Health Insurers Are Seeking Rate Hikes Again. Here Is What To Know

As many residents worry about the price of gas, groceries, housing, and other necessities, Connecticut insurers are proposing double-digit rate increases for state-regulated health plans next year.

Carriers are seeking a 16.2% average rate increase for individual policies and 17.8% for small group plans.

The policies cover about 220,000 people — 157,000 with individual plan coverage and 63,000 with small group plans.

Here is what to know about the proposed rate hikes.

Who Decides Whether Insurance Companies Can Raise Their Rates, And By How Much?

The Connecticut Insurance Department annually reviews requests by insurance companies to raise or lower rates on health coverage.

Department leaders can choose to approve the full requested increases, reject them, or amend them. State officials must ensure the requests are not excessive, inadequate, or unfairly discriminatory. Actuaries review the proposals, examining trends in unit cost (total expenditure incurred by the company), utilization of services, and expected severity of claims.

There is a public comment period online and a hearing in person before decisions are made on rate requests.

What Kind Of Increases Are Insurers Asking For This Year?

Two carriers, Anthem Health Plans and ConnectiCare Benefits Inc, are selling policies through Access Health CT, the state’s insurance exchange where anyone can purchase a healthcare plan. ConnectiCare Insurance Company Inc will not offer plans on the exchange this year.

Anthem asked for an average rate hike of 12.8% on individual plans that cover 103,176 people — with changes ranging from a decrease of 3.4% to an increase of 13.3%, depending on the policy.

ConnectiCare requested an average hike of 22.7% on individual plans that cover 50,114 residents — with increases ranging from 20.8% to 25.2%.

Anthem sought an average increase of 17.4% on small group policies that cover 46,934 people.

Those companies and others are also selling plans directly to consumers, outside of the exchange.

How Much Did The Cost Of Plans Go Up Last Year?

Officials with the Connecticut Insurance Department signed off on an average rate hike of 16.8% for individual health plans and 11% on small group policies last year.

Carriers had originally requested rate hikes of 17.8% on individual plans (though the number later rose to 23% after factoring in the expiration of enhanced federal subsidies) and 13.1% on small group plans.

Why Are Carriers Seeking Rate Hikes?

Insurers say they need customers to pay more for coverage because the cost of administering those plans is rising.

According to state officials in the insurance department, the companies tend to attribute the higher costs to things like more expensive prescription drugs, higher demand for medical services and — recently — the expiration of federal subsidies.

Stephanie DuBois, a spokesperson for Anthem Blue Cross and Blue Shield, said, “Our submitted rates are based on the healthcare services we expect members to access next year, along with the anticipated costs associated with that care.” DuBois added, “Additionally, a growing number of legislative mandates and restrictions on carriers’ ability to manage rising healthcare costs continue to add pressure. We look forward to continuing to work with the state on the regulatory process.”

What Can Residents Do?

Residents can post comments online by clicking “select” under each rate request listed on the insurance department’s website or submit them by mail to the Connecticut Insurance Department at P.O. Box 816, Hartford, CT 06142-0816.

A public hearing is planned for August, though a date has not yet been announced.

When Will The State Announce A Decision?

The final decisions are typically announced in late summer or early fall. Open enrollment for the 2027 coverage year will begin October 23.

This story is part of CT Mirror Explains, an ongoing effort to distill its wide-ranging reporting into a "what you need to know" format and provide practical information to its readers.

The Newtown Bee is a proud partner and is sharing this story originally appearing at CTMirror.org, the website of The Connecticut Mirror, an independent, nonprofit news organization covering government, politics, and public policy in the state.