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Here's what CSR payment uncertainty looks like to insurers

Accounting for lost subsidies, premium increases for 2018 silver-tiered plans range from 7.1 to 38 percent, Kaiser Family Foundation finds.

Susan Morse, Senior Editor

Senate committee Chairman Lamar Alexander speaks with state health insurance commissioners about CSR payments on Sept. 6. Credit: C-SpanSenate committee Chairman Lamar Alexander speaks with state health insurance commissioners about CSR payments on Sept. 6. Credit: C-Span

Insurers have faced increasing instability in the Affordable Care Act market going into the start of open enrollment on Nov 1.

Nowhere is this felt more than in the price of premiums, after the federal government on Oct. 12 ended cost-sharing reduction payments to insurers.

The CSR payments flowed through insurers to lower-income consumers enrolled in silver-level plans to help enrollees pay for deductibles and out-of-pocket costs. Without the CSRs, insurers have said, premiums would have to increase by 20 percent for them to follow the ACA law in continuing to pay these subsidies.

Insurers had to submit their rates by Sept. 29, before the end of CSRs. Some submitted two sets of premium rates to account for the possibility of no payments. Other were able to change their rates. In two states, Vermont and North Dakota, according to a Kaiser Family Foundation report, insurers had to stick to their original premium price, leaving them to absorb the cost of paying the subsidies for lower-income consumers on their ACA silver plans.

Some insurers adjusted their rates only for silver-level plans within the marketplace, while others increased premiums for all ACA-compliant products both inside and outside the marketplace, the report said.

Insurers also differed on how they reported premiums without the CSRs.

The result is that premium increases for 2018 silver-tiered plans based on the end of CSRs range from 7.1 to 38 percent. But the average of a 19 percent increase is consistent with KFF projections, the report said.

The report shows by plan and state, how the loss of the payments has added CSR surcharges of 6.1 to 34.29 percent to the price of premiums.

Examples of 2018 Insurer Strategies and Rate Increases Attributed to Cost-Sharing Reduction Payments Ending, by State and Insurer

