By Chris Comisac
Bureau Chief
Capitolwire
HARRISBURG (March 10) – Not much has changed regarding the overall national and state figures released last month by the U.S. Department of Health and Human Services regarding health insurance signups through federal- and state-run exchanges.
However the DHHS provided more details about those signups on Tuesday.
For Pennsylvania, total enrollment grew to nearly 473,000 (472,697), from the slightly more than 318,000 reported last May following the end of first open enrollment period – so an increase of approximately 155,000. The department did note the number could change during the remainder of the year. There will be an extended signup period offered between March 15 and April 20, and there is also an assumption, based on past experience, that at least 10 percent (nationally) of those who signed up won’t pay their insurance premium.
However, while the total state figure went up by 155,000, the DHHS indicates more than 193,000 of the nearly 473,000 selections are new customers. Almost 277,000 are people who got coverage during the first open enrollment period last year, with about 116,000 having actively renewed their coverage (and almost 56,000 switching their coverage), with the rest being automatically re-enrolled. That would seem to indicate about 41,000 Pennsylvanians who were enrolled through the federal exchange as of May 2014 dropped their coverage since then, either because they didn’t pay their insurance premium or they chose not to renew their coverage.
Dr. Meena Seshamani, director of the department’s Office of Health Reform, said information regarding payment of insurance premiums by those who selected plans would be released later in the spring.
The demographics of those Pennsylvania residents selecting plans this year did not change significantly from last year: in May 2014, 66 percent of those who signed up for insurance were 35 years of age or older, with 50 percent being 45 or older and more than one-quarter (28 percent) being 55 or older; the 2015 figures show 67 percent are 35 years of age or older, 51 percent are 45 or older, and 29 percent are 55 or older. In 2014, those between the age of 18 and 34 were 30 percent of those who selected plans; in 2015, that age group dipped slightly to 29 percent.
Those demographics could be some cause for concern as older individuals (who are expected to be more costly) represent a larger proportion of the insured population than younger (and less costly) individuals. If the insurance pool in the exchanges is older and sicker than insurers expected, they will raise premiums.
That’s something we might already be seeing both nationally and in Pennsylvania.
At the national level, the average premium paid by those who selected plans on the federally-run exchange, after applying tax credits, was $101 in 2015; in 2014 the average premium paid was $82. The average tax credit in 2015 was slightly smaller (by $1), but the pre-tax credit premiums were $18 higher. The DHHS claimed the increase was due to tobacco-users being included in the premium calculations in 2015, but they weren’t in 2014.
In Pennsylvania, the price jump was even more pronounced (and likely can’t be entirely explained by the tobacco-users defense): in 2014, after tax credits, the average premium was $84; in 2015, after the credits, the average premium was $129. The average tax credit was $20 less in 2015 ($226 compared to 2014’s $246), and the average premium cost jumped by $25 ($355 compared to $330).
A Capitolwire analysis done at the beginning of the 2015 open-enrollment period illustrates that many of the insurance options available to Pennsylvanians in 2015 are more expensive than the ones available during the first open enrollment period – a situation which the most recent federal data would seem to confirm.
In addition to insurance appearing to cost the average Pennsylvanian more, it also seems as though plenty of Pennsylvanians – nearly 380,000 – missed out on saving themselves money on the insurance they selected.
According to the DHHS data, 81 percent of state residents who qualified for a federal tax credit toward their insurance premiums could have gotten insurance coverage for less than $100 a month (with the credit included), but only 51 percent actually selected such a plan. Sixty-two percent could have gotten coverage for less than $50 per month, but only 23 percent did. In 2014, 68 percent of those selecting plans selected ones with premiums, after applying credits, of $100 or less per month.
Those decisions could be due to the lower-priced insurance products, particularly those in the Bronze metal category, having higher deductibles and covering less of one’s medical costs – meaning more out-of-pocket expenses – but Seshamani cautioned that lower-cost plans might not always be in the Bronze category.
“When we were talking about people having premiums available to them of less than $100, that takes in account what their tax credit is as well, so that’s not just a function of the actual plan, but what their income situation is and what the second lowest cost silver plan is, etc. – and so it’s taking all of that into account to come up with that final premium value for them,” said Seshamani.
While the DHHS offered state-level details for the type of plans selected last year, the just-released 2015 report only offers national-level figures. Compared to the May 2014 national figures, the percentage of Bronze products purchased went up in 2015 to 22 percent, from 17 percent, while the percentage of Silver products dropped slightly, from 69 percent in 2014 to 67 percent in 2015. Until the department releases state-level data for 2015, no such comparison can be drawn for Pennsylvania insurance selections.
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