Health Care

Obamacare health insurance premiums to rise 9.5 percent for 2016, state regulator reports

Nearly 1.4 million Floridians were enrolled in a health plan through the Affordable Care Act’s insurance exchanges as of March 2015. Unlike 2014 and 2015, Florida regulators will have authority to approve or deny rate increases for 2016 plans. In this photo, applicants speak with an agent from Sunshine Life and Health Advisors at a storefront in the Mall of the Americas in December 2014.
Nearly 1.4 million Floridians were enrolled in a health plan through the Affordable Care Act’s insurance exchanges as of March 2015. Unlike 2014 and 2015, Florida regulators will have authority to approve or deny rate increases for 2016 plans. In this photo, applicants speak with an agent from Sunshine Life and Health Advisors at a storefront in the Mall of the Americas in December 2014. Gaston De Cardenas

Health insurance premiums for Floridians who buy their own plans will rise 9.5 percent on average for 2016, though some consumers will pay less for their coverage than they did this year, state insurance regulators reported Wednesday.

A total of 19 health insurance companies submitted rate filings to Florida’s Office of Insurance Regulation, which this year regained the authority to deny rate increases for health plans sold on the Affordable Care Act’s insurance exchange at HealthCare.gov.

Average rate changes for 2016 plans sold on the ACA exchange will range from a decrease of nearly 10 percent for some plans, to an increase of as much as 16 percent for others.

Rate increases could have been higher, though, if not for the return of prior-approval authority for the Office of Insurance Regulation this year. A 2013 state law barred the state agency from regulating rates for ACA exchange plans, but that prohibition expired in March.

As a result, Florida regulators denied proposed rate increases for more than half of the issuers in the state for 2016. The majority of health plans received approval for single-digit increases, and four will decrease their rates from 2015.

Insurers submitted the rate filings in May for all major medical plans sold on and off the ACA exchange — also known as Obamacare — for the individual market. State regulators approved them this week following a review of the actuarial soundness and financial solvency of the plans.

The U.S. Department of Health and Human Services has yet to complete its review of the rate filings, but the federal government does not have the authority to deny rate increases — only states have that power. However, HHS does require insurers to justify rate increases of more than 10 percent.

Ben Wakana, HHS press secretary, issued a written statement noting that this year Florida denied insurers’ proposed rate increases more often than it approved them — effectively lowering the rate of increase. “We are glad Florida was able to review rates,” Wakana said.

The largest rate increase approved by Florida regulators for plans sold on the ACA exchange went to UnitedHealthcare of Florida. UnitedHealthcare had requested an average increase of 18.2 percent. But Florida regulators denied those requests and instead approved an increase of about 16 percent. The average monthly premium per person for that UnitedHealthcare plan will rise from $398 in 2015 to about $463 in 2016.

The largest reduction among ACA exchange plans was for Florida Health Care Plan, which will lower its premiums by 9.7 percent on average statewide.

Florida consumers likely benefited from the state’s insurance regulator regaining the authority to deny rate increases, said Cynthia Cox, an associate director studying health reform and private insurance for the Kaiser Family Foundation, a nonprofit think tank that focuses on health policy.

“The purpose of rate review,’’ she said, “is to ensure that rates are reasonable — and that can go either way.”

Cox noted that, on average, Florida insurance companies requested an increase of 8.6 percent. But Florida’s insurance regulator approved an increase of 9.5 percent on average

That’s because sometimes state insurance regulators require insurers to raise their premiums in order to ensure the company’s solvency and maintain market stability, Cox said.

Given the fluctuation of health insurance rates, Cox said, consumers should remember they now have the flexibility to shop around and change plans because of the health law, which prohibits denial of coverage for pre-existing conditions.

Florida Blue, the state’s largest health insurer in the individual market, raised its rates for 2016 plans in South Florida by an average of 3 percent. Statewide, premiums for Florida Blue plans will rise by 8.9 percent on average. The company had requested a statewide average increase of 4.3 percent.

Penny Shaffer, Florida Blue’s market president for Miami and Fort Lauderdale, attributed the company’s relatively low rate increases to a company-wide effort to reduce administrative costs, and to more customers than anticipated.

But while premiums for 2016 increased at their lowest rate since the launch of the ACA exchange in 2014, it’s too early for consumers to consider this year’s single-digit average rate increase a trend.

The health law has been repeatedly tweaked since its adoption in March 2010, she said. Republicans in control of both chambers in Congress continue efforts to repeal the law, and the party’s leading presidential candidates are opposed to the law.

With so many “unpredictable pieces, I wouldn’t call them stable rates yet,” Shaffer said.

Healthcare plans on the ACA exchange are sold according to levels that indicate the co-insurance rate, or the percentage of costs for which the policy holder will be responsible. Bronze plans offer the least coverage, or 60 percent of costs, while platinum plans offer the most, or 90 percent. Silver plans cover 70 percent, and gold plans cover 80 percent.

For 2015, an estimated 1.4 million Floridians were insured through the ACA exchange. The great majority — 94 percent — received a subsidy to make their premiums more affordable. The average subsidy in Florida was $294 per month.

According to Florida regulators, a family of four living in Miami-Dade County and earning $53,000 a year can expect its monthly premium to cost $1,032. But that family also qualifies for a monthly subsidy from the government of $467 to make their plan more affordable. The cost to that sample family per month for silver-level coverage: $565.

A 28-year-old individual with the same silver level plan living in Miami-Dade and earning $27,000 a year can expect an average monthly premium of $293, reduced by a government subsidy of $55 a month. The monthly premium: $238.

A previous version of this article misquoted a written statement from Ben Wakana of the U.S. Department of Health and Human Services.

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