and I guess I’d attribute it as much to the PL 90 work as anything,” he said.
The proposed rates released Tuesday also included plans sold solely off the exchange, as well as policies for Maine small businesses. The small group changes ranged from a decrease of 10 percent for MCHO to an increase of 7.8 percent for an Aetna plan. Historically, those rates have risen by double digits each year.
While the proposed rates shed light on insurers’ expectations for 2015, they’re not necessarily a reliable reflection of the health of new enrollees, said Joe Ditre of Consumers for Affordable Health Care, an Augusta-based advocacy group.
Insurers typically set rates based on how much they expect to spend to cover their beneficiaries’ claims. But Maine insurance companies had to file their proposed rates for 2015 just months after enrolling a largely new population of beneficiaries under the Affordable Care Act. Some of those enrollees applied just weeks ago, at the end of the open enrollment period in April.
Insurers are still getting a handle on those individuals’ health needs, setting premiums for next year with less information than they’d typically have. Insurers want to keep rates low enough to attract and keep customers but high enough to cover the cost of providing benefits.
“I think it’s a little early to tell what the risk over a full year is going to be,” Ditre said. “Hopefully they got the right mix of healthy [enrollees] and people who are going to file claims to make these projections work.”