Rise in health premiums will be muted by subsidies

By Randy Tucker

The average monthly premiums increased by $4 last year for Ohio customers buying subsidized health insurance under the Affordable Care Act through the state’s federally run health insurance marketplace, according to a new report from the U.S. Department of Health and Human Services (HHS).

And the vast majority of Ohio marketplace’s customers will continue to have affordable coverage options in 2017, even though several of the 13 health insurers planning to sell marketplace coverage next year have requested rate hikes as high as 40 percent next year, according to HHS Press Secretary Jonathan Gold.

“The vast majority of consumers in Ohio qualify for tax credits that reduce the cost of coverage below the sticker price,” Gold said, noting that the proposed rates are still subject to regulatory approval and typically aren’t what most consumers end up paying.

Health insurers nationwide, including Dayton-based CareSource and Premier Health, have requested significant rate increases next year, in part, to offset the expiration of government-mandated cost controls designed to protect insurers from higher-than-expected medical claims.

Nationwide, benchmark rates are expected to rise about 10 percent next year, compared to an average 5 percent increase in each of the first three years of marketplace enrollment, according to several studies.

But even if finalized rates are significantly higher, the vast majority of marketplace customers who receive premium tax-credit subsidies under the health law will be protected from the increases.

About 80 percent of the more than 243,000 people enrolled in private plans through the Ohio marketplace during the 2016 open enrollment period qualified for subsidies, which will be increased to compensate for premium hikes if all premiums in a market go up by similar amounts.

Still, about 49,000 Ohioans did not benefit from the premium subsidies this year and could be faced with huge premium increases next year.

Dr. Michael Bloom, a local physician, said he purchased un-subsidized health insurance though the marketplace from health co-op, Coordinated Health Mutual, which insures nearly 22,000 Ohioans under its InHealth Mutual brand.

Bloom said his plan carries a $1,600-a-month premium for a family of five with a $4,500 deductible, which he recently met. But he’ll be forced to find a new plan by the end of this month after the Ohio Department of Insurance in June took control of Coordinated Health because the insurer did not have enough money to cover claims and remain in business.

“We have paid around $15,000 so far with nothing in return and are being forced to find a new plan that would restart our deductible,” Bloom said. “We are looking at $30,000 for this year out of pocket. Seems pretty unfair and unaffordable.”

Most marketplace customers with or without subsidized coverage should be able to lower their costs next year simply by shopping around, according to Trey Daly, Ohio director for Enroll America- a national organization working to get the uninsured signed up for coverage.

Daly pointed out that rates vary dramatically from one insurer to another, and the marketplace enrollment website, HealthCare.gov, is designed to help consumers find the best deal.

“Over the last two years, we’ve seen more and more people opt to shop around rather than let plans automatically renew. And the folks who did that generally saved money,” Daly said.

CONTINUING COVERAGE: This newspaper has been first to report the facts, not the talking points, about the Affordable Care Act, which has expanded health coverage to hundreds of thousands of Ohioans and will continue to deliver the latest news and information impacting our readers’ lives.

Health Insurance Marketplace coverage in Ohio, by the numbers:

* 243,715: The number of Ohioans enrolled in private plans through the Ohio exchange during the 2016 open enrollment period.

* 80 percent: The number of enrollees in the Ohio exchange in 2016 receiving premium tax-credit subsidies, which average $240 a month.

* $405: The average pre-subsidy monthly premium in Ohio in 2016.

* $164: The average after-subsidy premium in Ohio.

* 834,000: The number of Ohioans still medically uninsured, which is down from an estimated 1.5 million when the state’s marketplace first opened for enrollment in late 2013.

Sources: U.S. Department of Health and Human Services and the Kaiser Family Foundation.

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