Dane County insurance companies participating in the Affordable Care Act exchange are proposing double-digit premium increases for next year as they adjust to the realities of the federal online marketplace.
But federal health officials say most consumers won’t face steep hikes because the vast majority receive tax credits to help pay premiums, they can shop around for cheaper plans and proposed rate increases are sometimes reduced when approved in the fall.
“Headline rate increases do not reflect what consumers actually pay,” Kathryn Martin, acting assistant secretary for planning and evaluation with the U.S. Department of Health and Human Services, said Wednesday. “Even in a scenario where all plans saw double-digit rate increases, consumers in each state will continue to have affordable options.”
Even if rates go up 25 percent in Wisconsin next year, 69 percent of people using the exchange could find a plan for $75 a month or less, according to a new report by the federal health department.
Many insurers set rates low during the first two years of the exchange, in 2014 and 2015, but the people who signed up for plans ended up being sicker than projected, according to the Kaiser Family Foundation.
That led many companies to boost rates for this year. With open enrollment for next year set to begin Nov. 1, many insurers have proposed significant increases again for the fourth year of the exchange.
One reason is that a government reinsurance program, which helped protect insurers with high medical expenses, expires this year. It reduced premiums by about 5 percent, Kaiser experts said.
About 224,000 people in Wisconsin were insured through the exchange as of March, with 85 percent receiving tax credits. The average monthly premium of $455 was reduced to $125 for those with tax credits.
The premiums don’t take into account deductibles, which can be thousands of dollars for some plans. This year, the median deductible is $850, federal health officials said.
Though the national carriers Anthem and UnitedHealthcare have left the exchange in many places, the main plans in Dane County remain the same.
Proposed rate increases next year for individual plans on the exchange for plans based in Dane County range from 5.4 percent to 37.9 percent.
Rates for Unity Health Insurance’s three plans could go up by 28.3 percent to 37.9 percent. “Our price reflects the underlying risk in the pool, changes in the population, health status and claims,” spokeswoman Jennifer Dinehart said.
Unity initially proposed increases of 18.3 percent and 10.3 percent for its two plans this year, but the actual increases were 11 percent and 3.8 percent.
Rates for Dean Health Plan’s two policies next year might go up 20.9 percent and 16.2 percent. “Dean Health Plan values all our members, and we are committed to providing sustainable plan options and rates utilizing our integrated health delivery system,” spokeswoman Mary Carr Lee said.
Dean’s rates this year decreased 10.3 percent and 3.9 percent.
WPS Health Plan’s proposed rate increases for its two plans, offered outside of Dane County and marketed as Arise Health Plan, are 36.4 percent and 32.4 percent.
“We are filing for a rate change to account for continued increased cost in providing medical care, increased utilization of services by consumers, and the impact of numerous additional taxes and fees imposed upon our plan,” a WPS statement said.
The WPS plans went up 10.5 percent this year.
Physicians Plus proposed a rate increase of 18.7 percent for its individual plan off the exchange next year. It is withdrawing from the individual exchange next year. “This decision was based on several important factors, including low enrollment in this product line, as well as the high administrative costs to maintain our participation in the exchange,” spokeswoman Leah Huibregtse said.
Group Health Cooperative of South Central Wisconsin submitted a rate increase of 5.4 percent for its plan next year. The plan went up 10.9 percent this year.
For more information, go to ratereview.healthcare.gov.