One insurance company proposes raising its premiums for Affordable Care Act health plans by 10 percent on average next year in Indiana, while the other insurer intends to hold its average rate steady and expand coverage statewide.
The Indiana Department of Insurance on Thursday released 2019 rate requests for insurance plans offered through the federal marketplace. For the second straight year, the same two insurers filed requests to sell coverage in Indiana: Dayton-based CareSource and Chicago-based Celtic Insurance Co., doing business as Ambetter from MHS.
CareSource Indiana Inc. seeks an average monthly premium of $540.15, a 10.2 percent increase from the current average. Its coverage prices would fall by as much as 7.7 percent for a bronze plan sold in a cluster of five counties in east-central and southeast Indiana, and would jump as much as 33.6 percent for a certain gold plan sold in Allen County.
CareSource did not answer The Journal Gazette's question about why the premium for a specific gold plan in Allen County is rising so sharply.
“Some consumers may see a slight increase in rates due to the elimination of the Affordable Care Act's individual mandate penalty and the expansion of short-term health plans and association health plans, which tend to pull out young, healthy populations from the Marketplace and drive increases in medical costs and rates,” Steve Smitherman, president of the Indiana market for CareSource, said in an email.
CareSource will sell its plans in the same 79 counties as this year, offering coverage in northeast Indiana except for DeKalb and Kosciusko counties. It has 76,000 marketplace customers in the Hoosier State.
Ambetter proposes a $479 average monthly premium, a 0.5 percent decrease from this year. Its coverage prices would decline by as much as 15.2 percent for a gold plan sold in a cluster of five central and southwest Indiana counties and increase by as much as 5.4 percent for a silver plan sold in six counties in central Indiana that include much of the Indianapolis metropolitan area.
Ambetter, which currently has 65,000 Hoosiers enrolled in its marketplace plans, will expand coverage from 43 counties this year to all 92 Indiana counties next year. It offered plans in northeast Indiana except for Noble County this year.
Bronze plans offer lower monthly premiums but higher out-of-pocket costs than silver plans, and silver plans offer lower premiums but higher out-of-pocket costs than gold plans. Income-based tax credits are available for qualifying customers.
Ambetter said in an email that its premium levels and coverage expansion “are a natural outgrowth of applying what we have learned serving Marketplace members in Indiana over the past five years.”
The state has until Sept. 25 to review and submit the requests to the U.S. Department of Health and Human Services. Open enrollment will be from Nov. 1 until Dec. 15.
The Indiana Department of Insurance said Thursday the overall average rate increase for marketplace plans sold for 2019 coverage is 5.1 percent. That is a huge shift downward from last year's filings, when CareSource raised its average premium by 20 percent and Celtic/MHS/Ambetter raised its average by 35.7 percent.
Premiums for 2018 soared around the nation as President Donald Trump eliminated cost-sharing reduction payments that subsidized insurers and the Republican Congress tried unsuccessfully to repeal the Affordable Care Act and later removed its individual mandate, which had required Americans to carry health insurance or pay tax penalties.
The 2019 insurance premium proposals drew mixed reviews from Indiana advocates for accessible, affordable health care.
The filings are “much more in line with what has historically been seen in the private market year-over-year, and suggest that the insurers feel that their costs next year will be more predictable,” said Mark Fairchild, public policy director for Covering Kids & Families of Indiana.
Fairchild said in an email that Ambetter's statewide coverage expansion is a “very positive sign for the Indiana health coverage market. Although we would love to see even more options, this takes us much closer to all Hoosiers having at least some degree of insurer choice.”
But Kate Shepherd, spokeswoman for Protect Our Care Indiana, said in an email that the 5.1 percent average growth in premiums “is a significant hike for families already struggling to pay the bills and those facing the maximum increases now have some incredibly hard decisions to make.”
Shepherd also said: “While we're happy that the two current providers in the Marketplace chose to remain for another year, we remain concerned that may not be the case in the future. The continued assault from Republicans designed to kill the ACA has created instability in the Marketplace that will only worsen as they continue to chip away at the ACA's protections. There seems to be no end in sight to that effort.”
Sen. Joe Donnelly, D-Ind., said in a statement: “These health care cost increases are unnecessarily being driven by the Administration's continued and deliberate efforts to undermine the marketplaces.”
Data compiled by the Centers for Medicare and Medicaid Services show that 18,648 people in nine counties in northeast Indiana – including 9,816 in Allen County – were enrolled in federal marketplace insurance plans for 2018.
Northeast Indiana enrollments were down 957 from 2017, with Allen County enrollments falling by 734.
Nationwide participation in the federal marketplace dropped from 12.2 million plan selections in 2017 to 11.8 million this year, CHS has said.
A number of factors might have contributed to the dwindling numbers. Some federal marketplace customers could have obtained employer-provided insurance or qualified for Medicare, the federal health insurance plan for people 65 and older.
Also, the Trump administration cut the enrollment period in half last year from what it had been during Barack Obama's administration.