Friday, September 21, 2018

In New Jersey's 2019 ACA marketplace, fruits of reinsurance, individual mandate, and silver loading

New Jersey's Dept. of Banking and Insurance has posted individual market health plan prices for 2019. Thanks to the state's new reinsurance program, state-based individual mandate, and silver loading (actively encouraged by DOBI), unsubsidized enrollees will see price drops from 2018. According to DOBI, premiums are down 9% on average, and 22% below where they would be if not for the reinsurance program and the state individual mandate enacted this year. For the subsidized, it looks pretty much like status quo ante -- although network changes and plan design changes could alter that picture.

As was the case last year, AmeriHealth has sewn up all the lowest price points. AmeriHealth and Oscar are offering discounted silver plans off-exchange -- presumably because of silver loading (Cost Sharing Reduction, available only with silver plans and only on-exchange, is not priced into off-exchange silver).  Horizon is not offering any off-exchange discounts, but it has dropped prices about 7% from last year. A few salient year-to-year comparisons below. Quoted premiums are for a 46 year-old -- where they're a clean 1.5 times the base rate posted by DOBI.
  • The cheapest silver plan for a 46 year-old was $468 per month in 2018. This year, cheapest silver is $359, offered off-exchange only. They're both AmeriHealth, but they're not the same plan. The off-ex 2019 cheapest is a "Select Silver EPO", a new designation for AmeriHealth, and it's an HSA plan, which means that all services except mandatory free preventive care are subject to the deductible. The cheapest non-HSA silver is an AmeriHealth HMO ("Local Value"), for $381 per month. That plan may have a better network than the "Advantage" network, which in some areas at least is quite limited.
  • The 2019 plan that appears closest to 2018's cheapest silver, varying only by copay, is the "IHC Silver EPO AmeriHealth Advantage $25/$50" -  last year's plan of the same name was "$15/$35." The 2019 version, the cheapest on-exchange silver, is $401 per month, vs. $468 in 2018 (albeit with apparently higher copays in 2019). So as close to apples-to-apples as we can get, there appear to be real savings for those who can live with this network.
  • Horizon's cheapest silver plan in both years is the OMNIA HSA. In 2018 it was $520 per month; in 2019, it's $484. OMNIA silver, no HSA is $558/month in 2018; in 2019 it's $515. 
  • Oscar's cheapest silver in 2019 is off-ex only, and it is well below 2018's cheapest offering. The 2019 Classic Silver Off-ex Only is $408 per month, compared to $536/mo. this year for Classic Silver (something called "Backup Silver" is $524 per month in 2018). If Oscar's Classic Silver network is better than AmeriHealth's Advantage and Local Value, this could be a viable option.
  • The cheapest bronze plan available in 2019, AmeriHealth's Bronze EPO HSA AmeriHealth Advantage $25/$50, is the same plan as 2018's cheapest, at a considerable discount.  In 2018 the premium is $377/mo. -- more than 2019's cheapest silver. In 2019 it's $327. Oscar's Classic Bronze is down from $401/mo. to $364. Horizon? It's OMNIA Bronez HSA is down a bit, from $447/mo. to $418.
  • For subsidized enrollees, silver loading did not yield heavy discounts in bronze or gold plans in 2018, and that hasn't changed. The spreads between the benchmark and cheaper plans have narrowed slightly. The base rate for benchmark silver in 2019 is just $5/mo. more than for cheapest silver, compared to $9 in 2018. Cheapest bronze at the base rate is $54/mo. below benchmark silver in 2019, compared to a $70 spread in 2018. Those spreads widen with age; multiply by 1.5 for our 46 year-old.
Unsubsidized enrollees were hit hard by last year's premium increases, which averaged 22% and were driven by the uncertainty caused by Republican attempts to repeal the ACA, coupled with Trump administration sabotage that included the cutoff of direct federal reimbursement to insurers for the Cost Sharing Reduction subsidies they are obligated to provide to qualified enrollees. The New Jersey legislature's swift remedial action, passing a state individual mandate and a law directing DOBI to seek federal funding for a reinsurance program -- which DOBI did successfully -- was a real accomplishment.  The relief delivered to unsubsidized enrollees is substantial.

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