Thursday, April 19, 2018
Health

Rate for a standard Obamacare plan to go down in Tampa Bay, bucking national trend

The average price of standard Obamacare health plans will drop in the Tampa Bay area next year, federal health officials announced.

The 2.4 percent average rate decrease for "benchmark plans" — the second-lowest-cost silver plan in the county where the consumer lives — is good news for people who are new to the marketplace, said Cynthia Cox, associate director of health reform and private insurance at the non-profit Kaiser Family Foundation.

But it may also mean smaller subsidies for people who earn between 100 percent and 400 percent of the federal poverty level. That's because the federal government uses the price of the benchmark plan to calculate how much assistance to give lower-income consumers.

"For people who are already in existing plans, if their plan goes up 30 percent, they are not only going to have to pay that increase but a little more," because the subsidy decreased, Cox said.

Consumers can log onto healthcare.gov to see which plans are being offered in their county.

Open enrollment starts Sunday.

Plans offered on the Affordable Care Act marketplace are labeled bronze, silver, gold or platinum, depending on the coverage level. The midrange silver plans, which cover about 70 percent of health care costs, attract a number of consumers. One in 10 consumers chose the silver plan in 2015.

Next year, the benchmark plan will cost a single 40-year-old in Hillsborough County who doesn't smoke about $250 a month without any subsidies, down from $275 in 2015. A single 40-year-old in Pinellas County will pay about $299 a month, a few dollars more than in 2015.

The overall trend across Tampa Bay — a drop in prices — doesn't reflect what's happening nationally. Across the 37 states using federally run insurance exchanges, the cost of the benchmark plan is set to increase an average of 7.5 percent, according to an analysis released late Monday by the Centers for Medicare and Medicaid Services.

There were large swings in markets such as Albuquerque, N.M.; Tulsa, Okla.; and Oklahoma City, where the price of the benchmark plan increased at least 25 percent. In Indianapolis, it dropped nearly 12 percent.

Why the variation? It's hard to say.

Federal health officials pointed out that rating decisions are "specific to each state and the dynamics of their market" — and that the insurance company offering the second-lowest-cost silver plan can change year to year.

Cox, of the Kaiser foundation, said insurance companies sometimes offer particularly competitive midrange options when entering a new market.

While many Tampa Bay area residents who choose the benchmark plan will pay less in premiums than last year, that won't be true for all consumers.

In August, the state Office of Insurance Regulation projected premiums would rise an average of 9.5 percent in Florida. That translates to an average of $36 per month or $432 per year for people purchasing all levels of coverage.

The uptick is more in line with what experts have been forecasting for Florida and other states. Their theory: Rising prescription drug prices — and the fact that many plans were underpriced in 2015 — would lead to increases across the board.

Federal health officials have acknowledged that most consumers nationwide will face single-digit premium increases in 2016. But they also say nearly 80 percent will be able buy a plan for less than $100 a month after tax credits.

Heading into the 2016 open enrollment period, consumers in the Tampa Bay area can expect to see about the same number of plans as they did last year.

One notable difference: There won't be any offerings from Cigna.

The company decided to exit the Florida marketplace due to an "exponential increase in fraudulent and abusive care delivery practices in 2015 in Florida," particularly with out-of-network substance abuse clinics and labs, spokesman Joe Mondy said.

Cigna intends to offer a new portfolio of health plans on the exchange for 2017, he added.

Meanwhile, Ambetter from Sunshine Health has started offering bronze, silver and gold plans to consumers in the Tampa Bay area. The plans are among the most competitively priced.

In addition, Florida Blue has a new low-cost plan in Pasco, Pinellas and Hillsborough counties designed for consumers who are eligible for the tax credits. The plan does not have a copayment for preventative, primary care doctor visits and routine lab work, and requires only a $1 copay after a member's second visit to the doctor and a $3 copay for specialists.

Contact Kathleen McGrory at [email protected] or (727) 893-8330. Follow @kmcgrory.

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