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Health exchange premiums should fall in 2015, state says

Copyright © 2014 Albuquerque Journal

Health insurance premiums will generally dip in 2015 for individuals and families obtaining coverage directly through the New Mexico Health Insurance Exchange, a marketplace created by the state Legislature under the federal Affordable Care Act.

One reason for the general dip in premiums, which runs counter to the more usual trend of ever-rising health insurance costs, is a growing familiarity with the workings of the roughly one-year-old health insurance system forged to implement the ACA, also known as Obamacare.

Among the five insurance carriers participating in the exchange, premiums will drop on average by 7 percent at Molina Healthcare, 1.5 percent at New Mexico Health Connections and 1 percent at Blue Cross and Blue Shield of New Mexico, according to the state Office of the Superintendent of Insurance.

Premiums will be unchanged at Presbyterian Health Plan. The fifth insurance carrier participating in the exchange, Christus Health Plan, is in its first year.

Premiums are but one factor in deciding on a health insurance plan. Other considerations include the extent of the plan’s benefits, or what it covers, the amounts of deductibles, copayments and other out-of-pocket expenses, and who’s in the plan’s health care provider network.

As 2014 was the pioneering year for the new health insurance system and involved insurance products that hadn’t been offered before, the participating carriers tapped their own experience with Medicaid or data from actuaries with broad national experience, various spokespersons said.

A common premise for setting the first-year rates in 2014 was that the initial enrollment would include a lot of uninsured people with existing health problems. These high-risk signees, from an insurance standpoint, cannot be turned away under the ACA.

“We saw some pretty significant conditions – people with cancer, people with heart conditions who had immediate needs (for medical care),” said Lisa Farrell Lujan, president for Presbyterian Health Plan.

“For 2015, we are expecting healthier individuals to enroll,” said Lisa Rubino, senior vice president of Medicare, duals and exchanges for Molina Healthcare. “The penalties will increase next year, so healthier people who sat on the sidelines last year will be more likely to enroll.”

Blue Cross insurance premiums also dropped some due to cost savings in new contracts with health care providers, CEO Kurt Shipley said. While the state reported a 1 percent drop on average in Blue Cross premiums in 2015, Shipley said the company’s calculations put it at a 3 to 4 percent drop.

The exchange is a one-stop shop for hundreds of individual health insurance plans approved by the state insurance superintendent’s office.

Open enrollment for the 2015 plans begins Nov. 15 and ends Feb. 15.

The kickoff enrollment period for the current 2014 health insurance plans, which lasted six months, resulted in 32,062 signing up by the time it ended March 31, a number that the Kaiser Family Foundation estimates is 17 percent of the potential pool of 193,000 people in New Mexico eligible for individual plans.

The plans are offered on the basis of five regions: one each for the state’s four official “metropolitan statistical areas” – Albuquerque, Farmington, Las Cruces and Santa Fe – and a fifth region comprising the rest of the New Mexico.

Each region has two sets of plans, one for nonsmokers and another for smokers. The Albuquerque MSA region, for example, lists 73 plans for nonsmokers and 70 plans for smokers.

The five insurance carriers participating in the New Mexico exchange took two distinct approaches to the variety of plans they offer.

For nonsmokers in the Albuquerque MSA region, Blue Cross offers a total of 40 approved health insurance plans, a number inflated by nine plans that are not offered on the exchange but rather are available directly from the company. The nine nonexchange plans are identical to exchange plans, Shipley said.

In contrast, the other four carriers kept it streamlined. Molina offers three plans, Christus four plans, Health Connections 12 and Presbyterian 13.

The plans are divided into four categories named after metals – platinum, gold, silver and bronze – that point to an inverse relationship between premiums charged and benefits provided. Higher premiums mean lower deductibles, copayments and other out-of-pocket expenses. The opposite is true with lower premiums.

“The differences in cost of the premiums is related to the richness of the benefits, what we call the relativity of the benefits to the price of the product,” Lujan said. “It’s usually a trade-off in what people are looking for. The preference in New Mexico is to have predictable expenses.”

Federal subsidies are available for plans in the silver category as a means to achieve the ACA goal of universal health coverage. Nationwide in the first year of the marketplace or exchange system, the Kaiser Foundation reports 83 percent of enrollees in individual plans qualified for some form of federal subsidy.

Subsidies are available for individuals with annual incomes up to 400 percent of the federal poverty level, which in New Mexico is about $46,000 a year for one person and about $62,000 a year for two people.

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