State Insurer Plans with CSR surcharges Amount of CSR surcharge
Arkansas Celtic Insurance Company Silver - Both on and off-exchange 11.5% added to the overall rate increase
  QCA Health Plan Silver - Both on and off-exchange 15.53% added to the overall rate increase
  QualChoice Life & Health Insurance Company Silver - Both on and off-exchange 16% added to the overall rate increase
  USAble Mutual Insurance Company Silver - Both on and off-exchange 6.4% added to the overall rate increase
California L.A. Care Health Plan Silver - Exchange only 21% added to silver exchange plans
  Blue Shield of California Silver - Exchange only 8% or 16% added to silver exchange plans
  Health Net Silver - Exchange only 12% or 13% added to silver exchange plans
  Molina Healthcare Silver - Exchange only 12% or 20% added to silver exchange plans
  Kaiser Permanente Silver - Exchange only 15% added to silver exchange plans
  Oscar Health Plan of California Silver - Exchange only 10% added to silver exchange plans
  Sharp Health Plan Silver - Exchange only 27% added to silver exchange plans
  Valley Health Plan Silver - Exchange only 12% added to silver exchange plans
  Chinese Community Health Plan Silver - Exchange only 16% added to silver exchange plans
  Western Health Advantage Silver - Exchange only 17% or 18% added to silver exchange plans
  Anthem Silver - Exchange only 11% added to silver exchange plans
Colorado Bright Health Insurance Company All metals levels 2.6% added to the overall rate increase
  Cigna Health and Life Insurance Company All metals levels 8.5% added to the overall rate increase
  Colorado Choice Health Plans All metals levels 6.1% added to the overall rate increase
  Denver Health Medical Plan All metals levels 12% added to the overall rate increase
  HMO Colorado All metals levels 1.6% added to the overall rate increase
  Kaiser Foundation Health Plan of Colorado All metals levels 8.2% added to the overall rate increase
  Rocky Mountain HMO All metals levels 14% added to the overall rate increase
Connecticut Anthem Blue Cross and Blue Shield of Connecticut Silver - Exchange only 16.7% added to silver exchange plans
  ConnectiCare Benefits Silver - Exchange only 16.7% added to silver exchange plans
Georgia Blue Cross Blue Shield Healthcare Plan of Georgia Not specified 16.9% added to the overall rate increase
  Alliant Health Plans Silver - Exchange only 22.3% added to the overall rate increase
  Kaiser Foundation Health Plan of Georgia Silver - Exchange only 26.1% added to the overall rate increase
  Ambetter of Peach State Not specified 27.2% added to the overall rate increase
Iowa Medica Insurance Company Silver - Unclear if all or exchange only 13.3% added to the overall rate increase
Indiana Celtic Insurance Company All metal levels 16.6% added to the overall rate increase
Kentucky CareSource Kentucky Silver - Both on and off-exchange 10.4% added to the overall rate increase
Maryland CareFirst BlueChoice Silver - Exchange only 20.14% added to silver exchange plans
  Group Hospitalization and Medical Services Silver - Exchange only 15% added to silver exchange plans
  CareFirst of Maryland Silver - Exchange only 15% added to silver exchange plans
  Kaiser Foundation Health Plan of the Mid-Atlantic States Silver - Exchange only 16.86% added to silver exchange plans
Maine Harvard Pilgrim Health Care Silver - Both on and off-exchange 17.3% added to silver plans
  Maine Community Health Options Silver - Exchange only 22% added to silver exchange plans
Michigan Blue Care Network of Michigan Silver - Both on and off-exchange 14.8% added to silver plans
  Blue Cross Blue Shield of Michigan Silver - Both on and off-exchange 9.9% added to silver plans
  McLaren Health Plan Community Silver - Exchange only 19% added to silver exchange plans
  Meridian Health Plan of Michigan Silver - Both on and off-exchange 38% added to silver plans
  Molina Healthcare of Michigan Silver - Both on and off-exchange 28.1% added to silver plans
  Physicians Health Plan Silver - Exchange only 20% added to silver plans
  Priority Health Silver - Both on and off-exchange 21.7% added to silver plans
Montana Montana Health Cooperative Silver - Both on and off-exchange 22% added to silver plans
  PacificSource Health Plans Silver - Both on and off-exchange 12.1% added to silver plans
North Carolina Blue Cross & Blue Shield of North Carolina Not specified 14% added to the overall rate increase
New Mexico CHRISTUS Health Plan Silver - Both on and off-exchange 12.6% added to the overall rate increase
Nevada Health Plan of Nevada Silver - Exchange only 11% added to silver exchange plans
New York Capital District Physicians Health Plan Silver - Both on and off-exchange 0.3% added to the overall rate increase
  Health Insurance Plan of Greater New York Silver - Both on and off-exchange 0.4% added to the overall rate increase
  Excellus Health Plan Silver - Both on and off-exchange 0.2% added to the overall rate increase
