The Affordable Care Act (ACA) requires individual and small group rate increases that exceed 10% to be published, reviewed, and approved by state or federal regulators. This requirement does not apply to grandfathered health plans that predate the ACA. This rate review process is one of two ways the ACA addresses the issue of health plan costs, with the 80/20 Medical Loss Ratio being the other.
Rates for 2015 and 2016 are now available for public viewing at https://ratereview.healthcare.gov. For 2016 ACA-compliant plans in Wisconsin, four carriers filed for rate increases that will be subject to the >10% review: WPS, MercyCare, Unity, and UHC/AllSavers. These four carriers filed for a total of 11 plans, all but three of which were individual. The three small group plans were a WPS HMO, a WPS PPO, and a MercyCare PPO product.
In all, WPS had the most plans listed (5) and the highest requested rate increase (32% for an individual PPO product). The three other carriers had two plans each, with requested rate increases between 10% and 19%.
In 2015, 9 carriers filed rates for 30 plans that were subject to review:
- Dean Health Plan – 7 plans
- WPS Health Plan, Inc. – 7 plans
- Unity Health Plans– 6 plans
- Humana Insurance Company– 3 plans
- US Health & Life – 2 plans
- Time Insurance Company – 1 plan
- Health Partners Insurance Company– 1 plan
- Medica Insurance Company– 1 plan
- MercyCare HMO, Inc. – 1 plan
The three highest filed (and approved) rate increases from 2015 are as follows:
- Time Insurance Company – Individual EHB IM plan: 23.55%
- WPS Health Plan, Inc. – Individual PPO: 21.46%
- Unity Health Plan – SHOP small group three product Community, POS, HMO: 20.44%
When a carrier knows that a rate filing will be subject to review they may artificially inflate the initial requested rate in an attempt to get a higher final rate approved, similar to commercial negotiations. However, this may not be the case in Wisconsin, because all rates filed in 2015 were approved as requested. As of this posting, no final rate increases are available for 2016.