Marketplace Insurance Premiums in Early Approval States: Most Markets Will Have Reductions or Small Increases in 2015

Transcription

1 Mrketplce Insurnce Premiums in Erly Approvl Sttes: Most Mrkets Will Hve Reductions or Smll Increses in 2015 Revised, December 2014 John Holhn, Lind J. Blumberg, Erik Wengle, Megn McGrth, nd Emily Hyes The Urbn Institute

2 With support from the Robert Wood Johnson Foundtion (RWJF), the Urbn Institute is undertking comprehensive monitoring nd trcking project to exmine the implementtion nd effects of the Ptient Protection nd Affordble Cre Act of 2010 (ACA). The project begn in My 2011 nd will tke plce over severl yers. The Urbn Institute will document chnges to the implementtion of ntionl helth reform to help sttes, reserchers nd policymkers lern from the process s it unfolds. This report is one of series of ppers focusing on prticulr implementtion issues in cse study sttes. Reports tht hve been prepred s prt of this ongoing project cn be found t nd The quntittive component of the project is producing nlyses of the effects of the ACA on coverge, helth expenditures, ffordbility, ccess nd premiums in the sttes nd ntionlly. For more informtion bout the Robert Wood Johnson Foundtion s work on coverge, visit INTRODUCTION Despite mrketplce insurnce premiums in 2014 being surprisingly modest in mny res, some people fered tht lrge increses would occur in 2015 with significnt implictions for premiums of unsubsidized individuls nd for government subsidy costs. 1 The positive experience with premiums in 2014 my well hve resulted from the pressure to gin erly mrket shre by being one of the two lowest cost silver plns becuse federl subsidies re tied to the second-lowest cost premium in ech rting re. 2 Under the Affordble Cre Act (ACA), premium costs for individuls who re eligible for mrketplce nongroup subsidies re limited to percentge of their incomes, ssuming they choose the second-lowest cost silver pln or less expensive pln. They must py the full mrginl cost for higher cost pln. Insurers, understnding those incentives, hve strong resons to set premiums s ggressively s possible while protecting themselves ginst losses. 3 This report nlyzes the reltive growth in mrketplce premiums in 2015 compred to We drw premiums from rte filings for ech crrier s lowest cost silver pln offering in select rting res in sttes tht hve finlized, pproved premiums. We find tht consumers in most of the res studied will be ble to obtin 2015 silver-level coverge t lower rtes thn were vilble in 2014 or t premium increses of less thn 5 percent. Frequently for 2015, different crrier from the one in 2014 offers the lowest priced silver option in rting re. BACKGROUND The ACA s incentives, centered on the silver pln premiums in n re, resulted in helthy competition over rtes in mny mrkets in 2014, prticulrly in urbn res. Mrkets generlly sw lrge number of competing crriers offering severl plns. Mny insurers limited their provider networks, thereby generlly excluding higher cost providers, or negotited competitively with physicins nd hospitls to ccept lower rtes in order not to be excluded from the pln s network. 4 Ntionl commercil plns, prticulrly Blue Cross Blue Shield (BCBS) plns, s well s locl crriers, entered the helth insurnce mrketplces in Plns previously providing coverge only for Medicid beneficiries nd co-ops lso entered the mrketplces in number of res. As result of competition, premiums were surprisingly modest in mny res, prticulrly in comprison with benchmrks such s smll group mrket premiums. 5 ACA Implementtion Monitoring nd Trcking: Cross-Cutting Issues 2

3 Some mrkets were less competitive, however, prticulrly in sttes or less populted prts of sttes where BCBS crrier ws dominnt nd hd few significnt competitors. Rtes in those mrkets were somewht higher but not drmticlly so. Some sttes highly dominted by BCBS plns still hd quite modest premiums for mrketplce plns. 6 Premiums in 2014 my hve been rtificilly low becuse insurers did not dequtely understnd the helth sttus of individuls who would enter the mrkets. Hving seen tht they hd priced too ggressively, insurers my hve incresed premiums to djust for underestimting enrollee risk profiles. Insurers my hve to broden their provider networks to some extent to meet the demnds of the incresed enrollment expected in 2015; brodening networks my necessitte somewht higher pyment rtes to certin providers. Finlly, underlying helth cre costs re beginning to trend upwrd, which could lso ffect 2015 premiums. On the other hnd, the pressure to be one of the lowest cost plns remins intct. Lrge premium increses likely would men reduced mrket shre. Insurers could not recoup 2014 losses by setting premiums high in 2015 if doing so reduces enrollment. 7 Further, mrketplce enrollment is expected to grow in The Congressionl Budget Office estimtes tht n dditionl 7 million people will purchse helth insurnce through the mrketplces in Higher mrketplce enrollment should improve the overll mix of helthy nd sick individuls within the risk pool, ssuming tht those with the highest expected costs would hve been the first to enroll. The ACA-complint plns risk pools should lso improve in the coming yers, s more individuls move into those plns from the remining noncomplint plns. Mny insurers llowed their pre-aca enrollees to renew their plns erly in order to lengthen the time before those enrollees would move into the new options, nd the federl government extended the time period during which individuls could re-enroll in their pre-aca plns. Both of those moves likely reduced the number of helthy individuls enrolling in mrketplce nd other ACAcomplint plns in the erly yers of reform, conditions tht will chnge in the coming yers. The cost-shring requirements of silver plns should lso dmpen utiliztion becuse sizble deductibles, for exmple, tend to decrese use of services. Insurer efforts to reduce costs by limiting networks or reducing provider pyments re lso likely to reduce premium growth. Severl studies hve lredy been relesed tht provide some informtion bout 2015 mrketplce premiums. 9 This study offers more in-depth look t the dynmics in brod rry of mrkets with finlized rtes. Unlike the other studies, this one provides dt t the crrier level in ech re studied, which then llow us to more clerly understnd the competitive forces t ply. Additionlly, we include the clculted chnge in the lowest price silver pln premium vilble ech yer, which no other studies provide nd which llows us to understnd how the price of entering the silver tier of coverge is chnging cross the first two yers of reform. Finlly, this nlysis includes dt from severl sttes tht hve not been reported in other studies, including Delwre, South Dkot nd Montn. SUMMARY OF FINDINGS In this pper, we present dt on how premiums re chnging between 2014 nd 2015 in nongroup mrketplce plns; we focus on 17 sttes nd the District of Columbi, which were the first to complete their rte review nd pprovl processes. In ech rting re studied, we report the reltive difference between the lowest cost silver plns in 2014 nd in In ddition, we show the verge percentge chnge in the lowest cost silver mrketplce premiums cross ll crriers in the mrketplce. Tbles 1 nd 2 provide the summrized results. The key findings of this pper re s follows: Premium increses will be quite low between 2014 nd In the rting res we exmine in the 17 sttes plus the District of Columbi, ten sttes will hve verge premium reductions cross the crriers lowest cost silver plns, seven will hve smll premium increses (defined s 5% or less), nd one will hve n increse greter thn 5 percent. Across the 39 rting regions studied within those sttes, 25 will hve verge premium reductions cross their crriers lowest cost silver plns, 9 will hve smll increses, nd five will hve lrger increses (greter thn 5%). 10 Mny of the smll increses or reductions in 2015 ACA Implementtion Monitoring nd Trcking: Cross-Cutting Issues 3

