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Minor increase projected for Affordable Care Act insurance rates next year

July 24, 2018 GMT

Affordable Care Act health plan prices could go up by an average of less than 1 percent next year in Pennsylvania, with some plans even seeing significant decreases in price, according to rate requests insurers filed with the Pennsylvania Insurance Department.

Highmark’s plans are going up an average of 5.4 percent in Western Pennsylvania, spokesman Aaron Billger said. Across the state, the insurer’s plans are going down an average of 1 percent, Billger said.

UPMC Health Plan’s offerings are increasing an average of 2.3 percent across the state, according to rate filings.

Highmark and UPMC Health Plan are the only two insurers selling plans in Southwestern Pennsylvania for 2019. For Highmark’s biggest group of plans, rate changes vary from a 25 percent decrease to a 9 percent increase. UPMC’s plans range from a 25 percent decrease to a 22 percent increase, and the insurer will sell plans in 21 new counties in the eastern half of the state.


Pennsylvania Insurance Commissioner Jessica Altman told reporters Monday that plans with few members tended to have the biggest variability in price, while more popular plans were more stable.

Altman said the low rate increases “indicate Pennsylvania has a healthy and competitive health insurance market.”

The numbers reflect insurers’ rate requests for next year. Under federal law, state insurance departments review rates and can approve or deny the requests. Final rates will be announced in the fall, before the six-week open enrollment period starts Nov. 1.

The insurance department previously estimated rates would increase by an average of 4.9 percent for 2019. Insurers lowered the requested increases after the department adjusted an estimate of what insurers would pay for a set of benefits that lowers co-payments, deductibles and other costs for some of the lowest-income policyholders, Altman said.

“Our filings reflect our success in driving down costs through improved care management programs and benefit designs that encourage efficient utilization,” Highmark spokesman Billger said in a statement.

Pennsylvania’s low increases come amid uncertainty surrounding the ACA’s future. Congressional Republicans got rid of a requirement that everyone has health insurance, a change that takes effect next year. The change could prompt younger, healthier people to leave the market and rates to rise, Altman said.

“We have a lot to do to watch what happens in our market,” she said. “At the end of the day the question is, are people going to leave the market altogether.”


Changes affecting the 2018 market didn’t drastically affect enrollment, and didn’t prompt healthy people to leave the market in disproportionate numbers, she said. President Trump last year eliminated federal funding for added benefits that had been included in plans for the lowest-income policyholders. The benefits remain in the plans without federal funding to offset their costs.

The state’s enrollment in the plans has remained steady despite hefty average increases of 30 percent for 2018 and 33 percent for 2017.

“Pennsylvanians want and deserve access to the comprehensive health coverage that the ACA provides,” Gov. Tom Wolf said in a statement. “Enrollment over the past few years has remained steady, and this fall, enrollees will have more choices, despite the Trump administration’s relentless efforts to dismantle the ACA.”

Most people with the plans don’t pay the full percentage increases each year, since federal subsidies adjust what they pay each month according to their income.

The average monthly premium for a 27-year-old living in Pittsburgh in 2018 was $293 per month before any adjustments from subsidies, according to a federal Department of Health and Human Services report. Premiums are higher for older people and those who smoke, and prices vary by region.

About 80 percent of Pennsylvanians receive the subsidies, which are available to people who make up to 400 percent of the federal poverty level -- about $48,000 for an individual or $98,000 for a family of four.

The plans, sold to individuals on the federal insurance marketplace, are often bought by people who don’t get insurance through work. The rate increases don’t affect people with Medicare or those who get their insurance through an employer.

About 389,000 Pennsylvanians had bought the individual ACA plans and were paying their monthly premiums as of April, according to Centers for Medicare and Medicaid Services data.