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Crazy Health Premium Ride Ahead For Mass. Small Businesses

This article is more than 9 years old.

The next time you renew health insurance may be an even crazier experience than usual. The Affordable Care Act is changing the factors insurers consider when setting your rates. And, some insurers will benefit more than others, based on a pretty complicated "risk adjustment" for their members. The result is a 30 percent spread between increases and decreases, as of Jan. 1, 2014. It's the biggest difference in rates that anyone I spoke to has seen in Massachusetts.

Here are the rates for the beginning of the year, and for the next quarter, which the state put out:

Rates in August 2013 with the Massachusetts Office of Consumer Affairs and Business Regulation

Here's some reaction:

Health Care for All's research director, Brian Rosman, said the rates are "encouraging and reflect both the state's efforts to control medical costs and the impact of the ACA on the market. Anytime you see an insurer reducing rates by 25 percent, that's good news."

Lora Pellegrini, president of the Massachusetts Association of Health Plans, said "folks need to do the comparison shopping. People could see wide swings in their premiums, so they should take time during open enrollment to consider all their options."

Jon Kingsdale, managing director for Wakely Consulting Group, had predicted a higher average base rate. He says the numbers in the chart above show that insurers are being very competitive to gain new members next year. Kingsdale agrees that shopping for the best deal may be more important now, but he has one caution:

Everyone is guessing what 2014/15 will look like under this new arrangement, so the rate change from '13 to '14 for any carrier may fluctuate yet again in 2015 and 2016. It may not be the right time to change carriers for a 2, 3 or 4 percent advantage in premiums because you might have to just change again in 2015.

Jon Hurst, president of the Retailers Association of Massachusetts, emailed these observations:

The lower trend that we have seen the last two years continues, and much of that has to do with lower utilization rates by consumers, as well as lower increases for provider reimbursements. Yet many of these increases are still greater than our state target under payment reform. So the real test will be what actual small businesses and the employees see at renewal time. We are certainly not done with any and all efforts to secure a MA waiver on the rating factors since we are 7 years ahead of the rest of the nation, and our state reforms face real injury due to the loss of the market gains we have recently seen.

Meanwhile, over at the Pioneer Institute, Joshua Archambault has a post about the rate filings. He writes that the filings don't really tell us much about the ACA's impact in Massachusetts.

We’d love hear your reactions in the comments.

This program aired on August 16, 2013. The audio for this program is not available.

Martha Bebinger Reporter
Martha Bebinger covers health care and other general assignments for WBUR.



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