4 premiums will occur in lrge cities, including Bltimore, Cincinnti, Clevelnd, Denver, Detroit, the District of Columbi, Minnepolis, New York City, Portlnd (Oregon), nd Settle. There is no consistent pttern of differences in rte increses between urbn nd rurl res. For exmple, the rurl counties studied in Tennessee will see 0.7 percent increse in the verge lowest cost silver premiums offered by crriers in 2015, compred to 2.7 percent in Nshville. Premiums will increse in the study s selected rurl counties in Michign by 1.1 percent nd will decrese in Oregon by 1.8 percent. On the other hnd, premiums in rurl prts of New York nd West Virgini ech increse by 9 percent. Of the 39 rting regions, 26 will see chnge from 2014 in the crrier offering the lowest cost silver premium in As result, the lowest cost silver option vilble to consumers in 17 of the rting regions will be lower in 2015 thn in Those chnges reflect tht mny of the lowest cost crriers in 2014 hve firly low premiums nd believe tht they cn increse those rtes, while other crriers re responding to competitive pressure in the mrketplces nd will reduce their premiums in This chnge is desirble nd direct outcome of mrket competition, but individuls will need to chnge plns to minimize their shre of their premium pyments. Finlly, we sw tht price competition is driven by different crriers in different sttes. BCBS-ssocited plns re highly competitive nd will remin so in Delwre, the District of Columbi, Mine, Mrylnd, Michign, Tennessee, Virgini, nd West Virgini. They re less competitive in Colordo, Ohio, Minnesot, Montn, nd New York. Medicid-only plns tht entered the mrketplce will ply n importnt role in keeping premiums low in sttes such s New York, Ohio, Rhode Islnd, nd Wshington. Kiser Permnente generlly will hve premium reductions or smll increses in 2015 nd will become more competitive in Colordo, the District of Columbi, Mrylnd, nd Virgini. Co-ops re extremely competitive in Colordo, Mine, Mrylnd, Montn, New York, Oregon, Tennessee nd West Virgini. Tble 1. Chnges in Lowest Cost Silver Premiums, in Selected Rting Ares in 18 Sttes, Stte Averge Percentge Percentge Chnge Lowest Cost Silver Chnge in Lowest in Lowest Cost Silver Pln, 2015 Premium Cost Silver Premiums Pln Avilble on for 40-Yer-Old Across All Crriers,b Mrketplce,b Colordo $ % -10.9% Connecticut $ % 0.4% Delwre $ % 5.0% District of Columbi $ % 1.3% Mine $ % -3.1% Mrylnd $ % 3.4% Michign $ % 11.9% Minnesot $ % 7.2% Montn $ % -5.4% New York $ % -6.3% Ohio $ % 2.7% Oregon $ % -0.3% Rhode Islnd $ % -10.8% South Dkot $ % 1.6% Tennessee $ % 5.8% Virgini $ % 3.9% Wshington $ % -5.8% West Virgini $ % 8.3% Dt re bsed on selected rting res (see Tble 2). b ACA Implementtion Monitoring nd Trcking: Cross-Cutting Issues 4

5 Tble 2. Chnges in Lowest Cost Silver Premiums, in Selected Rting Ares in 18 Sttes, Colordo Stte Connecticut Rting Are Lowest Cost Silver Pln, 2015 Premium for 40-Yer-Old Averge Percentge Chnge in Lowest Cost Silver Premiums Across All Crriers,b Percentge Chnge in Lowest Cost Silver Pln Avilble on Mrketplce,b Rting Are 3: Denver, Auror, Lkewood $ % -15.7% * Rting Are 5: Grnd Junction $ % 2.7% Rting Are 2: Colordo Springs $ % -19.7% * Rting Are 1: Bridgeport, Stmford $ % -0.8% * Rting Are 2: Hrtford $ % 1.5% Delwre Rting Are 1: Entire Stte $ % 5.0% District of Columbi Rting Are 1 $ % 1.3% * Mine Rting Are 1: Portlnd $ % -3.1% * Mrylnd Michign Minnesot Rting Are 1: Bltimore $ % -0.7% * Rting Are 3: Wshington DC Suburbs $ % -0.9% * Rting Are 2: 12 Rurl Counties $ % 11.7% * Rting Are 1: Detroit $ % 15.2% Rting Are 7: Lnsing $ % 9.8% * Rting Are 15: 13 Rurl Counties $ % 10.6% * Rting Are 8: Minnepolis $ % 17.9% * Rting Are 2: Duluth $ % -3.4% * Montn Rting Are 1: Billings $ % -5.4% * New York Ohio Oregon Rting Are 4: New York City $ % 3.5% * Rting Are 2: Bufflo $ % -4.8% Rting Are 7: 13 Rurl Counties $ % -17.5% * Rting Are 9: Columbus $ % 2.3% Rting Are 4: Cincinnti $ % 7.4% * Rting Are 11: Clevelnd $ % -1.7% * Rting Are 1: Portlnd $ % 1.3% * Rting Are 3: Slem $ % 0.6% * Rting Are 6: 15 Rurl Counties $ % -2.9% Rhode Islnd Rting Are 1: Entire Stte $ % -10.8% * South Dkot Rting Are 2: Sioux Flls $ % 1.6% Tennessee Virgini Wshington Rting Are 4: Nshville $ % 7.2% * Rting Are 6: Memphis $ % -0.1% * Rting Are 8: 16 Rurl Counties $ % 10.2% * Rting Are 7: Richmond $ % 5.2% Rting Are 9: Virgini Bech, Norfolk $ % 1.3% * Rting Are 10: Wshington D.C. Suburbs $ % 5.1% * Rting Are 1: Settle $ % -4.2% Rting Are 4: Spokne $ % -6.9% Rting Are 5: 14 Rurl Counties $ % -6.2% Rting Are 2: Chrleston $ % 9.0% West Virgini Rting Are 9: 9 Rurl Counties $ % 7.6% * Dt re bsed on selected rting res. b * Indictes chnge in crrier with lowest cost silver pln vilble, from. ACA Implementtion Monitoring nd Trcking: Cross-Cutting Issues 5

