Private Health Insurers to Increase Premiums for 2016

By Bill Bunker, Executive Vice President, SCI Solutions

The Centers for Medicare and Medicaid Services (CMS) released a new proposal of health insurer premium rate increases for 2016, ranging from 10 to 85 percent. These proposed increases affect the 37 states using Healthcare.gov as their exchange.

CMS emphasized these proposed rates still have several months before they are finalized. Regulators in some states have the authority to overrule rate increases if they are determined to be too high.

Some Insurers Worry What the Future Will Bring

Many insurers say they are asking for higher premiums because they remain uncertain about how many people will be signing up for coverage in the future and how healthy they will be. Experts are wary that insurers are relying too heavily on data as a predictor for 2016 prices, as the volume of new patients enrolling next year will be lower.

Not all insurers are planning to raise rates. Anthem, one of the largest for-profit insurers, reported strong financial results in part due to the subsidies that have generated millions more paying customers. More than 85 percent of people in the Obamacare marketplaces are receiving federal subsidies to help them pay for their insurance.

Consumers Still in Control to Choose

CMS reminds consumers that they will still have a choice of plans for 2016. Of the Americans who re-enrolled in plans last year, 29 percent picked a different policy from the previous year to keep costs low.

Healthcare.gov released a new website that makes searching for rate change requests easier than before. Both consumers and medical practices can utilize this resource to make sure they have the latest information on patient premiums to avoid surprises. Simply enter the state, insurer, and plan effective dates to view requested rate increase and status.

The Challenge for Providers and Reimbursement

For providers, a significant percentage of their patient population is likely to change their insurance plan in 2016 to avoid higher premiums. It is essential practice staff members have the most current insurance plan information for their patients to avoid any reimbursement surprises and maintain patient satisfaction. This can include verifying their patient’s eligibility, network status, benefits, and obtaining insurance authorizations as needed.

What do you think of the proposed increases? How do you stay on-top of the changes? Share your comments below.

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