Concerns over double digit increases abound, but there are also signs that individual premiums on average and in a lot of places may be modest.
As state and federal regulators review and approve individual and small group premiums this summer, there are areas where insurers are seeking particularly high rate hikes for populations like the new exchange customers.
BlueCross BlueShield of Tennessee is proposing a 36 percent average premium increase for its 222,000-person individual membership on and off exchange, ranging from 19.5 percent to 59.5 percent in one plan.
In Maryland, CareFirst BlueCross BlueShield, is seeking an average premium price increase of 28 percent for individual health plans in 2016. In Oregon, Moda Health Plan is seeking a 25 percent increase and Premera Blue Cross subsidiary Lifewise is seeking a 38.5 percent increase. In Florida, United Healthcare is proposing to raise individual exchange plan rates by an average of 18 percent and raise non-exchange premiums by an average of 31 percent.
In Florida, Aetna is seeking an average 17 percent increase for on/off exchange individual plans, including those sold by its Coventry subsidiary. Healthcare costs and utilization in individual plans have been increasing higher than the rate of inflation, Aetna wrote in its actuarial report. Inpatient hospital costs have increased 8 percent in Aetna's individual plans in Florida. Average costs for outpatient services and pharmacy prescriptions have each grown by about 8 percent, the company said.
Blue Cross and Blue Shield of North Carolina is proposing an average rate increase for individual on/off exchange plans of 25 percent--a hike needed to balance a year of exceptionally high utilization in the population, the company said.
For 2015, some 397,000 customers chose BCBSNC individual plans, and they "use more healthcare services and more expensive services than our individual customers had historically," said Patrick Getzen, the insurer's chief actuary. Inpatient care for cardiology and cancer, as well emergency treatment and speciality drugs, have been major drivers, he said. "Based on what we saw from this year's enrollment, we're not optimistic this will change in 2015."
The proposed premium increases come amid signs that national healthcare spending is rising at a higher rate than hoped for. U.S. healthcare spending in the first quarter of 2015 was 7.3 percent higher than in the first quarter of last year, according to the Quarterly Services Survey, as noted by the Wall Street Journal.
But, looking at proposed premium increases nationally, the rates increases may not necessarily be unreasonable when they're averaging in the low double digits.
On average nationally, proposed premiums for 2016 exchange plans are 12 percent higher than 2015, according to a study by consumer research group HealthPocket examining the largest metropolitan areas in 45 states.
Silver and gold plans have the highest proposed average rate increases, of 14 percent and 16 percent, while the average proposed bronze rates come with increases of 9 percent, HealthPocket found.
Silver plans, the most popular metal tier with two-thirds of marketplace enrollees, have increases in part linked to their plan types. Silver EPOs have the highest proposed increases, an average of 20 percent, in the regions examined by HealthPocket, while HMOs have proposed increases of 19 percent, POS at 15 percent and PPOs at 11 percent.
Before accounting for subsidies, the average 2016 silver EPO is on track to cost $404 per month, the average HMO $379 and the average PPO $395, according to HealthPocket.
Another analysis by Avalere Health also came to the conclusion that super high double digits won't be the norm, especially considering that these are proposed increases and in many places may be negotiated down.
In seven states and Washington D.C. average premiums for silver plans are on track to increase by less than 6 percent, ranging from 12 percent in Oregon to a 5.3 percent decrease in Michigan.
"While recent public attention has focused on a subset of plans that filed for premium increases of 10 percent or more, these data reveal that most plans are proposing more modest increases," said Caroline Pearson, senior vice president at Avalere. "Notably, final premiums could be even lower than those proposed."
And average premium increases for low-cost silver plans are likely to be smaller than silver plans as a whole, "if the states analyzed are representative of the broader market," Pearson said.
Consumers may have to change carriers of course, but if they shop around, they may still be able to get a good deal.
(Source: Avalere Health aggregation of state insurance filings.)
Still, the news about incidents of such high proposed rate hikes upwards of 20 and 30 percent have raised concerns about the affordability and sustainability of the exchange population.
"This year the health plans have hard claim data to show the regulators and a 35 percent rate increase is hardly going to be rolled back to 5 percent," wrote Robert Laszewski, president of Health Policy and Strategy Associates and a former executive at Liberty Mutual Insurance.
"That these big rate increases are coming a year before the "3Rs" reinsurance program is to end, that was supposed to subsidize the health plan's high claims experience, is not good news."
The 3Rs, membership health risks and the looming Supreme Court decision about the legitimacy of federal subsidies are all uncertain factors. But at least one thing is clear, Laszewski argues: Exchange enrollment needs to increase to have a sustainable risk pool.