6 METHODS Our nlysis focuses exclusively on compring ech crrier s lowest cost silver mrketplce pln premium for 40-yer-old in chosen rting res within 17 sttes nd the District of Columbi in 2014 nd Reltive chnges in premiums for 40-yer-old re identicl to those for ny other ge becuse of the fixed-ge rting curves required under the ACA. We gthered 2015 premium dt for the study sttes nd regions from publicly vilble rte filings posted on the websites of stte deprtments of insurnce. We obtined the 2014 premiums from combintion of the websites of stte deprtments of insurnce (some posted the rtes in esily ccessible tbles), the 2014 rte-filing documents, or the respective mrketplce websites. In some instnces, publicly vilble filings do not include complete rte tbles; however, the rtes of interest cn be clculted from the pln specific bse vlue (i.e., the consumer djusted index rte) nd pplying the provided rte fctors (geogrphic rting re, ge rting fctor, nd tobcco usge fctor). We selected only sttes tht, s of erly October 2014, hd completed the rte review process nd closed the filings for ll of the crriers prticipting on the mrketplce for We updted the nlysis by re-checking mrketplce websites fter the strt of open enrollment on November 15. For most of the selected sttes, we studied multiple rting res: one to two mjor metropolitn res nd one rurl rting re. In the cses of Mine, Montn, nd South Dkot, smll popultion size nd popultion concentrtion in the lrgest metropolitn re led us to include only one rting re. Two of our study sttes Delwre nd Rhode Islnd plus the District of Columbi hve only one rting re, which spns the entire mrketplce. The nlysis focuses on silver level plns becuse tht tier of coverge is used to determine the size of dvnced premium tx credits vilble to the modest income popultion to support the purchse of helth insurnce coverge under the ACA through the mrketplces. We do our nlysis on the silver plns s these re the most frequently purchsed nd re the only options tht llow subsidized individuls to utilize vilble cost-shring reductions. We study the lowest cost silver option offered by ech crrier s these re their most competitive plns in this tier nd best llow n nlysis of competitive dynmics in the mrket. Of course, price is not the only fctor on which crriers compete. Others of importnce to consumers include provider networks, deductibles, nd out-of-pocket limits. We compiled the premium price for the lowest cost silver pln vilble from ech crrier for 40-yer-old nonsmoker for 2014, long with the lowest cost silver pln premiums pproved for ech crrier prticipting in We then clculted the percentge chnge in the lowest monthly premium price from the 2014 pln yer to the 2015 pln yer for ech crrier. In some cses, we were unble to clculte the percentge chnge for one of the following resons: () the crrier ws new entrnt to the mrketplce in 2015, (b) the crrier expnded its service into new rting re in 2015, (c) the crrier left the mrketplce, or (d) prt of the filing ws incomplete or missing (technicl issue). In some cses, prticulr plns my only be offered in portion of rting re; this is not tken into ccount in the clcultions provided. Some crriers introduced new products for 2015, often helth mintennce orgniztion (HMO) or exclusive provider orgniztion (EPO) to lower premium costs nd to become more competitive in prticulr re. Unless the new products were filed under seprte subsidiries, such chnge my mnifest s significnt decrese in the lowest cost option offered by crrier; we hve noted such chnges where possible. We computed the reltive chnges in lowest cost silver plns between 2014 nd 2015, by rting re nd cross ll rting res selected in stte. We lso clculted the reltive chnge in the crriers lowest cost silver pln premium tht is vilble on the mrketplce in 2014 to the lowest cost silver pln tht will be vilble in 2015, ignoring possible chnges in the crrier tht offers the lowest cost option. This ltter clcultion provides n indictor of whether the silver tier of coverge is getting more or less expensive in prticulr re. We do not hve the enrollment dt necessry to clculte weighted verges, however. In the tbles tht follow, ll monthly premiums re rounded to the nerest dollr nd reltive chnges re rounded to the nerest one-tenth percent. ACA Implementtion Monitoring nd Trcking: Cross-Cutting Issues 6

7 STATE-BY-STATE FINDINGS IN SELECTED RATING AREAS As described in the methods section, we hve identified nd re reporting on only the lowest cost silver pln premium offered by ech insurnce crrier prticipting in ech rting re studied in 17 sttes plus the District of Columbi. Thus, ny references to premium chnges, verge premiums, or reltive chnges in verge premiums refer to the crriers lowest cost silver pln premiums in given yer or yers. At times, reported premium chnges reflect chnge in the price being chrged for the sme pln offered by the crrier in both yers; t other times, crrier introduces n dditionl or replcement pln in All premiums reported re monthly premiums prior to ny pplied subsidy for 40-yer-old single dult; reltive chnges between the two yers will be identicl for ll ges, however, becuse of fixed premium rtios between dults of ech ge under the lw. In ddition, verges t the stte level include dt only on the rting res studied. Colordo Between 2014 nd 2015, Colordo chnged the definitions of some of its premium rting res. We report only on three mrkets tht remined the sme cross the two yers; the chnges in res re the reson we do not include rurl rting region for the stte. Colordo hs hd considerble competition in ech of the three mrkets we exmined. Overll, crriers lowest cost silver pln premiums fell cross the stte by 8.0 percent, on verge, for 2015 (see Tble 3). In the Denver region, intense competition mong 10 crriers in 2014 cused premiums to fll by 4.0 percent for In 2014, Kiser Permnente nd Humn hve the lowest cost premiums; most other plns hve considerbly higher premiums. Both Kiser nd Humn re lowering their premiums by bout 2.0 percent for 2015, to $240 nd $244 respectively. But Colordo HelthOP, co-op, chose to ggressively mrket for 2015 nd is lowering its monthly premiums from $273 in 2014 to $207 in 2015, 24.3 percent reduction. The co-op will be the lowest cost crrier in Denver for the 2015 pln yer. The premium for the lowest cost silver pln offered in Denver in 2015 will be 15.7 percent lower (see Tble 2) thn the lowest cost pln offered in 2014 ($245 offered by Kiser Permnente in 2014, compred to $207 offered by the Colordo HelthOP in 2015). Access Helth Colordo, lso known s New Helth Ventures, reduced its lowest cost silver premium by bout 40 percent in 2015 by introducing n EPO pln into the mrket for the first time, but its lowest cost silver premium is still more expensive thn the equivlent plns from the co-op, Kiser, nd Humn in the second yer. HMO Colordo, product of Anthem, lowered its premiums slightly, but it is still more expensive thn mny of its competitors. In Grnd Junction, premiums re flling by 10.2 percent, primrily becuse of premium reductions of more thn 20 percent by both Colordo HelthOP nd Access Helth Colordo. Rocky Mountin Helth Pln, lrge crrier bsed in Grnd Junction, will increse the premium of its lowest priced silver pln by 2.7 percent, but it will remin the lowest cost crrier in this region. In Colordo Springs, Humn is the lowest cost crrier in 2014 by considerble mrgin. It will reduce its premiums for 2015 by 3.9 percent. Colordo HelthOP nd New Helth Ventures re ech introducing n EPO pln into the mrket for 2015, thereby reducing the premiums for its lowest cost silver offerings (previously PPO plns) by lmost 40 percent. Colordo HelthOP will offer the lowest cost silver pln in 2015, with premiums significntly below those of the lowest cost crrier in 2014 ($194 per month in 2015 versus Humn s $242 per month in 2014). Kiser Permnente is lso extremely competitive in this mrket in 2014 nd will remin so in Overll, the Colordo Springs mrket will see n verge reduction of 9.8 percent in its crriers lowest cost silver plns. Thus, the Colordo mrket, led by two crriers tht set premiums very ggressively, will see considerble premium reductions in Connecticut Among ll of the sttes we exmined, Connecticut hs the highest verge premiums cross its crriers lowest cost silver plns (see Tble 1); however, premiums will fll in 2015 in the two rting res we studied by n verge of 2.4 percent. The lowest cost crrier in Connecticut in 2014 in Bridgeport nd Hrtford, the two rting regions studied, is ConnectiCre Benefits Inc. (see ACA Implementtion Monitoring nd Trcking: Cross-Cutting Issues 7

