Health Insurance Exchanges:

Appendix: Michigan Public Exchange Analysis Michigan Health & Hospital Association 2014 Kaufman, Hall & Associates, Inc. All rights reserved. 1 2015 Kaufman, Hall & Associates, Inc. All rights reserved.

Public Exchange Geographic Rating Areas Michigan Rating Areas The public exchange splits Michigan into 16 rating areas Insurers must price their plans at the same level for all counties within a rating area However, plans do not need to participate in all counties within a rating area Rating areas provide a useful way to summarize geographic variation within a state Note: See appendix for a list of counties included in each rating area. Michigan Health & Hospital Association 2015 Kaufman, 2014 Kaufman, Hall & Associates, Hall & Associates, Inc. All Inc. rights All rights reserved. reserved. 2

Michigan Geographic Rating Areas Rating Area Counties 1 Monroe, Wayne 2 Macomb, Oakland 3 St. Clair 4 Lenawee, Washtenaw, Livingston 5 Lapeer, Genesee, Shiawassee 6 Huron, Sanilac, Tuscola 7 Clinton, Eaton, Hillsdale, Ingham, Jackson 8 Arenac, Gratiot, Saginaw, Bay 9 Berrien, St. Joseph, Cass, Van Buren 10 Branch, Calhoun, Kalamazoo 11 Allegan, Barry 12 Ionia, Kent, Lake, Mason, Mecosta, Montcalm, Muskegon, Newaygo, Oceana, Osceola, Ottawa 13 Gladwin, Clare, Isabella, Midland 14 Antrim, Benzie, Charlevoix, Emmet, Grand Traverse, Manistee, Kalkaska, Missaukee, Wexford, Leelanau 15 Alcona, Alpena, Cheboygan, Chippewa, Crawford, Iosco, Mackinac, Montmorency, Ogemaw, Oscoda, Otsego, Presque Isle, Roscommon 16 Alger, Baraga, Delta, Dickinson, Gogebic, Houghton, Iron, Keweenaw, Luce, Marquette, Menominee, Ontonagon, Schoolcraft Michigan Health & Hospital Association 2015 Kaufman, 2014 Hall Kaufman, & Associates, Hall & Associates, Inc. All rights Inc. All reserved. rights reserved. 3

Rating Area Insurer Participation By Rating Area in the Michigan Public Exchange Issuer Name BCN of MI BCBSM Assurant Health Consumers Mutual HAP Harbor Health Plan Humana McLaren Meridian Molina Physicians Health Plan Priority Health Total Health Care UnitedHealthcare Comm. 1 o o 12 2 o o o 11 3 o o o o o o o 7 4 o o o o o o o 7 5 o o o o o 9 6 o o o o o o o 7 7 o o o o o o o 7 8 o o o o o o 8 9 o o o o o o o o o 5 10 o o o o o o o o 6 11 o o o o o o o o o 5 12 o o o o o o 8 13 o o o o o o 8 14 o o o o o o o o 6 15 o o o o o o o o 6 16 o o o o o o o o o o o 3 Total Total 16 16 14 15 9 1 3 12 2 2 5 15 3 2 115 Source: Health Insurance Marketplace Premiums for 2014 Databook (Information Current as of Sept 18, 2013). Michigan Health & Hospital Association 2015 Kaufman, 2014 Kaufman, Hall & Associates, Hall & Associates, Inc. All Inc. rights All rights reserved. reserved. 4

Michigan Exchange Rates Compare Favorably To Those of Other States $500 $450 $449 Monthly Premium of Second Lowest Cost Silver Plan in State 1 $400 $350 $300 $250 $200 $150 $100 $50 National Avg: $231 $207 $158 $0 AK WY IN ME NC NJ LA WI MS ND WV DE AR MO Avg. FL VA SC GA OH AL NE SD IA UT TX MI NH MT PA IL KS OK TN NM AZ Note: 1) Age weighting for all states is based on expected age distribution in the Marketplaces, estimated by the RAND Corporation. Source: APSE Issue Brief, Health Insurance Marketplace Premiums for 2015, Health and Human Services, avail able at: aspe.hhs.gov (accessed May 12, 2015). Michigan Health & Hospital Association 2015 Kaufman, 2014 Kaufman, Hall & Associates, Hall & Associates, Inc. All Inc. rights All rights reserved. reserved. 5

