Pa.’s ACA market plan rates to rise about 4%

Open enrollment runs from Nov. 1 to Dec. 15

The 400,000 or so Pennsylvanians planning to enroll in an Affordable Care Act individual marketplace in coming weeks should find only moderate increases from this year’s rates.

Pennsylvania Insurance Commissioner Jessica Altman on Thursday released the state-approved rates, which show that consumers statewide should see an average 4% rate increase for individual market plans and 9.7% increase for small group plans.

The 4% individual rate increase compares with trending national increases of 5% to 8%.

“The rate increases can largely be attributed to what the industry refers to as ‘medical trend,’ which includes the forecasted change in health spending and medical claims inflation,” Ms. Altman said in a telephone media briefing.

Insurers, she added, typically point to rising drug prices as a significant factor for the increase.

Open enrollment for the ACA plans runs from Nov. 1 to Dec. 15. Information on all plans can be found online.

Locally, Highmark returns with marketplace plans in Fayette and Greene counties and will have exchange products in 12 new central Pennsylvania counties.

That will put the Pittsburghbased insurer in head-to-head competition across much of the state with hometown rival UPMC Health Plan, which will continue to have an ACA presence in 53 counties in western and central regions of the state next year.

UPMC offers plans in all Western Pennsylvania counties — and a total of 53 of the state’s 67 counties — while Highmark has exchange plans in all but three counties: Lawrence, Mercer and Venango. In those counties, it offers off-exchange plans.

Mark Nave, Highmark’s senior vice president of individual and small group markets, said Thursday the insurer will be introducing a new ACA plan next year called Together Blue EPO Silver 2900.

Similar to Highmark’s other Community Blue products, Together Blue is a lower-cost plan that limits in-network access solely to Highmark Health’s Allegheny Health Network.

For a 40-year-old, the plan would carry a $349 or so premium, a $40 copayment for physician office visits after two free visits, a $25 copayment for Tier 1 prescription drugs and a $2,900 yearly deductible.

In what it says is the lowest-cost mid-range silver plan in the state, Highmark’s Together Blue EPO Silver 3950 HSA monthly premiums are about $328 for a 40-year-old. After the deductible is met, there is a $50 copayment for doctor office visits, $25 for Tier 1 prescriptions and a $3,950 yearly deductible.

Separate from the exchange, Highmark will offer a broader network individual plan, called my Blue Access, featuring access to UPMC.

Mr. Nave said Highmark currently has less than 10,000 individuals in Affordable Care Act plans in Western Pennsylvania while a UPMC spokesman said it has 115,000 ACA individual members.

Ms. Altman said Pennsylvania’s ACA marketplace has stabilized in recent years but added, “There’s a difference between stability and affordability.”

For example, while 80% of those enrolling in a marketplace plan will qualify for a cost-reducing subsidy based on income, those who do not qualify may be unable to find an individual plan they can afford.

Ms. Altman said legislation signed by Gov. Tom Wolf earlier this year creating a state-based exchange for Pennsylvania could lower premiums 5-10%.

The exchange and reinsurance program should be available Jan. 1, 2021.