8 Tble 3. Lowest Cost s for 40-Yer-Old, by Crrier, in Selected Rting Ares, in 2014 nd 2015 in Colordo Issuer Nme Rting Are 3: Denver, Auror, Lkewood Percentge Chnge, Kiser Permnente $245 $ % Humn $250 $ % Colordo HelthOP $273 $ % Denver Helth Medicl Pln $275 $ % Colordo Choice Helth Pln $294 $ % Rocky Mountin Helth Plns $309 $ % Cign $318 $ % HMO Colordo (Anthem) $320 $ % All Svers $381 $ % New Helth Ventures (Access Helth Colordo) b $454 $ % Rting Are Averge 4.0% Rting Are 5: Grnd Junction Rocky Mountin Helth Plns $285 $ % HMO Colordo (Anthem) $359 $ % Colordo HelthOP $408 $ % New Helth Ventures (Access Helth Colordo) b $503 $ % Rting Are Averge -10.2% Rting Are 2: Colordo Springs Humn $242 $ % Colordo Choice Helth Pln $264 $ % Kiser Permnente $270 $ % Rocky Mountin Helth Plns $274 $ % HMO Colordo (Anthem) $300 $ % Colordo HelthOP c $309 $ % New Helth Ventures (Access Helth Colordo) b $416 $ % Rting Are Averge -9.8% Averge of Select Rting Ares -8.0% b Access Helth Colordo is subsidiry of New Helth Ventures. New Helth Ventures introduced n exclusive provider orgniztion (EPO) product for This tble compres the 2014 preferred provider orgniztion (PPO) product to the 2015 EPO product. c Colordo HelthOP expnded its EPO product into Rting Are 2; the comprison is 2014 PPO to 2015 EPO. Tble 4). Anthem Blue Cross Blue Shield is the lrgest crrier in the stte nd hs the second lowest cost mrketplce premiums in those rting res in For 2015, Anthem will keep its lowest cost silver premiums in Bridgeport essentilly fixed, but it will become the highest cost crrier. HelthyCT Inc., the stte s co-op, reduced its lowest cost silver pln premiums by 12.8 percent in Bridgeport. As result of those reductions nd becuse ConnectiCre is incresing its rtes very modestly, the ordering of crriers by their lowest cost silver offerings chnged. For 2015, HelthyCT s lowest silver pln is more competitive thn ConnectiCre s yet the 2015 premiums cross those two crriers re much closer to ech other thn ws the cse in ACA Implementtion Monitoring nd Trcking: Cross-Cutting Issues 8

9 Tble 4. Lowest Cost s for 40-Yer-Old, by Crrier, in Selected Rting Ares, in 2014 nd 2015 in Connecticut Issuer Nme Percentge Chnge, Rting Are 1: Bridgeport, Stmford ConnectiCre Benefits Inc. $383 $ % Anthem Blue Cross Blue Shield $421 $ % HelthyCT Inc. $436 $ % Rting Are Averge -3.1% Rting Are 2: Hrtford ConnectiCre Benefits Inc. $316 $ % Anthem Blue Cross Blue Shield $328 $ % HelthyCT Inc. $363 $ % Rting Are Averge -1.7% Averge of Select Rting Ares 2.4% A similr pttern occurred in Hrtford. ConnectiCre hs the lowest cost silver pln premium for 2014, but premium decrese by HelthyCT nd smll (less thn 2 percent) increses by ConnectiCre nd Anthem in 2015, men tht the premium spred hs tightened. For 2015 Anthem s nd HelthyCT s lowest cost silver offerings will be lmost identicl nd much closer to ConnectiCre s thn in Within nd cross the two rting res, the substntil reduction by HelthyCT hs demonstrted competitive response to ConnectiCre s ggressive first-yer premiums. Premiums for the lowest cost crrier in 2015 will be less thn those of the lowest cost crrier in 2014 by 0.8 percent in Bridgeport nd will increse by only 1.5 percent in Hrtford (see Tble 2). Delwre Delwre is smll stte without mny mrketplce competitors; nonetheless, the 2015 premium increses for the lowest cost silver offerings will be low, verging less thn 4 percent (Tble 5). Highmrk Blue Cross Blue Shield is the primry insurer in Delwre. Aetn Helth, hving recently merged with Coventry, is the only other competitor in the stte s mrketplce, which hs one rting re for the entire stte. Highmrk offers the lowest cost silver pln in the stte s mrketplce in both 2014 nd The gp between Highmrk s nd Aetn/ Coventry s lowest cost silver plns will be closing slightly for 2015, however, becuse Highmrk is incresing its lowest cost silver premium by 5 percent while Aetn/ Coventry is incresing its by less thn 3 percent. Tble 5. Lowest Cost s for 40-Yer-Old, by Crrier, in 2014 nd 2015 in Delwre Issuer Nme Percentge Chnge, Rting Are 1: Entire Stte Highmrk Blue Cross Blue Shield Delwre $286 $ % CoventryOne/Aetn Helth b $319 $ % Aetn Life Insurnce Co. b N/A $337 N/A Stte Averge 3.7% b. Aetn purchsed Coventry in lte For the 2014 pln yer, plns re filed under CoventryOne. For 2015, the filing will be under Aetn Helth nd Aetn Life Insurnce. Aetn Life Insurnce offers PPOs, while Aetn Helth offers HMOs. N/A indictes not pplicble. ACA Implementtion Monitoring nd Trcking: Cross-Cutting Issues 9

10 District of Columbi In Wshington, D.C., nother mrketplce with single rting re, the lowest cost silver pln premiums re reltively low for 2014 nd will remin so in 2015 (see Tble 6), incresing by n verge of 2.4 percent. CreFirst Blue Shield hs the lowest cost silver pln offering in 2014, followed by Kiser nd then Aetn. CreFirst Blue Shield will increse the premiums for its lowest cost silver pln by 7.4 percent for 2015, while Kiser will reduce its by 0.5 percent. The result is tht Kiser s 2015 option will be bout 6 percent less thn CreFirst s lterntive ($242 vs. $256). Aetn s lowest cost silver option premium remins significntly higher thn the other two, despite virtully no increse in premium for Overll, the increse in the lowest cost silver option vilble in the District of Columbi is only 1.3 percent between 2014 nd 2015 (see Tble 2). Mine The Portlnd mrket in Mine hs two competitors in 2014, with the Mine Community Helth Options (co-op) lowest cost silver pln hving slightly lower premiums thn Anthem (see Tble 7). For 2015, Anthem will reduce its premium by 7.5 percent nd become the lowest cost Tble 6. Lowest Cost s for 40-Yer-Old, by Crrier, in 2014 nd 2015, in the District of Columbi Issuer Nme Rting Are 1: Entire District Percentge Chnge, CreFirst BlueCross BlueShield $238 $ % Kiser Permnente $243 $ % Aetn $306 $ % District Averge 2.4% Issuer Nme pln. On verge, crriers lest expensive premiums in the Portlnd region will fll by 4.0 percent in 2015 compred to Hrvrd Pilgrim is the one new entrnt for the mrketplce s second yer. Anthem, prticipnt in 2014, will introduce multistte pln, but ech of these plns will hve higher premiums thn the incumbents. Mrylnd All three Mrylnd rting res studied Bltimore; the suburbs of Wshington, D.C.; nd 12 rurl counties in the southern prt of the stte hve significnt crrier mrketplce prticiption in 2014, nd prticiption in ll of them will increse in 2015 (see Tble 8). Across ll three rting regions, crriers lowest cost premiums will sty virtully constnt, incresing by only n verge of 0.1 percent. Two of the crriers prticipting in the Mrylnd mrketplce hve multiple subsidiries listing seprte plns nd premiums. CreFirst subsidiries include CreFirst of Mrylnd, d.b.. Blue Cross Blue Shield; BlueChoice, Inc., d.b.. CreFirst BlueCross BlueShield; nd Group Hospitl nd Medicl Services (the ltter is not included in our tble becuse its plns nd premiums re identicl to those of CreFirst of Tble 7. Lowest Cost, for 40-Yer-Old, by Crrier, in 2014 nd 2015 in Mine Percentge Chnge, Rting Are 1: Portlnd Mine Community Helth Options (Co-op) $283 $ % Anthem $297 $ % Hrvrd Pilgrim b N/A $366 N/A Anthem (multistte pln) c N/A $305 N/A Rting Are Averge 4.0% b Hrvrd Pilgrim did not offer mrketplce plns in c No multistte pln ws offered in N/A indictes not pplicble. ACA Implementtion Monitoring nd Trcking: Cross-Cutting Issues 10

