Patients May Face Premium Spikes for 2017 Health Plans

June 9, 2016

Health care in 2017 is shaping up to be expensive. Citing financial losses, private insurers who offer health plans through an Affordable Care Act exchange want to increase their premiums – some by double digits. Federal subsidies may soften the blow for low-income patients. But with steep deductibles already straining household budgets, higher premiums may leave patients tottering under the mounting weight of health care costs.

The Wall Street Journal reports that large insurance plans in Georgia, New York and Pennsylvania have requested rate hikes of more than 20 percent. Meanwhile, an analysis from Avalere Healthprojected that premiums for silver plans in nine states could rise by varying degrees, from 5 percent in Washington to 44 percent in Vermont. Avalere calculated the average monthly premium for 2017 at $503, a hike of 12 percent.

Requests for premium increases reflect the challenges faced by exchange plan insurers – namely lower-than-expected enrollment and expensive care for sick patients. In addition, several Affordable Care Act programs designed to protect insurers against the risk of joining the exchange marketplace expire in 2016.

State insurance commissioners must approve premium increases before they go into effect. And while some insurers’ requests are steep, regulators may find them justified. The Affordable Care Act requires that insurers be allowed to charge rates that allow them to pay out coverage claims.

To dodge rising premiums, exchange patients may shop around to find lower rates. Doing so, however, may also require them to sacrifice access to the physicians in their current network. Some patients and physicians have expressed concerns that frequent swaps among health plans can impact care by weakening the relationship between physicians and their patients. It may also introduce complications regarding the transfer of patients’ health care records.

Some patients may choose to shoulder the risk – and pay the fine – associated with dropping their coverage altogether. Meanwhile, patients who absorb the premium increases could find their tolerance for other out-of-pocket expenses, such as co-pays for physician visits and prescription medications, reduced. Higher costs have been cited as disincentives for patients to pursue medical care and can result in patients not taking necessary medications as prescribed.

Enrollment for exchange health plans begins November 1.

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