AK NC ND WV FL TN NE OK WY DE IA AL IL TX VA LA OH UT WI Avg. MI SC MO IN ME NJ PA AR AZ KS MT GA SD NM NH MS Michigan Exchange Rates Compare Favorably To Those of Other States 40% 30% 28% 2014-2015 % Change for Second-Lowest Cost Silver Premium 20% 10% National Avg:1% 0% -10% -20% -30% -2% -20% Note: 1) Age weighting for all states is based on expected age distribution in the Marketplaces, estimated by the RAND Corporation. Source: APSE Issue Brief, Health Insurance Marketplace Premiums for 2015, Health and Human Services, avail able at: aspe.hhs.gov (accessed May 12, 2015). Michigan Health & Hospital Association 2015 Kaufman, 2014 Kaufman, Hall & Associates, Hall & Associates, Inc. All Inc. rights All rights reserved. reserved. 6

Exchange Premiums Vary Materially Across the State Adult Age 27 Lowest Cost Silver Rates Rating Area Lowest Silver Rates 1 $180 2 $181 3 $220 4 $218 5 $199 6 $209 7 $222 8 $209 9 $231 10 $229 11 $224 12 $179 13 $209 14 $209 15 $223 16 $260 Plan Premiums Plan premiums (before subsidies) vary across the state Rates are lowest around Detroit, where plan competition is greatest Rates are highest in the Upper Peninsula, where the number of plans and exchange eligibles is low Source: Health Insurance Marketplace Premiums for 2014 Databook (Information Current as of Sept 18, 2013). Michigan Health & Hospital Association 2014 Kaufman, Hall & Associates, Inc. All rights reserved. 7 2015 Kaufman, Hall & Associates, Inc. All rights reserved.

Rating Area Rating Area Blue Cross and Priority Health Has the Lowest Premiums in Most Regions Lowest Cost Bronze Age 27 Monthly Premium Issuer 1 $148 2 $148 3 $170 4 $168 5 $159 6 $162 7 $175 8 $162 9 $179 10 $177 11 $173 12 $139 13 $162 14 $162 15 $172 16 $213 Lowest Cost Silver Age 27 Monthly Premium Issuer 1 $180 2 $181 3 $220 4 $218 5 $199 6 $209 7 $222 8 $209 9 $231 10 $229 11 $224 12 $179 13 $209 14 $209 15 $223 16 $260 Michigan Health & Hospital Association 2015 Kaufman, 2014 Kaufman, Hall & Associates, Hall & Associates, Inc. All Inc. rights All rights reserved. reserved. 8

Penetration Rate Exchange Products Have Limited Penetration Across the State 6.0% Michigan Exchange Penetration Rate By Rating Area 5.0% 4.0% Michigan Avg: 3.39% 3.0% 2.0% 1.0% 0.0% 14 2 16 3 6 11 9 4 15 12 1 5 10 7 13 8 Rating Area Source: https://www.enrollamerica.org/research-maps/maps/marketplace-enrollment-maps/ Michigan Health & Hospital Association 2015 Kaufman, 2014 Hall Kaufman, & Associates, Hall & Associates, Inc. All rights Inc. All reserved. rights reserved. 9

Michigan Public Exchange Plan Offerings by Issuer and Plan Type Issuer Name HMO PPO Grand Total Assurant Health 342 342 Blue Care Network of Michigan 560 560 Blue Cross Blue Shield of Michigan 996 996 Consumers Mutual Insurance of Michigan 884 884 HAP 104 161 265 Harbor Health Plan, Inc. 3 3 Humana, Inc. 20 20 McLaren Health Plan 175 175 Meridian Choice: Your Connection to Bronson Healthcare 12 12 Molina Marketplace 9 9 Physicians Health Plan 62 62 Priority Health 897 621 1,518 Total Health Care USA, Inc. 8 8 Total 1,880 3,004 4,884 Source: Health Insurance Marketplace Premiums for 2014 Databook (Information Current as of Sept 18, 2013). Michigan Health & Hospital Association 2015 Kaufman, 2014 Kaufman, Hall & Associates, Hall & Associates, Inc. All Inc. rights All rights reserved. reserved. 10

Monthly Premium (Pre-Subsidy) Limited Network Case Study: Rating Area 1 Minimum and Maximum Pre-Subsidy Premiums Adult Age 50 Bronze $500 $450 $461 $400 $350 $300 $250 $200 $328 $235-29% $331 $150 $100 $50 $- HMO Plan Type PPO Source: Health Insurance Marketplace Premiums for 2014 Databook (Information Current as of Sept 18, 2013). Michigan Health & Hospital Association 2015 Kaufman, 2014 Hall Kaufman, & Associates, Hall & Associates, Inc. All Inc. rights All reserved. rights reserved. 11