The real 2017 health insurance rate reviews of Oregon

The real 2017 health insurance rate reviews of Oregon

Oregon Rate HikeOregon may have 10 carriers returning to its individual major medical market in 2017, but not because they earned solid profits in 2017.

State regulators were making 2017 individual market rate filings for at least 10 carriers public on Oregon’s section of the System for Electronic Rate and Form Filing (SERFF) rate review portal.

A review of filings for a sampling of six of the carriers shows that proposed increases range from an average of zero to an average of 36 percent, and that most of the carriers that had a significant amount of business in Oregon in 2015 are reporting heavy underwriting losses for 2015.

Oregon posts at least some financial information for all of the filers along with actuarial memoranda describing proposed rates, answers to regulators’ general questions about market conditions, and rate increase summaries.

The initial 2017 product filing deadline will not come until next Wednesday in the states. States with state-based rate review systems can set somewhat different filing schedules. The Centers for Medicare & Medicaid Services (CMS) hopes to make the 2017 health rate proposals available online May 25.

Most states other than Oregon have posted few or no 2017 individual health filings online, either on the SERFF system or on their own rate filing access systems, at this point.

There is no guarantee that all of the carriers that have submitted filings will actually sell individual health coverage, either inside or outside the Patient Protection and Affordable Care Act (PPACA) public exchange system. It’s possible that some carriers could find ways to enter the market after the official entry deadline has passed, especially in states where 2017 filing activity proves to be a weak.

For a look at more about what we found in issuers’ rate filings, read on.


1. Big gorillas

Regence BlueCross BlueShield of Oregon and Kaiser Foundation Health Plan of the Northwest are both on track to return to Oregon’s individual PPACA exchange and off-exchange markets in 2017.

Health Net, which was recently acquired by Centene Corp. (NYSE:CNC), sold coverage in Oregon’s off-exchange market this year and has filed the forms it needs to file to continue to sell in the off-exchange market next year.

Kaiser had about 18,900 in 2015 and lost $12 million on $64 million in revenue. It expects its 2017 individual rates to be an average of about 14.5 percent higher for returning enrollees.

Regence had 14,822 individual coverage enrollees. It notes that, given how large it is, the financial performance of its individual business is not significant to its overall performance. But “significant losses seem an indication that the market has not yet stabilized,” the company says in a discussion of the market climate.

Regence expects to increase its Oregon individual rates an average of 17.9 percent.

BridgeSpan, a Regence affiliate with a separate rate filing, says it expects to have 645 enrollees renewing coverage in 2017, and that premiums for those enrollees will increase an average of 18.9 percent.

Health Net expects to have just 233 renewing off-exchange individual customers in 2017. That company says it lost $5.2 million in 2015 on $8.3 million in premiums. It says it projects that, in 2017, it could make a maximum profit of $35,000 and suffer a maximum loss of $778,000.

A winner

2. A surviving CO-OP

Oregon opened 2015 with two plans started with funding from the PPACA Consumer Operated and Oriented Program (CO-OP): Health Republic Insurance of Oregon, which shut down Dec. 31, and Oregon’s Health CO-OP.

Oregon’s Health CO-OP is still in business, although it has sued the federal government to try to force the pay-out of $5 billion in PPACA risk corridors program benefits.

The program was supposed to use cash from thriving PPACA exchange plan issuers collected for 2014, 2015 and 2016 to help struggling issuers. The program collected only enough cash from thriving issuers to pay less than 13 percent of the benefits owed in 2014, and Congress has prohibited the U.S. Department of Health and Human Services (HHS) from using any other HHS resources to help the struggling issuers.

The survivng Oregon CO-OP expects to have 12,627 individual enrollees renewing their coverage in 2017, and it expects to increase their premiums an average of 32 percent.

That carrier suffered a loss of $13 million on $38 million in the individual market in 2015. In the group market, it lost $5.7 million on $17 million in revenue.

Girl with a piggy bank

3. Non-CO-OP newcomers

New to Oregon, ATRIO has focused mainly on the Medicare Advantage market. It started selling ordinary commercial coverage in the state in 2014 but had only a few enrollees that year.

ATRIO earned $1.4 million on all of its business on $176 million in revenue in 2015.

The company generated $393 per member per month in premiums per ordinary individual commercial coverage enrollee, compared with projections of $360, but it also paid $1.4 million in claims in 2015, compared with a projected claim total of $1.1 million for 2015.

In 2017, it expects to increase premiums for 3,844 renewing enrollees an average of 15 percent.

Another new non-CO-OP carrier, ZOOM+, started offering individual coverage in the Portland, Ore., area this years and expects to return to the market next year.

That company, which had no insurance operations in 2015, expects to increase premiums for 1,677 renwing enrollees an average of 22.6 percent in 2017.