11 Mrylnd). United Helthcre of the Mid-Atlntic is new entrnt in the Mrylnd mrketplce in However, its subsidiry, All-Svers, prticipted in 2014 nd will continue in the mrketplce in 2015 longside United Helthcre. Issuer Nme Rting Are 1: Bltimore Blue Choice, which offers the CreFirst Blue Cross Blue Shield HMO, hs the lowest cost silver premium in Bltimore in 2014, followed by the CreFirst PPO (lso its multistte pln offering), the Evergreen Coopertive, nd Kiser Permnente. CreFirst Blue Choice lso hs the lowest cost 2014 silver pln in the other two rting res studied. Tble 8. Lowest Cost s for 40-Yer-Old, by Crrier, in Selected Rting Ares, in 2014 nd 2015 in Mrylnd Percentge Chnge, BlueChoice, Inc., d.b.. CreFirst BlueCross BlueShield b $228 $ % CreFirst of Mrylnd, d.b.. Blue Cross Blue Shield (MSP) b $240 $ % Evergreen Coopertive $252 $ % Kiser Permnente $270 $ % All-Svers c $339 $ % Cign N/A $340 N/A United Helthcre of the Mid-Atlntic d N/A $253 N/A Rting Are Averge 1.8% Rting Are 3: D.C. Suburbs BlueChoice, Inc., d.b. CreFirst BlueCross BlueShield b $213 $ % CreFirst of Mrylnd, d.b.. Blue Cross Blue Shield (MSP) b $223 $ % Evergreen Coopertive $239 $ % Kiser Permnente $270 $ % All-Svers c $339 $ % Cign N/A $345 N/A United Helthcre of the Mid-Atlntic d N/A $259 N/A Rting Are Averge 1.1% Rting Are 2: 12 Rurl Counties in the Southern Prt of the Stte BlueChoice, Inc., d.b.. CreFirst BlueCross BlueShield b $224 $ % CreFirst of Mrylnd, d.b.. Blue Cross Blue Shield b $235 $ % Evergreen Coopertive $239 $ % All-Svers c $339 $ % Cign N/A $345 N/A Rting Are Averge 3.3% Averge of Select Rting Ares 0.1% b Crefirst-owned compnies submitted three seprte filings for 2015: Crefirst of Mrylnd, Crefirst BlueChoice, nd Group Hospitliztion nd Medicl Services (GHPS). GHPS filing hs the sme pln nmes nd premium prices s Crefirst nd is therefore not included. c All-Svers is subsidiry of United Helthcre. d United Helthcre nd Cign re new entrnts to the mrket for N/A indictes not pplicble. ACA Implementtion Monitoring nd Trcking: Cross-Cutting Issues 11

12 In 2015, CreFirst s Blue Choice HMO products in ech of the three rting res will be bout 7 percent more expensive thn the crrier s 2014 offerings. The CreFirst PPO product, by comprison, will experience premium increse of bout 14 percent in ll three rting regions. Evergreen Coopertive will reduce its lowest cost silver premiums by 6.9 percent in Bltimore, 3.3 percent in the D.C. suburbs, nd 0.8 percent in the rurl res. Kiser Permnente will lower its lowest cost silver premiums by 16 percent in Bltimore nd the D.C. suburbs (the crrier does not prticipte in the stte s southern rurl counties). As result, both Evergreen nd Kiser will hve lower premiums thn Blue Choice in Bltimore, Kiser will be on pr with BlueChoice in the D.C. suburbs, nd Evergreen will lso be quite competitive. Evergreen will hve slightly lower premium thn Blue Choice in the rurl regions in southern Mrylnd in 2015, just edging Blue Cross out s the lowest cost crrier. All-Svers nd Cign premiums will be well bove the Evergreen nd Crefirst options in 2015, despite All- Svers premium decrese. Thus, the stte s dominnt crrier, CreFirst, no longer offers the lowest cost silver pln through its Blue Choice subsidiry. Kiser nd Evergreen, the stte s co-op, offer less expensive products in Bltimore. Kiser offers less expensive product in the D.C. suburbs, nd Evergreen is becoming incresingly competitive in the D.C. suburbs. Evergreen s 2015 lowest cost premium will be slightly less thn tht of CreFirst Blue Choice in the rurl res included in the study. Michign In Michign, we studied three rting res: Detroit, Lnsing, nd the rting re tht includes 13 rurl counties in the northern minlnd of the stte (see Tble 9). The verge premium decrese cross ll three rting regions will be 1.4 percent in All three rting res hve lrge number of crriers in the 2014 mrketplce (10 in Detroit, five in Lnsing, nd seven in the rurl re). Blue Cross offers plns through subsidiry (Blue Cre Network) throughout the stte. In the Detroit mrket, the crriers lowest cost silver premium will fll by 3.9 percent on verge in In 2014, Humn nd Totl Helthcre s lowest cost silver premium offerings re the most competitive, followed closely by the Blue Cre Network of Michign nd the McLren Helth Pln. Humn will increse its premiums by 15.2 percent for 2015 nd Totl Helthcre will increse its premiums by 8.5 percent. The Blue Cre Network nd Blue Cross Blue Shield of Michign will decrese premiums in 2015 by bout 3 percent. As result, Humn s lowest cost silver pln will remin the lowest cost silver offering in the Detroit mrket. In Lnsing nd the rurl re in the northern minlnd, ll crriers remining in the mrketplce will increse premiums for their lowest cost silver plns in 2015, with the exception of Consumers Mutul. Despite significnt decreses, Consumers Mutul will remin very high cost option in the rurl region. Physicins Plus will enter the Lnsing Mrket in 2015 nd will be the lowest cost option vilble there. The lrgest increses in these res reflect the mrket power of the Blue Cross plns in those regions, which gives them significnt leverge in negotiting with providers. The Blue Cre Network of Michign nd the Blue Cross Blue Shield plns re incresing their 2015 premiums of their lowest cost silver option by 12.9 percent nd 10.6 percent respectively in Lnsing nd 11.1 percent nd 10.7 percent in the rurl re. Their competitors, with the exception of Allince Helth nd Life in the rurl re, will increse their premiums by considerbly less. Despite its lrge increses the Blue Cre Network will remin the lowest cost crrier in the rurl re in Minnesot Minnesot s rting res of Minnepolis nd Duluth will experience very little chnge in verge premiums for their crriers lowest cost plns in 2015, nd the stte s premiums will remin mong the lowest in the country (see Tble 10). However, significnt shke-up will occur for mny Minnepolis re mrketplce enrollees in the second yer of reform. The region s lowest cost crrier, PreferredOne, will leve the mrketplce in 2015, despite hving obtined lrge mrket shre in 2014; the crrier will lso drmticlly increse premiums for its off-mrketplce individul mrket enrollees, citing high clims costs. 11 The next lowest cost pln in 2014, HelthPrtners, will increse its premiums in 2015 by 9.4 percent but will be the re s lowest cost crrier for UCre will hve virtully identicl premiums to HelthPrtners in 2015, following 10 percent reduction from its 2014 lowest silver premium option. Blue Cross Blue Shield hs three subsidiries prticipting in the Minnepolis region: BCBS Minnesot, BCBS Minnesot ( multistte pln, or MSP), nd Blue Plus the ltter two re newly entering the mrket in Although still competitive, the Blue ACA Implementtion Monitoring nd Trcking: Cross-Cutting Issues 12

