Phila. area faces hefty increases in Affordable Care Act rates

Because of market turmoil and decisions by United Healthcare and Aetna to withdraw from Affordable Care Act exchanges in Pennsylvania for 2017, the remaining insurer in the Philadelphia area, Independence Blue Cross, has been granted a bigger rate increase -- 28 percent -- than it requested in the spring, the state Insurance Department said Monday.

Insurance Commissioner Teresa Miller said additional companies beyond United and Aetna were considering ending their ACA individual-exchange businesses in Pennsylvania. If that happened, some counties might have been left without any offerings on the exchange, which is where individuals have to buy plans to qualify for federal subsidies.

"Consumers have to have access to coverage, and they have to have a way to access federal subsidies to help them afford that coverage," Miller said.

Independence's rate increases range from 12.1 percent to 39.9 percent. They affect about 10 percent of Pennsylvanians who have health insurance, officials said. But for those who qualify for federal subsidies, premium increases will be balanced out by increased aid.

"Philadelphia is likely to be the largest market in the nation to be served by only one insurer on the exchange," said Mark Cherry, an analyst at Decision Resources Group. a health-care data firm. Nevertheless, "lack of competition shouldn't be a deal-breaker in Southeastern Pennsylvania," because Independence still has to spend at least 80 percent of premiums on medical costs.

In a bid to keep at least one insurer in every Pennsylvania county, "the department allowed insurers to adjust their rate filings to reflect their emerging 2016 experience and their concerns regarding potentially large influxes of enrollment due to the ongoing volatility in the individual market," regulators said in a filing approving an average rate increase of 28.4 percent for individual plans offered by Independence subsidiary QCC Insurance Co. QCC had requested 23.8 percent in the spring.

The approved increases for QCC, which sells traditional preferred-provider plans, ranged from 16.6 percent to 39.9 percent, regulators said. The lowest monthly premium for a 40-year-old nonsmoker in a mid-range "silver" plan will increase 16.6 percent, to $453.95 a month, from $389.18 per month.

The Insurance Department approved a 28 percent average rate increase for Independence's Keystone Health Plan East unit, which sells HMO plans, up from the 20 percent initially requested, the filing said.

The HMO increases ranged from 12.1 percent to 39.5 percent. A 40-year-old nonsmoker will pay $373.94 a month, up 35 percent from $276.01, for a mid-range plan.

The plans in question are largely for individuals who cannot get group insurance through their employers. Consumers can start shopping online Nov. 1 for 2017 plans at www.healthcare.gov. Open enrollment will run through Jan. 31.

Monthly premiums are just part of the cost for consumers -- they do not include out-of-pocket expenses, such as deductibles and co-pays.

In Southeastern Pennsylvania, consumers will be able to choose from a dozen plans.

The withdrawal of United and Aetna means that 30,000 will receive reenrollment packages for comparable Independence plans late next month, unless they choose a plan themselves.

Independence will give Aetna and United customers access to its member portal on Nov. 15, earlier than normal, so they can select a primary-care physician or even pay their bill, said Paula Sunshine, Independence's chief marketing officer.

The first bill will be due Jan. 1, but to ensure seamless coverage, Sunshine encouraged consumers to pay their bill by Dec. 15.

"We do want people to stay covered," she said.