People who buy their own health insurance will have more options for 2019.
The Pennsylvania Insurance Department announced Monday that UPMC will start offering Lancaster County plans through the Affordable Care Act marketplace healthcare.gov, joining existing insurers Capital BlueCross, Highmark and Geisinger.
Details won’t be finalized until the fall, but the preliminary data shows the lowest statewide increase in rates since healthcare.gov opened in 2013, with at least one insurer planning to cut rates instead of increase them.
Diane Hess, executive director of the Central Penn Business Group on Health, said in an email that having more insurers in the marketplace is good for consumers.
“It helps spread the risk across multiple vendors and I believe it also sparks competition,” she wrote.
What increases are insurers asking for?
Statewide, insurers are asking for an average rate increase of 0.7 percent, down from the 4.9 percent regulators predicted earlier this year.
Regulators don’t provide county-level rate averages, but across the regions they serve, the overall average requests from the three returning insurers here are as follows: Capital BlueCross, 20.4 percent decrease; Highmark, 5 percent decrease; Geisinger, 5.1 percent increase.
In an email, Capital BlueCross senior vice president of government programs Debbie Rittenour said, the past few years have been challenging because of the changing dynamics in the individual health insurance market.
The requested decrease "reflects our work to help members achieve healthier outcomes from effective outreach and engagement, including targeted clinical programs for chronic conditions," she wrote.
Are there dollar estimates?
Yes, and because they are county-specific, they’re probably the best yardstick to use.
Since healthcare.gov opened, silver plans were always been used for comparisons, because they were the middle option between lower-cost bronze plans and higher-cost gold ones.
The monthly premiums the insurers are requesting for silver plans here are as follows.
- Capital BlueCross, $475 at age 21 and $609 at age 40. This year it’s $637 and $814.
- Geisinger, $549 at age 21 and $702 at age 40. This year it’s $552 and $706.
- Highmark, $488 at age 21 and $623 at age 40. This year it’s $553 and $707.
- UPMC, $469 at age 21 and $599 at age 40. It’s not currently in this market.
Those figures are before premium tax credits, aka federal subsidies, that are available to people with income below 400 percent of the federal poverty level.
The credits can steeply reduce what people pay out-of-pocket for premiums; this year, some Lancaster County residents got plans for $0.
Does that mean everyone will pay less?
Silver plans are less useful for comparison than they used to be, due to a complicated set of circumstances last year that resulted in some bronze and gold plans being cheaper than silver ones.
Those circumstances look like they will remain largely the same for 2019, and insurers are responding by asking to increase rates for bronze and gold plans even as they cut them for silver plans.
Daniel Sosa, an outreach and enrollment specialist with Lancaster Health Center, said premium tax credits should keep many people who qualify for them from seeing any significant premium increases in 2019.
“You might see $10, $15 difference,” he predicted.
For those with higher incomes, who do not qualify for the subsidies, he advised checking with insurers about the Affordable Care Act-compliant plans they sell directly. Those meet the same requirements as plans on healthcare.gov but can be cheaper.
Can people weigh in?
Yes. The department is accepting comments on the rate requests at email@example.com through August 22.
It’s also holding four public meetings, in Harrisburg, Philadelphia, Allentown and New Kensington.
The Harrisburg one is scheduled for 1 p.m. Wednesday, July 25, at Hamilton Health Center, 110 S. 17th St. Anyone interested in attending can call the department at 1-877-881-6388 for more information.
This is the information that the Pennsylvania Insurance Department has released about what insurance companies are requesting for Lancaster County plans in 2019.
|Metal Level||Parent Company||Marketing Plan Name||Product||On / Off Exchange||Age 21 Non-Tobacco Rate|
Age 40 Non-Tobacco Rate
|Silver||Capital Blue Cross||Silver PPO 5000/10/30||PPO||On/Off||$476.26||$608.66|
|Gold||Capital Blue Cross||Gold PPO 2000/10/20||PPO||On/Off||$469.89||$600.52|
|Bronze||Capital Blue Cross||Bronze PPO 7350/0/60||PPO||On/Off||$350.83||$448.36|
|Silver||Capital Blue Cross||Silver PPO 4950/10/30||PPO||Off||$400.47||$511.80|
|Gold||Capital Blue Cross||Gold Capital Advantage EPO 2000/0/25||EPO||On/Off||$441.72||$564.52|
|Catastrophic||Capital Blue Cross||Catastrophic PPO 7900/0/75||PPO||Off||$258.84||$330.80|
|Catastrophic||Capital Blue Cross||Catastrophic HMO 7900/0/75||HMO||Off||$242.19||$309.52|
|Bronze||Capital Blue Cross||Bronze HMO 7350/0/60||HMO||Off||$335.29||$428.50|
|Gold||Geisinger Health||Geisinger Marketplace HMO 20/40/3000||HMO||On/Off||$535.32||$684.14|
|Bronze||Geisinger Health||Geisinger Marketplace HMO 30/60/6600||HMO||On/Off||$382.89||$489.33|
|Silver||Geisinger Health||Geisinger Marketplace HMO 30/60/4600||HMO||Off||$457.94||$585.25|
|Silver||Geisinger Health||Geisinger Marketplace HMO 30/60/4650||HMO||On/Off||$549.05||$701.69|
|Catastrophic||Geisinger Health||Geisinger Marketplace Value||POS||On/Off||$321.98||$411.49|
|Silver||Geisinger Health||Geisinger Marketplace PPO 30/50/5000||PPO||Off||$482.90||$617.15|
|Gold||Geisinger Health||Geisinger Marketplace PPO 20/40/3000||PPO||On/Off||$561.71||$717.87|
|Silver||Geisinger Health||Geisinger Marketplace PPO 30/60/4650||PPO||On/Off||$578.56||$739.40|
|Bronze||Geisinger Health||Geisinger Marketplace PPO 30/60/6600||PPO||On/Off||$404.30||$516.70|
|Gold||Highmark||my Direct Blue EPO Gold 1000 - 2 Free PCP Visits||EPO||On/Off||$519.78||$664.28|
|Silver||Highmark||my Direct Blue EPO Silver 2400 - 2 Free PCP Visits||EPO||On/Off||$507.67||$648.80|
|Bronze||Highmark||my Direct Blue EPO Bronze 4000||EPO||On/Off||$368.22||$470.59|
|Bronze||Highmark||my Direct Blue EPO Bronze 7900||EPO||On/Off||$346.46||$442.78|
|Silver||Highmark||my Direct Blue EPO Silver 0||EPO||On/Off||$533.07||$681.26|
|Silver||Highmark||my Direct Blue EPO Silver 3500 - 2 Free PCP Visits||EPO||Off||$414.70||$529.99|
|Catastrophic||Highmark||my Direct Blue Major Events EPO 7900||EPO||On/Off||$298.23||$381.14|
|Silver||Highmark||my Direct Blue EPO Silver 4450 HSA||EPO||On/Off||$487.60||$623.15|
|Bronze||UPMC||UPMC Advantage Bronze $6,950/$35 - Premium Network||PPO||On/Off||$360.12||$460.23|
|Silver||UPMC||UPMC Advantage Silver $3,500/$25 - Premium Network||PPO||On/Off||$468.87||$599.22|
|Silver||UPMC||UPMC Advantage Silver $2,000/$60 - Premium Network||PPO||Off||$386.29||$493.68|
|Gold||UPMC||UPMC Advantage Gold $800/$20 - Premium Network||PPO||On/Off||$504.26||$644.44|