13 Tble 9. Lowest Cost s for 40-Yer-Old, by Crrier, in Selected Rting Ares, in 2014 nd 2015 in Michign Issuer Nme Humn Medicl Pln of Michign, Inc. Rting Are 1: Detroit Percentge Chnge, $190 $ % Totl Helth Cre USA, Inc. $224 $ % Blue Cre Network of Michign $242 $ % McLren Helth Pln, Inc. $288 $ % Helth Allince Pln (HAP) $302 $ % Blue Cross Blue Shield of Michign $311 $ % Priority Helth $313 $ % Molin Mrketplce $327 $ % Allince Helth nd Life $337 $ % Consumers Mutul Insurnce of Michign $433 $ % Rting Are Averge -3.9% Rting Are 7: Lnsing Blue Cre Network of Michign $245 $ % McLren Helth Pln, Inc. $278 $ % Blue Cross Blue Shield of Michign $311 $ % Priority Helth $326 $ % Consumers Mutul Insurnce of Michign $440 $ % Physicins Plus N/A $269 N/A Rting Are Averge -1.5% Rting Are 15: 13 Rurl Counties in the Northern Minlnd Blue Cre Network of Michign $245 $ % McLren Helth Pln, Inc. $266 $ % Priority Helth $276 $ % Blue Cross Blue Shield of Michign $277 $ % Allince Helth nd Life $370 $ % Helth Allince Pln (HAP) b $370 N/A N/A Consumers Mutul Insurnce of Michign $411 $ % Rting Are Averge 1.1% Averge of Select Rting Ares -1.4% b Helth Allince Pln (HAP) is not prticipting in rting re 14 for N/A indictes not pplicble. ACA Implementtion Monitoring nd Trcking: Cross-Cutting Issues 13

14 Tble 10. Lowest Cost s for 40-Yer- Old, by Crrier, in Selected Rting Ares, in 2014 nd 2015 in Minnesot Issuer Nme Percentge Chnge, Rting Are 8: Minnepolis, St. Pul, Bloomington PreferredOne b $154 N/A N/A HelthPrtners $166 $ % Blue Cross Blue Shield Minnesot $201 $ % UCre $203 $ % Medic $211 $ % Blue Cross Blue Shield Minnesot (MSP) d N/A $249 N/A Blue Plus d N/A $205 N/A Rting Are Averge 1.3% Rting Are 2: Duluth HelthPrtners $213 $ % UCre $233 $ % Blue Cross Blue Shield Minnesot $235 $ % Medic c N/A $254 N/A Blue Cross Blue Shield Minnesot (MSP) d N/A $289 N/A Rting Are Averge 0.9% Averge of Select Rting Ares 0.2% b PreferredOne hs left the Mrketplce for c Medic hs entered rting re 2 for d BCBS MN (MSP) nd Blue Plus re subsidiries of BCBS MN nd re new entrnts in N/A indictes not pplicble. Cross Blue Shield subsidiries hve prices t the higher end of the spectrum. In Duluth, verge premiums will fll by bout 1.0 percent in UCre will displce HelthPrtners s the lowest cost option in the re, resulting from the former s significnt price cut nd the ltter s significnt price increse. Thus, overll, the selected Minnesot metropolitn res will continue to hve low-cost options vilble from rnge of competing crriers nd will experience little chnge in verge premiums. However, significnt numbers of 2014 enrollees in the Minnepolis re will be required to chnge their insurnce crrier in 2015 becuse of the exit of PreferredOne, tht region s lowest priced crrier. Also becuse of the exit, 2015 premiums for the lowest cost silver option will be bout 18 percent higher thn the lest expensive 2014 option in the Minnepolis re (see Tble 2). Montn In Montn, we exmined only one rting re, Billings, becuse of the smll size nd geogrphic concentrtion of the stte s popultion (see Tble 11). Overll, Billings premiums will fll by 1.2 percent on verge in The three crriers in this region re Blue Cross Blue Shield of Montn, Montn Helth Co-op, nd PcificSource Helth Plns. PcificSource hs the lowest silver pln premium for 40-yer-old in 2014 ($251), nd Blue Cross Blue Shield hs the highest premium of ech crrier s lowest cost offering ($274), but the premiums for ll three crriers lowest cost plns re quite close in In 2015, the Montn Helth Co-op s lowest cost silver pln will hve lrge premium decrese (11.2%), giving the co-op competitive price edge over PcificSource. In fct, premiums for the lowest cost Montn Helth Co-op silver pln in 2015 will be less thn ll of the crriers 2014 silver premiums. Becuse of the significntly lower co-op premium in 2015, the premium for Billings lowest cost silver option will fll by 5.4 percent in 2015 reltive to the lowest cost option vilble in 2014 (see Tble 2). ACA Implementtion Monitoring nd Trcking: Cross-Cutting Issues 14

