As Obamacare enrollment opens, insurers offering fewer plans, higher premiums

Listen to this article

Pittsburgh-based Highmark Inc. quietly pulled some health plans from the ACA marketplace in some Pennsylvania counties for next year, and consumers across the state will pay an average of 32.5 percent more for coverage in 2017.

Despite all of the controversy surrounding high premiums and limited access for consumers, the Pennsylvania Insurance Department reminded everyone Tuesday in a press release that this year, 78 percent of people insured by health plans under the ACA marketplace are receiving subsidies to help pay for premiums.

In 2017, 75 percent of people who purchase health insurance from the marketplace will find a plan costung less than $100 a month after subsidies are applied, Insurance Commissioner Teresa Miller said.

“It is critical that consumers consider this when shopping for a plan,” Miller said.

Highmark drops York, Adams County ACA marketplace

Yet, what about consumers who no longer have access to the health plan they had previously, because an insurer stopped offering health plans in those counties?

Highmark confirmed on Tuesday that it has dropped health plans from the ACA marketplace in at least York and Adams counties, because it was “unable to put together a product and benefit network that was fully viable in York,” spokesperson Leilyn Perri said.

All other midstate counties still have ACA health plan options from Highmark, according to the insurance department’s website.

Highmark said it has spent $1.19 for every dollar that it took in for ACA health plan members. Due to their older age and increased likelihood of health issues such as cancer, ACA health plan members tend to be about 30 percent more costly than commercial insurance members. The insurer decided to adjust in certain markets due to the high costs.

Highmark is still selling an ACA-compliant product outside the ACA exchange in both York and Adams counties – meaning that the plan meets the law’s requirements, such as covering essential health benefits and free preventive care services. The rates for these off-exchange products are, in some cases, lower than on-exchange products, said Ali Fogarty, a spokesperson for the insurance department.

But people do not have access to subsidies when they purchase plans outside the exchange, Fogarty said.

Highmark’s withdrawal from certain counties is one of many ways the insurer has repositioned itself in the ACA marketplace, which it claims cost the company millions of dollars.

Insurers raise ACA premiums higher than requested

Highmark also reduced the number of plans it is offering, decreased reimbursement rates for physicians caring for ACA health plan members and  requested to raise individual premium rates in 2017 by 48 percent.

Highmark isn’t alone. Another insurer serving the midstate, Harrisburg-based Capital BlueCross, also requested to increase individual premium rates by 20 percent, and it is no longer paying insurance brokers commissions to sell ACA health plans to consumers.

Although Capital BlueCross also reduced the number of health plans it will offer through the ACA, it did not stop selling health plans on the marketplace in any midstate counties, according to spokesperson Kirsten Page.

The insurance department, after considering insurers’ requests to increase premium rates, not only allowed them to raise rates, but approved even higher rates – a move the agency says will hopefully keep insurers in the marketplace at a time when many across the country are dropping out.

Legislators this week sent a letter to insurers begging them not to charge consumers the approved rates, but only the rates they originally requested, stating, “Consumers should be charged  for insurance based on actuarial  soundness, not political timing.”

The letter asked insurers, “Why you would have requested less than you need, and we want to know why you would now need to charge more than you need.”

Capital BlueCross confirmed on Tuesday that it is charging consumers the rates that were approved by the insurance department, and not the rates it originally requested because those rates had to be modified to meet the instability of the market, Page said.

“Capital BlueCross’ top priority is the health and well-being of our customers and community,” Page said. “The decisions made concerning our 2017 product offerings and rates are to ensure the long-term sustainability of our individual plans so customers can receive access to quality health care.”

Highmark, although it did not confirm the rates it is charging, said that the rates it filed for 2017 are “actuarially sound.”