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Health Plans Scramble To Calculate 2015 Rates

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"It is an actuarial nightmare to try to guess what you’re going to get," said Gold.

It's not just member health that insurers have to think about. President Barack Obama allowed many people to keep old plans that aren't compliant with ACA rules. Carriers must calculate how that exception (people covered under old plans are thought to be healthier on average) affects average costs in their new policies.

Backup resources for plans with disproportionate shares of sick and expensive members will become a little weaker next year. Insurers have to factor that into their rates.

And they need to look at the big picture.  

What economists call the cost trend -- how high prices rise per procedure and how many procedures Americans get this year -- may be the single biggest variable in setting prices for 2015, experts said.

And the trend seems to be up. After several years of relatively tame increases that many tie to a sluggish economy, analysts saw medical spending accelerate late last year.

Even so, the forces affecting 2015 premiums may not drive up Obamacare prices as much as some are forecasting. Finding that insurers have gotten discounts from select hospitals and doctors, the Congressional Budget Office recently lowered its estimate for the cost of premiums and taxpayer subsidies under the health law.

"I'm not expecting double digits like some people have predicted" for 2015 rate increases, said Axene. "I'm expecting mid-to-high single digits" — somewhere from 6 percent to 8.5 percent.

That would still be far higher than growth in the economy or family incomes.

Given the uncertainties that come with a major new social law, Independence Blue Cross believes the picture won't become fully clear until much later.

"We always viewed this as a three-year plan," said Lobley. "We always thought there would be a lot of volatility in years one and two. We really thought 2016 would [bring] market stability in the individual market."

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Fri, Apr 25 2014

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