ok, that’s the headline, but it’s so generalized that it’s all but useless. In fact, premium increases vary quite a bit around the country and even within markets.
Our plan is up less than 1 percent. And here’s why.
The 10% figure is a very rough average of the price changes for the two lowest-cost “Silver” plans – the second-tier plans offered on the Exchanges in 12 states plus DC. In fact, premium changes for the benchmark second-lowest Silver plans range from a 13% decrease to an increase if 18% – and these are preliminary, before the state review process.
A couple other factoids.
- 7 of the markets reviewed by KFF.org will have fewer insurers participating, while the other 7 will either stay steady or have more competitors.
- Most of the plans that were the lowest-priced in 2016 will not be the cheapest next year. However, in most markets, consumers who shop around will be able to find plans with premiums below their 2016 rates.
- On average, 5.5 insurers will participate in the 14 markets next year, down from 5.9 in 2016.
We buy our insurance thru the Exchange in upstate New York. Our premiums will increase about 1% in 2017 – for a platinum plan, narrow network, no out-of-network coverage for a three member family aged 58, 57, 24. Very low deductibles, but a very limited choice of providers.
So, what does this all mean?
Clearly, the narrow network is working for Fidelis, our insurer.
Contrast this with UnitedHealthcare, which is exiting most markets after a financially abysmal couple of years. Humana has also been hammered. UHC (and to a slightly-lesser extent Humana) has long focused on the employed market, one where care management is far less of a priority than marketing to brokers, benefits managers, and folks with jobs. Broad networks and generous benefit plans are absolute necessities, as moms – who are very influential in insurer selection – want their ob/gyns and pediatricians in-network.
Brian Klepper and Fred Goldstein said it very well when discussing Molina and Centene, two plans that are much like New York’s Fidelis:
[Plans with deep experience in managed Medicaid] have of necessity learned to manage risk more effectively than commercial plans. Medicaid plans receive a monthly rate for each enrollee, and then manage within that set budget. To accomplish this, they have become adept at understanding their populations’ clinical and financial risks, and putting medical management approaches into place that can mitigate those risks. In other words, when a plan with Medicaid experience moves into a fully insured (at-risk) commercial plan space, it is more likely to succeed.
The commercial plans, not so much. Most commercial plans have not been required to adhere to rigorous risk management disciplines and, if anything, their incentives are different. They can go light on large case management, for instance, allowing the costs of high-intensity patients to balloon, knowing that when costs exceed premium, they can recoup those costs through subsequent premium increases.
What does this mean for you?
Health insurance is changing, and plans that understand risk management are going to beat the pants off those who don’t – in the Exchanges.
It would be ideal to have a health premium that gives us full coverage without affecting our money. This may be possible if companies appear many more health insurance coverage premium in the market. The market competition drives down prices.