15 Tble 11. Lowest Cost s for 40-Yer- Old, by Crrier, in Selected Rting Ares, in 2014 nd 2015 in Montn Issuer Nme Percentge Chnge, Rting Are 1: Billings PcificSource Helth Plns $251 $ % Montn Helth Co-Op $268 $ % Blue Cross nd Blue Shield of Montn $274 $ % Rting Ares Averge 1.2% New York We present dt from three rting res in New York: New York City, Bufflo, nd 13 rurl upstte counties (see Tble 12). Overll, premiums will increse in the three rting regions by n verge of 2.7 percent in Strong competition cross multiple crriers in New York City hs held premium growth to reltively low levels, with n verge reduction in ech crriers lowest cost silver offering of 2.4 percent. The lowest cost silver pln in the city s rting re in 2014 is from Metro Plus; the crrier s lowest cost silver premium in 2015 will be 6.5 percent higher thn in However, five of the 10 crriers prticipting in 2014 will hve lower premiums in 2015 compred to 2014; New York Fidelis by 1.7 percent, North Shore LIJ by 6.1 percent, Helthfirst by 11.9 percent, United by 15.2 percent, nd Affinity by 15.6 percent. As result, Affinity will replce Metro Plus with the lowest cost silver pln offered in 2015, followed closely by Helth Republic nd then Metro Plus. For the five crriers chrging higher premiums in 2015 thn in 2014 for their lowest cost silver plns, increses rnge from 2.5 percent (Oscr) to 7.3 percent (Empire Blue Cross). The stte s co-op, Helth Republic, which offers very low premiums for its products in 2014, will increse the price of its lowest cost silver offering by 4.0 percent in New York City in United, which chrged much higher rtes thn the other crriers in 2014, will reduce the price of its lowest cost silver option by 15.2 percent for Although United will remin the most expensive of the silver tier options, the djustments from 2014 levels will compress rtes for crriers lowest cost silver options in New York City in 2015 compred with Two new entrnts into this mrketplce in 2015 re MVP Helth nd Wellcre HMO, both towrd the more costly end of the distribution of offerings. In Bufflo, Helth Republic, the lowest cost silver pln crrier in 2014, will remin so in 2015, with the premium for its lowest cost option 4.8 percent lower in the coming yer. Fidelis will keep its lowest cost silver option premium roughly constnt for the new pln yer, keeping it s the second lowest cost crrier. BCBS of Western New York nd Independent Helth Benefits Corportion (IHBC) will both offer lower cost premium in 2015 thn they did in 2014, while Univer s lowest cost silver premium will be more thn 10 percent higher in 2015, keeping it the most expensive crrier in this rting re. The overll verge premium in Bufflo for the lowest cost silver plns offered by crriers will be bout the sme s in In the upstte rurl counties, premiums for the lowest cost silver plns will increse from 1.1 percent to 15.6 percent depending on the crrier, with n overll verge increse of 9.0 percent. Fidelis offers the lowest priced silver option in 2014 nd will increse its lowest premium by 5.6 percent for Interestingly, Helth Republic will enter the rting region in 2015 with premium ($278) fr less thn Fidelis s 2014 rtes, mking it the most price competitive option in 2015 by significnt mrgin. Severl commercil plns in the region hve substntilly higher premiums thn do either Helth Republic or Fidelis. Becuse of the entry of Helth Republic, the lowest silver premium in the re will decrese by 17.5 percent in 2015 (Tble 2). Ohio We studied three rting res in Ohio: Columbus, Cincinnti, nd Clevelnd. In those three metropolitn res, crriers lowest cost offerings will decrese, on verge, by 3.0 percent in All three mrkets re highly competitive in 2014, nd n dditionl crrier ACA Implementtion Monitoring nd Trcking: Cross-Cutting Issues 15

16 Tble 12. Lowest Cost s for 40-Yer- Old, by Crrier, in Selected Rting Ares, in 2014 nd 2015 in New York Issuer Nme Rting Are 4: New York City Percentge Chnge, Metro Plus $359 $ % Helth Republic Insurnce of New York Freelncers $365 $ % Oscr $385 $ % Emblem $385 $ % New York Fidelis $390 $ % Empire BlueCross BlueShield $418 $ % Northshore LIJ $420 $ % Helthfirst $440 $ % Affinity All Stndrd Benefits $440 $ % United Helth $642 $ % Wellcre HMO b N/A $472 N/A MVP Helth c N/A $417 N/A Rting Are Averge 2.4% Rting Are 2: Bufflo Helth Republic Insurnce of New York Freelncers $275 $ % New York Fidelis $338 $ % BlueCross BlueShield of Western New York $372 $ % Univer $430 $ % IHBC $432 $ % MVP Helth c N/A $365 N/A Rting Are Averge -0.8% Rting Are 7: 13 Rurl Counties Upstte New York Fidelis $337 $ % MVP Helth $373 $ % Excellus $443 $ % CDPHP $493 $ % BlueShield of Northestern NY $505 $ % Emblem d N/A $488 N/A Helth Republic Insurnce of New York Freelncers d N/A $278 N/A Rting Are Averge 9.0% Averge of Select Rting Ares 2.7% b Wellcre HMO entered rting re 4 for c MVP Helth entered rting res 2 nd 7 for d Emblem, nd Helth Republic entered rting re 7 for ACA Implementtion Monitoring nd Trcking: Cross-Cutting Issues 16

17 Tble 13. Lowest Cost s for 40-Yer- Old, by Crrier, in Selected Rting Ares, in 2014 nd 2015 in Ohio Issuer Nme Rting Are 9: Columbus Percentge Chnge, CreSource $298 $ % Prmount Insurnce Compny $317 $ % Anthem BlueCross BlueShield (community insurnce) $354 $ % MedMutul $418 $ % Molin Mrketplce N/A $ % InHelth N/A $307 N/A HelthAmericOne (Aetn Life Insurnce Compny) c N/A $303 N/A Rting Are Averge -5.1% Rting Are 4: Cincinnti Humn $216 $ % CreSource $238 $ % Ambetter $262 $ % HelthSpn $274 $ % Anthem BlueCross BlueShield $294 $ % MedMutul $359 $ % Molin Mrketplce $431 $ % InHelth N/A $300 N/A Rting Are Averge -3.7% Rting Are 11: Clevelnd Kiser Foundtion Helth Pln of Ohio b $246 $ % CreSource $249 $ % MedMutul $286 $ % HelthSpn b $299 $ % Prmount Insurnce Compny $316 $ % Anthem BlueCross BlueShield $320 $ % SummCre $321 $ % Molin Mrketplce $377 $ % HelthAmericOne (Aetn Life Insurnce Compny) c N/A $283 N/A Ambetter N/A $242 N/A InHelth N/A $325 N/A Rting Are Averge -0.1% Averge of Select Rting Ares -3.0% b Kiser Foundtion Helth Pln merged with HelthSpn; Kiser plns re now dministered by HelthSpn. c Aetn is new entrnt to the mrket for 2015; plns will be dministered by HelthAmericOne. N/A indictes not pplicble. ACA Implementtion Monitoring nd Trcking: Cross-Cutting Issues 17

