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Insurers seek sizable rate increases on Affordable Care Act health plans

Posted June 1, 2015

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— Blue Cross Blue Shield of North Carolina has asked state regulators for a 25.7 percent average rate increase on individual insurance plans purchased under the Affordable Care Act for 2016.

The request, which still needs to be approved by the North Carolina Department of Insurance, doesn't include employer-sponsored health plans or to any existing coverage grandfathered in under the federal health care law.

Two other insurers, Coventry Health Care of the Carolinas and United Healthcare, also offer plans through the HealthCare.gov marketplace to North Carolina residents. Coventry, which is merging with Aetna, has asked for an average 18 percent increase, while United submitted a request for an average 12.5 percent increase.

Blue Cross Vice President and Chief Actuary Patrick Getzen said more than 325,000 people statewide enrolled in the insurer's plans offered on the HealthCare.gov marketplace for 2015. Although the demographics are similar to those who enrolled in 2014, he said, the current group of clients has more chronic health conditions, such as cancer, heart disease and diabetes.

Those conditions drove more consumption of costly medical services, such as hospital admissions, MRIs, CT scans, ultrasounds and specialty prescriptions, Getzen said. Enrollees also are visiting hospital emergency rooms more than expected – the health care law was designed to provide coverage to more people so they wouldn't resort to an ER visit for routine care.

Higher premiums would help offset the growing cost of medical services, he said, noting the Blue Cross could revise its request in the next month or so and seek an even larger increase. The company based its current request on 2014 data and wants to collect more information on 2015 costs before deciding on amending its filings with state regulators.

The Affordable Care Act requires that insurers spend at least 80 cents of every premium dollar directly on health care. Blue Cross officials have said the company spends 86 cents of every dollar on care.

Rates for Blue Cross plans on HealthCare.gov increase by an average of 13.5 percent this year.

Getzen also noted that 15 to 20 percent of customers with HealthCare.gov plans canceled their coverage after paying initial premiums and consuming costly medical services.

For the first time next year, Humana plans to offer health plans through the marketplace in North Carolina. But its coverage will be limited to residents in Davidson, Forsyth, Mecklenburg and Rowan counties.

26 Comments

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  • Paul Jones Jun 2, 2015
    user avatar

    The initial year or two of Obamacare would predictably result in higher healthcare costs. The reason is that those who were not insured can, for the first time in ages, get treatment where they could not afford it before. However, that initial rush to the doctor will slow.

    The bigger problem isn't insurance companies (though I think we'd be better off without them and just move all coverage to Medicare -- yes, I said that), but the cost of healthcare. If you go to the hospital, they charge you a fortune. That's why insurance is a fortune. Question is healthcare so expensive? The government should strongly regulate the cost of healthcare, the healthcare insurance. Fix the underlying costs and insurance costs will come down accordingly.

  • James Jones Jun 2, 2015
    user avatar

    The government has been in health care for al long time and it has failed , you are not denied care but it your CT scan will be scheduled 6 months out, ask a veteran that goes to the VA. Americans have showed their ignorance to government programs unless you are receiving them it always cost the middle class no matter which or what politician you believe.

  • Chris Perry Jun 2, 2015
    user avatar

    This article did not stay on the main page to long. Wonder why?

  • Greg Dail Jun 2, 2015
    user avatar

    Obamacare is a lie predicated upon lies. It has nothing to do with insuring the uninsured or lowering premiums or making the system more efficient. It's all about control.

  • Uragoner Too Jun 1, 2015
    user avatar

    Blue Cross and Blue Shield is a pariah on the health care of America.

  • Uragoner Too Jun 1, 2015
    user avatar

    Blue Cross and Blue Shield is a pariah on the health care of America.

  • Uragoner Too Jun 1, 2015
    user avatar

    Blue Cross and Blue Shield is a pariah on the health care of America.

  • Tom Boswell Jun 1, 2015
    user avatar

    Our Czar first lies to the American public about you can keep your plan. No I could not. Then he lies and says premiums will be reduced by 25%. Mine with this increase will have increased 175%.

  • Norman Lewis Jun 1, 2015
    user avatar

    These increases are all part of the plan in place to eventually eliminate health coverage outside the ACA. Costs will continue to rise until all Americans will be REQUIRED to buy from the government sponsored plans to spread the costs of the bloated Obamacare system. Is the fact that subsidizing care to people with chronic medical conditions costs more the care provided to reasonably healthy people? We still provide that care but now there is a new heavy layer of expensive Government regulation to deal with.

  • Chris Coley Jun 1, 2015
    user avatar

    View quoted thread


    ^^^ This!
    Haven't seen a truer statement all day.

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