Pennsylvania Rates Rise For Individuals, Small Groups

Nov. 21--In the second year of open enrollment after the Affordable Care Act took full effect, most Pennsylvania health care plans are less affordable.

Of 38 individual and small group health Pennsylvania health care plans that existed last year and comply with AFA reforms, 30 were approved for a 2016 price hike by the Pennsylvania Insurance Department. Most increases are in the single digits, but some plans rose by as much as 26.7 percent, according to the department's website.

The biggest impact to consumers will likely come from increases by Highmark Inc., which owns the lion's share of the marketplace and gained an even larger membership last year by underselling its rivals, said Rebecca Zastowny, a health and life insurance agent at Strickler Insurance in Lebanon. The company hiked rates in 2016 to recover from its 2015 losses.

For example, one Highmark individual plan was approved for a 20.1 percent increase after losing about $137 million last year, according to insurance department records.

"A lot of (new) members needed more services than we thought," said Highmark spokesman Leilyn Perri. "We asked for rate increases so the health care premiums matched what the actual (need) is."

Highmark also reduced its range of plans for 2016. Strickler Insurance has been contacted by more than 100 people who received letters informing them that their plan was cancelled, Zastowny said.

In order to afford premiums this year, many people will have to choose a plan with a more restricted network or less desirable levels of coverage, she said.

"You're going to have to be willing to sacrifice something," she said.

Zastowny recommended individuals struggling to afford health insurance check to see if they qualify for a premium assistance tax credit.

Rates are also increasing for small and middle-market businesses, although those increases are less sporadic than they were last year when insurers were first adjusting plans to meet Affordable Care Act requirements, said Patrick Freer Jr., vice president of Strickler Insurance. Most plans have increased by 5 to 15 percent this year.

Companies in the 50 to 100 employee range also have an "obscene" amount of work to complete to prove they are complying with the law, Freer said.

"Premiums may be becoming more consistent, but the paperwork is a nightmare," he said.

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