18 HelthAmericOne will enter the Columbus nd Clevelnd mrketplce regions in The presence of previously Medicid-only plns, including CreSource, resulted in firly low premiums in 2014 reltive to the other mrkets studied (see Tble 2), while stbility or premium decreses in number of plns will led to low verge premium growth in CreSource hs by fr the lowest premiums in Columbus in Moreover, its lowest cost 2015 silver offering will be 2.3 percent more thn its 2014 option, but keeping CreSource the lowest cost crrier. Molin, which begn 2014 with very high premiums, will hve 2015 option tht costs 32.9 percent less, which will mke it the second-lowest cost crrier in the re. Anthem Blue Cross Blue Shield will increse the premiums for their most competitive option considerbly. Cincinnti insurers hve strong competition in 2014 from Humn nd two Medicid plns, CreSource nd Ambetter ( product of Centene Corportion). The ltter two will lower their 2015 premiums, while Humn will increse its by 16.7 percent. Combined with very lrge (34.8 percent) decrese in Molin s premium nd modest decrese in HelthSpn s premium, overll, premiums in Cincinnti will fll by n verge 3.7 percent cross the crriers lowest cost silver premiums. A similr pttern cn be seen in Clevelnd. Kiser Permnente hs the lowest cost silver premium option in 2014, followed closely by CreSource. Kiser merged with HelthSpn, nd the newly combined firm s lowest cost option will be 9.1 percent more expensive thn Kiser s 2014 offering nd 10.5 percent less thn HelthSpn s. CreSource will increse its 2015 premium modestly by 1.4 percent, mking it the lowest cost crrier, followed by the combined Kiser/HelthSpn venture. Molin will reduce its lowest cost premium by 26.4 percent, mking it strong competitor. Oregon We studied three rting res in Oregon: Portlnd, Slem, nd the 15 rurl counties in the northest prt of the stte (see Tble 14). On verge, premiums for the crriers lowest cost options will fll by 3.0 percent between 2014 nd 2015 in the res we exmined. All three regions hve lrge numbers of prticipting insurers. Mod Helth hs the lowest premium silver option in ech of those three res in 2014 but will increse the premiums by bout 10 percent in the Portlnd nd Slem rting res in Menwhile, in both of those res, the Providence Helth Pln will come into 2015 more ggressively, lowering its lowest cost silver option prices by 16.1 percent in Portlnd nd by 22.1 percent in Slem, mking Providence the lowest price crrier in these rting res for In fct, most of the crriers in ll three of the rting res studied re lowering the cost of their most competitively priced silver options in BridgeSpn, Regence Blue Shield subsidiry, will reduce the premium for its lowest cost silver pln by 14.2 percent in Portlnd, 10.1 percent in Slem, nd 11.2 percent in the rurl counties. In the rurl mrket in Oregon, Mod Helth will reduce its premiums by 2.9 percent nd will remin the lowest cost crrier for A notble exception to the premiumlowering trend is Helth Republic, which is co-op tht lso sells coverge in New York nd which will increse its lowest cost pln premiums in Slem nd in the rurl re by 23.6 percent nd 17.5 percent, respectively. On verge, however, low-cost premiums in the rurl region will fll by 1.8 percent. As result of the widespred premium decreses, those res will see compression in the rnge of crriers lowest cost silver offerings, which is n outcome of the highly competitive insurnce mrkets. Rhode Islnd Rhode Islnd (see Tble 15) hs one rting re spnning the entire stte nd three crriers prticipting in its mrketplce in 2015, up from two in BlueCross BlueShield of Rhode Islnd hs the lowest premium silver pln in 2014, but its 2015 lowest cost option will be priced 10.4 percent higher. Menwhile, Neighborhood Helth Pln will offer silver option tht costs 17.6 percent less thn its lest expensive offering in 2014, llowing it to gin significnt competitive edge over BlueCross BlueShield of Rhode Islnd in United Helthcre enters the nongroup mrketplce in 2015, setting its premiums between its two competitors. Tken together, in 2015, consumers in Rhode Islnd will be ble to obtin silver tier pln option tht costs 10.8 percent less thn the lest expensive option they could purchse in 2014 (see Tble 2). South Dkot We exmined the Sioux Flls rting re in South Dkot, which hs three mrketplce prticipting crriers in 2014 (see Tble 16). South Dkot s BlueCross BlueShield pln does not prticipte in the mrketplce. Two smller plns Aver Helth Plns nd Snford Helth Pln, together with DAKOTACARE offer plns in the mrketplce in Aver hs, by fr, the lowest ACA Implementtion Monitoring nd Trcking: Cross-Cutting Issues 18

19 Tble 14. Lowest Cost s for 40-Yer- Old, by Crrier, in Selected Rting Ares, in 2014 nd 2015 in Oregon Issuer Nme Rting Are 1: Portlnd, Greshm, Hillsboro Percentge Chnge, Mod Helth $194 $ % Helth Net Helth Pln of Oregon, Inc. b $215 N/A N/A Providence Helth Pln $234 $ % LifeWise Helth Pln of Oregon $248 $ % PcificSource Helth Plns $248 $ % Helth Republic Insurnce $256 $ % Kiser Permnente $256 $ % Oregon s Helth CO-OP $271 $ % BridgeSpn Helth Compny $278 $ % Rting Are Averge 5.1% Rting Are 3: Slem Mod Helth $201 $ % Helth Republic Insurnce $223 $ % PcificSource Helth Plns $248 $ % LifeWise Helth Pln of Oregon $254 $ % Kiser Permnente $256 $ % Providence Helth Pln $260 $ % Oregon s Helth CO-OP $271 $ % ATRIO Helth Plns $278 $ % BridgeSpn Helth Compny $296 $ % Rting Are Averge 2.0% Rting Are 6: 15 Rurl Counties in the Northest Prt of the Stte Mod Helth $213 $ % Helth Republic Insurnce $231 $ % LifeWise Helth Pln of Oregon $254 $ % PcificSource Helth Plns $293 $ % Oregon s Helth CO-OP $331 $ % BridgeSpn Helth Compny $338 $ % Rting Are Averge 1.8% Averge of Select Rting Ares -3.0%. b. Helth Net Pln of Oregon is not on the mrketplce for N/A indictes not pplicble. ACA Implementtion Monitoring nd Trcking: Cross-Cutting Issues 19

20 Tble 15. Lowest Cost s for 40-Yer- Old, by Crrier, in 2014 nd 2015 in Rhode Islnd Issuer Nme Rting Are 1: Entire Stte Percentge Chnge, Blue Cross & Blue Shield of Rhode Islnd $274 $ % Neighborhood Helth Pln of Rhode Islnd $296 $ % United Helthcre b N/A $284 N/A Stte Averge b United Helthcre entered the mrket for N/A indictes not pplicble. cost silver premium in 2014, the first yer of reform. Its premium is 61 percent of Snford Helth Pln s lowest cost silver option nd 78 percent of DAKOTACARE s lowest priced silver offering. In 2015, Aver will increse the premium for its lowest cost silver pln by 1.6 percent nd Snford will lower the cost of its lest expensive silver option by 1.0 percent, still leving Aver s the lowest cost crrier. DAKOTACARE will significntly lower its lowest cost silver pln premiums for 2015, by 37.7 percent, llowing it to be lmost identicl in premium to Aver s lowest cost offering. Tennessee We studied three rting res in Tennessee s mrketplce: Nshville, Memphis, nd 16 rurl counties in the middle-southern prt of the stte (see Tble 17). BlueCross BlueShield of Tennessee nd Community Helth Allince sell coverge in ll three of those rting res, wheres Cign Helth nd Humn prticipte in the Nshville nd Memphis res. Premium increses Issuer Nme 3.6% in 2015 for those regions of Tennessee re modest, on verge 1.2 percent, (Tble 17), due to lrge decreses by Community Helth Allince. However, BlueCross BlueShield nd Humn will increse their lowest cost option premiums significntly in BlueCross BlueShield is by fr the lowest cost crrier in ll three of those rting res in 2014, but the price of its lowest cost silver offerings will increse substntilly in the second yer of the mrketplces, going up by 21.7 percent in Nshville, 15.1 percent in Memphis, nd 19.9 percent in the rurl re studied. But even with such lrge reltive increses in 2015, BlueCross BlueShield will still be very competitive in ech of the three rting res in 2015, nd Tennessee premiums remin low by ntionl stndrds (see Tble 1). Community Helth Allince, the stte s co-op, will lower the premiums it chrges for its lowest cost silver offerings by 35.2 percent in Nshville, 37.2 percent in Memphis, nd 18.6 percent in the rurl counties, becoming the lowest cost crrier Tble 16. Lowest Cost s for 40-Yer- Old, by Crrier, in 2014 nd 2015 in South Dkot Percentge Chnge, Rting Are 2: Sioux Flls Aver Helth Plns $252 $ % Snford Helth Pln $322 $ % DAKOTACARE $414 $ % Averge of Select Rting Ares -12.4% ACA Implementtion Monitoring nd Trcking: Cross-Cutting Issues 20