San Diego Covered CA customers will face a range of rate changes in 2019
After announcing in July that the statewide average premium increase for 2019 will be 8.7 percent, the plan purveyor followed up late last week with a more specific breakdown, publishing detailed information on which carriers will increase their premiums the most during open enrollment, which runs from
Health insurance companies scrambled this summer to account for a big change brewing in the individual health insurance market next year. For the first time since Affordable Care Act plans became available in 2014, Americans will no longer face financial penalties in 2019 if they go without coverage due to the Trump administration's scrapping of the ACA's "individual mandate" last year.
The coming rate changes are all over the map.
This fluctuation, explained
"This time last year, when insurers were having to set their rates for 2018, there were a lot of questions about whether they would enforce the individual mandate this year. I think insurers were having to make a lot of guesses. Some guessed high and some guessed low," Cox said.
This year, she added, information is more certain, and, to some extent, the increases and decreases listed in Covered California's new rate booklet reflect insurers correcting their guesses from last year.
"Some plans are significantly overpriced, and they're dropping their rates while it's the opposite scenario for others," Cox said.
That's definitely the case for
The ACA requires all health exchanges to sell plans in four metal tiers from bronze and silver to gold and platinum. Each tier pays an additional 10 percent of overall healthcare costs with bronze at 60 percent and platinum at 90 percent.
"Even with this adjustment, we're still not going to have the highest premiums in the bronze tier. We're really just trying to establish a sustainable rate," Hayden-Cook said.
She said that Sharp's silver-through-platinum tier plans, which each pay a progressively-larger percentage of patients medical bills, will increase only 2.1 percent on average. Silver plan premiums will decrease by nearly 5 percent.
Health insurance premiums are complicated because they vary not just by carrier but also by the age of each person being covered. Covered
Those who just need to know their 2019 rates now, and who are skilled with a spreadsheet, can download the information from Covered California and follow instructions to calculate what they'll pay if they stick with the same coverage for next year. The spreadsheet can be found at bit.ly/COCA2019.
It's important to understand that the raw rates available now do not include the generous subsidies that the ACA provides for individuals and households earning between 138 percent and 400 percent of the federal poverty level.
Next year, those percentages translate to an annual income of
Because ACA subsidies cap an individual or family's maximum premium payment, many will not see much increase in their monthly bills even if their plan increases premiums by double digits. As it has in previous years, those who make enough that they don't qualify for a subsidy will feel the full
The state's overall rate increase of just 9 percent, Cox said, is lower than some might have predicted when it became clear that the government's mandate to buy insurance or pay a penalty is going away next year.
While other states have seen larger average premium increases, Cox said the sheer size of the Covered California marketplace has kept price hikes toward the lower end of the nationwide range. And, she added, insurance companies have started to realize that it's probably the subsidies, rather than the penalties, that were driving enrollment, so actuaries aren't freaking out about the mandate going away as much as some suspected they might.
"It's almost always about the subsidy. I've only ever heard one or two people buy Covered California plans because they're afraid of the penalty," Gussin said.
He added that 2019 rates for group plans offered by companies have, so far, been relatively stable with increases ranging from 0 percent to 6 percent.
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