Highmark to offer ACA plans in 14 additional Pa. counties
Pa. insurance chief says insurers are proposing rate increases for Affordable Care Act coverage
Highmark, which pulled back on its Affordable Care Act offerings a few years ago after being hit with major losses, will undertake a major expansion in 2020, offering plans in 14 additional counties.
The Pittsburgh health insurer’s new offerings will be made in Fayette, Greene, Centre, Mifflin, Juniata, Union, Snyder, Northumberland, Montour, Columbia, Fulton, Adams, York and Lebanon counties. In total, Highmark will have ACA exchange offerings in 49 counties statewide, still down from its 62- county total in 2014.
Its Pittsburgh- based rival UPMC, meanwhile, will again be offering Affordable Care Act plans in 53 counties and “among the lowest- priced” mid- range silver plan available in most counties, said spokesman Ned Schano.
The first glimpse of next year’s 2020 options came Wednesday during a media briefing by Pennsylvania Insurance Department Commissioner Jessica Altman. Ms. Altman said that, statewide, insurers offering Affordable Care Act plans next year have proposed an average rate increase of 4.9% for individual coverage and 9.6% for small group plans.
Regional and insurer- specific rate requests were not immediately available.
The department has the authority to approve, modify or reject a request before submitting it to the federal government later in August. Finalized rates will be announced in the fall.
“As filed, all 67 counties will maintain the insurers currently offering coverage in 2019 for the 2020 coverage year,” Ms. Altman said. “Pennsylvania’s market has seen great increases in competition and choices for consumers in recent years, and the trend will continue into 2020.”
When the ACA marketplace website debuted five years ago, Highmark had aggressively priced its midrange silver plan at $ 163.19 per month, selling 99,000 plans in Western Pennsylvania that first year.
But, between unexpectedly high claims costs and a major reduction in federal payments meant to mitigate insurers’ losses, Highmark officials said they were incurring $ 1.20 in costs for every $ 1 of revenue. The losses eventually exceeded $ 800 million, pushing Highmark to withdraw from several outlying counties.
Now, the insurer believes it has changed the situation.
“We believe we have stabilized the cost of care for our ACA members by implementing care management programs and designing benefits that encourage the use of lower- cost, higher- quality and preventionfocused options,” said Highmark spokesman David Golebiewski.
“We also continue to strengthen our range of provider partnerships, clinical joint ventures, and integrations across our markets. These partnerships offer excellent and affordable care close to where our members work and live. That progress, and the stability of the ACA marketplace, has enabled us to expand our ACA footprint.”
Caleb Wallace, UPMC Health Plan’s senior director for health policy, said the health giant remains committed to the Affordable Care Act marketplace and will continue to have plan offerings statewide. In 2020, that means UPMC will offer a plan in every county, except for a handful in the Philadelphia area and the northeast part of the state.
Senior director for consumer products John Mills said that if the insurer’s request is approved, most of UPMC’s individual plans will see only an $ 8 to $ 12 increase in monthly premiums next year.
Ms. Altman described the statewide rate increase requests as “modest” and noted the market’s relative stability, although she still has areas of concern.
Specifically, she mentioned ongoing concern about low- cost, short- term non- ACA plans being offered which do not comply with the act’s minimum coverage requirements.
The worry, she said, is that those plans will draw younger, healthier enrollees from ACA plans, which would lead to a lessfavorable ACA risk pool and higher rates for ACA plans.
Also, enrollees in those cut- rate plans may find that “when they need the coverage, it isn’t there,” she said.
Ms. Altman noted that 1.1 million Pennsylvanians have gained access to health insurance due to the Affordable Care Act, helping to lower the percentage of uninsured state residents to 5.5%.
The marketplace plans were a key feature of the 2010 Patient Protection and Affordable Care Act, designed in particular to give the uninsured and those with pre- existing medical conditions access to low- cost health insurance.
The law has come under a number of attacks by the Trump administration, most recently when the U. S. Justice Department said it supported a federal ruling earlier this year that the ACA is unconstitutional. That ruling is currently under appeal.