Lack of cost-sharing funds force rate increases

Oct. 16--The Pennsylvania Insurance Department announced Monday that individual market health insurance rates for next year will increase an average of more than 30 percent, with silver-level plans being disproportionately impacted.

"It is with great regret that I must announce approved rates that are substantially higher than what companies initially requested," said Jessica Altman, acting insurance commissioner, in a prepared statement. "This is not the situation I hoped we would be in, but due to President Trump's refusal to make cost-sharing reduction payments for 2018 and Congress's inaction to appropriate funds, it is the reality that state regulators must face and the reason rate increases will be higher than they should be across the country."

Cost-sharing reductions are only available on silver-level plans. The four levels of plans -- bronze, silver, gold and platinum -- represent different levels of cost-sharing based on monthly premiums and total out-of-pocket costs.

It would cost $606.29 for a 21-year-old nonsmoker on a Highmark Health Insurance Co. silver-level PPO exchange plan in Rating Area 4, a 10-county region in southwestern Pennsylvania that includes Beaver County, according to the Pennsylvania Insurance Department. The lowest rates for the same health care plan for this year were $408.48 per month, and in 2016, approved rates were $260.89 per month.

The lowest rates for a silver-level plan under UPMC Health Options next year will be $287.86 per month for a 21-year-old nonsmoker. That's up from $181.49 per month approved for 2017 plans and $146.58 in 2016 exchange health care plans.

Those who purchase health insurance plans through the Affordable Care Act can learn more about the upcoming open enrollment period at local informational sessions.

Cassie Narkevic, a certified navigator with the Consumer Health Coalition, said there will be informational meetings from 6 to 7 p.m. Oct. 25 at the Monaca Public Library, 998 Indiana Ave., Monaca, and from 5:30 to 6:30 p.m. Oct. 26 at the Carnegie Free Library of Midland, 61 Ninth St., Midland.

Narkevic said Trump's announcements last week, including potential cuts to cost-sharing reductions, would not have an impact on 2018 health care plans. That means the increased sticker prices will have increased subsidies to help cover the difference.

"The Affordable Care Act is still the law, health insurance is still available, financial help is still available, and the majority of people who enroll do receive a monthly tax credit to help lower the cost of their premium," she said. "There are also cost-sharing reductions available, which are discounts on out-of-pocket costs, and over half the people in Pennsylvania who enroll in the Affordable Care Act do receive those reductions."

She said the organization has received "frantic calls" from consumers this year who feared they would lose their health insurance through the Affordable Care Act, or that individuals with pre-existing conditions would no longer be covered, among other concerns.

Narkevic said she also will be available to meet free of charge with individuals from 9 a.m. to 4 p.m. Mondays at the Franklin Center, 524 Franklin Ave., Aliquippa, during the open enrollment period, which runs from Nov. 1 to Dec. 15. Previous open enrollment periods lasted for 12 weeks.

Scheduling an appointment is suggested for the Franklin Center meetings. Narkevic can be reached at 412-456-1877, ext. 212.

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