  New York State Catholic Health Plan Silver - Both on and off-exchange 0.6% added to the overall rate increase
  HealthNow New York Silver - Both on and off-exchange 0.4% added to the overall rate increase
  Independent Health Benefits Corporation Silver - Both on and off-exchange 0% added to the overall rate increase
  MetroPlus Health Plan Silver - Both on and off-exchange 1.1% added to the overall rate increase
  MVP Health Plan Silver - Both on and off-exchange 1.1% added to the overall rate increase
  Oscar Insurance Corporation Silver - Both on and off-exchange 0.1% added to the overall rate increase
  UnitedHealthcare of New York Silver - Both on and off-exchange 0.5% added to the overall rate increase
  Healthfirst PHSP Silver - Both on and off-exchange 1.1% added to the overall rate increase
Ohio CareSource Silver - Unclear if all or exchange only 12.2% added to the overall rate increase
  Medical Health Insuring Corporation of Ohio Silver - Exchange only 20% added to silver exchange plans
  Molina Healthcare of Ohio Silver - Unclear if all or exchange only 21.4% added to silver plans
  Oscar Insurance Corporation of Ohio Silver - Exchange only 14% added to silver exchange plans
  Paramount Insurance Company Silver - Exchange only 23.5% added to silver exchange plans
  Summa Insurance Company Silver - Exchange only 17.9% added to silver exchange plans
Oregon BridgeSpan Health Company Silver - Both on and off-exchange 7.1% added to silver plans
  Moda Health Plan Silver - Both on and off-exchange 7.1% added to silver plans
  PacificSource Health Plans Silver - Both on and off-exchange 7.1% added to silver plans
  Kaiser Foundation Health Plan of the Northwest Silver - Both on and off-exchange 7.1% added to silver plans
  Providence Health Plan Silver - Both on and off-exchange 7.1% added to silver plans
Pennsylvania Capital Advantage Assurance Company Silver - Exchange only 34.29% added to silver exchange plans
  First Priority Health Silver - Exchange only 34.29% added to silver exchange plans
  Highmark Silver - Exchange only 34.29% added to silver exchange plans
  Highmark Choice Company Silver - Exchange only 34.29% added to silver exchange plans
  Highmark Health Insurance Company Silver - Exchange only 34.29% added to silver exchange plans
  Geisinger Health Plan Silver - Exchange only 34.29% added to silver exchange plans
  Keystone Health Plan East Silver - Exchange only 34.29% added to silver exchange plans
  QCC Insurance Company Silver - Exchange only 34.29% added to silver exchange plans
  UPMC Health Options Silver - Exchange only 34.29% added to silver exchange plans
Rhode Island Neighborhood Health Plan of Rhode Island Silver - Exchange only 22.4% to 22.8% added to silver exchange plans
  Blue Cross & Blue Shield of Rhode Island Silver - Exchange only 19.5% added to silver exchange plans
South Carolina Blue Cross and Blue Shield of South Carolina Silver - Exchange only 24% added to silver exchange plans
Tennessee BlueCross BlueShield of Tennessee Silver - Both on and off-exchange 14% added to the overall rate increase
  Cigna Health and Life Insurance Company Silver - Both on and off-exchange 17.4% to 21.4% added to silver plans
  Oscar Insurance Company of Tennessee Silver - Exchange only 17% added to silver exchange plans
Utah University of Utah Health Insurance Plans Silver - Unclear if all or exchange only >30% added to silver plans
Virginia HealthKeepers Silver - Exchange only 12% added to silver exchange plans
  CareFirst BlueChoice Silver - Exchange only 21% added to silver exchange plans
  Cigna Health and Life Insurance Company Silver - Both on and off-exchange 18.8% - 20.5% added to silver plans
  Group Hospitalization and Medical Services Silver - Exchange only 24% added to silver exchange plans
  Kaiser Foundation Health Plan of the Mid-Atlantic States Silver - Exchange only 12.4% added to silver exchange plans
Washington BridgeSpan Silver - Exchange only 27% added to silver exchange plans
  Coordinated Care Corporation Silver - Exchange only 10% added to silver exchange plans
  Kaiser Foundation Health Plan of Washington Silver - Exchange only 23% added to silver exchange plans
  Kaiser Foundation Health Plan of the Northwest Silver - Exchange only 18% added to silver exchange plans
  LifeWise Health Plan of Washington Silver - Exchange only 14% added to silver exchange plans
  Molina Healthcare of Washington Silver - Exchange only 12% added to silver exchange plans
  Premera Blue Cross Silver - Exchange only 10% added to silver exchange plans

NOTES: "Not specified" indicates the insurer stated the amount of their overall average rate increase attributed to CSR payments ending but did not explicitly state how the increase was applied. Data for Colorado, Montana, and Pennsylvania were confirmed by state insurance departments.

SOURCE: Kaiser Family Foundation analysis of insurer rate filings to state regulators; state insurance regulators.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com


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