Pa. Affordable Care Act rates could drop in 2021

Health insurance premiums for policies sold in Pennsylvania’s Affordable Care Act market would dip in 2021 under rates proposed by insurers, while consumers would have more time to shop than last year with the enrollment period extended by 31 days.

Individuals shopping for health insurance on the ACA exchange could see rates fall by a statewide average of 2.6% next year, while small-group market premiums would dip by an average of 2.2% starting in January. The rate decreases, which were released Friday, were contained in filings by insurers submitted to the Pennsylvania Insurance Department in May for review.

The department can accept, reject or modify the proposed rates, which will be finalized in the fall.

Moreover, the 2021 enrollment period for the government-subsidized plans will begin Nov. 1 and end Jan. 15 — 76 days long compared to 45 days for 2020.

In the fall, the state will take over operation of the online health insurance marketplace from the federal government, joining 14 other states in running their own online markets.

No county would lose an on-exchange insurer, and 13 counties would gain at least one new carrier under plans submitted to the state in May, marking the third year of increased competition and decreasing or moderately increasing premiums, Insurance Commissioner Jessica Altman said.

“Pennsylvania’s efforts to stabilize and improve affordability in this market have been working,” she said in a prepared statement. “Pennsylvania has taken the necessary steps to ensure ACA-compliant health care coverage is accessible and continues to work toward making it more affordable.”

Helping hold down premiums was behind Pennsylvania’s decision to run its own online ACA marketplace, which the federal government had been doing for years with healthcare.gov.

Based on the proposed filings, a re-insurance program that’s part of the state’s takeover of the marketplace will shrink consumer premiums by 5.3% when compared to healthcare.gov, the insurance department said.

Consumers may also be benefiting from record second-quarter profits by commercial insurers, including Anthem, CVS Health (which owns Aetna), Humana and UnitedHealth Group. While second-quarter results were not available for Highmark or UPMC Health Plan, insurers overall benefited by the COVID-19 shutdown, which resulted in the postponement of many non-emergency medical procedures.

“Generally speaking, claims for most insurers are down,” Ms. Altman said. “A lot of elective procedures were shut down, but no one is expecting a full stop on elective procedures next year as we did this year.”

The average lowest cost silver plan premium this year is $449 a month in Pennsylvania, according to the Kaiser Family Foundation.

Highmark and UPMC Health Plan are the only two carriers selling ACA marketplace coverage in Western Pennsylvania. UPMC Health Plan will operate in 53 of the state’s 67 counties in 2021, the same number as 2020, said Joseph Bayura, director of product development and small group sales.

Highmark, which operates in 49 of the state’s counties, will expand into Lycoming County in 2021.

UPMC Health Plan has about 95,000 ACA members in Pennsylvania; Highmark has about 61,000. Some 400,000 Pennsylvanians get health insurance through the ACA marketplace, and 80% receive government subsidies, based on income, to offset the cost.

Before the outbreak of COVID-19 in the spring, the state’s uninsured rate was just 5.5%, a record low, Ms. Altman said.

With Pennsylvania’s unemployment rate jumping up to 13% in June due to COVID-19-related business shutdowns, the insurance department said many people had switched to COBRA health care coverage after losing their jobs, which is a continuation of an employer-sponsored plan. Many of these people may be eligible for Medicaid or ACA market plans, Ms. Altman said.

“They should absolutely explore options in Medicaid and the marketplace, which will cost less than COBRA,” she said.

Public comment on the rate requests by insurers, which can be emailed to rain-comment@pa.gov, will be accepted through Aug. 21.