AVALERE ANALYSIS: 2015 EXCHANGE PREMIUM FILE
AVALERE ANALYSIS: 2015 EXCHANGE PREMIUM FILE New analysis from Avalere Health examines the 2015 Federal Exchange Premium File. Tables below examine:
Average lowest-cost Bronze premium by state: 2014 vs. 2015 and percent change Average lowest-cost Silver premium by state: 2014 vs. 2015 and percent change Average second-lowest Silver (SLS) premium by state: 2014 vs. 2015 and percent change Percent of regions by state where the SLS benchmark plan has changed for 2015
Avalere Insights 2015 Exchange Premiums Changes in 2015 premiums vary widely by geography and regional market dynamics. When considering premium impact, note that approximately two-thirds of federal exchange consumers picked Silver plans in 2014. Of those, 43 percent picked the lowest-cost option, while only 22 percent chose the SLS or benchmark plan. “The bottom line is that exchange enrollees’ 2015 premiums will vary widely based on geography,” said Elizabeth Carpenter, director at Avalere Health. “Consumers should be wary of reports detailing national or state-wide premium changes and should instead focus on the details of their particular plan.” Changes in Benchmark Plan Changes in the SLS or benchmark plan will impact the value of subsidies in 2015. Specifically, consumers have to pay the difference if they enroll in a plan more expensive than the benchmark. Therefore, consumers who do not switch plans in 2015 may have to pay more than the limits established by the Affordable Care Act. Moreover, plans participating in the federal exchange have broad latitude to renew customers automatically in the same exchange plan in 2015, decreasing the likelihood that 2014 exchange enrollees with shop and compare again in 2015. “While automatic renewal could increase continuity of care for many consumers, many enrollees will be better off shopping and comparing again in 2015,” said Caroline Pearson, vice president at Avalere Health. “In particular, people who do not undergo a redetermination during the open enrollment period could end up paying more than they need to for insurance.”
November 14, 2014 Page 2
TABLE 1: AVERAGE LOWEST BRONZE AND SILVER PREMIUMS 2014 VS. 2015 Average Lowest Bronze Premium 50-year old, non-smoker 2014 2015 % Change
State FFM AK AL AR AZ DE FL GA IA IL IN KS LA ME MI MO MS MT NC ND NE NH NJ OH OK PA SC SD TN TX UT VA WI WV WY
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
298 433 276 307 261 346 326 332 247 246 347 236 306 384 266 301 389 282 324 315 268 317 391 304 193 233 308 334 209 228 247 282 333 314 474
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
307 553 291 310 236 334 343 314 257 264 342 254 319 371 284 329 314 286 345 323 287 263 390 297 213 252 293 310 219 264 263 291 335 342 507
3% 28% 6% 1% -9% -3% 5% -5% 4% 8% -2% 8% 4% -3% 7% 9% -19% 1% 6% 2% 7% -17% 0% -2% 11% 8% -5% -7% 5% 16% 7% 3% 1% 9% 7%
Average Lowest Silver Premium 50-year old, non-smoker 2014 2015 % Change $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
365 532 340 391 311 399 370 394 317 323 434 304 414 451 337 386 456 348 407 392 324 403 430 357 285 270 380 386 272 316 309 370 399 370 538
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
381 683 357 387 280 415 410 384 329 335 425 285 419 446 362 407 403 331 438 408 354 332 440 371 289 295 376 359 287 339 320 391 403 404 583
4% 28% 5% -1% -10% 4% 11% -2% 4% 4% -2% -6% 1% -1% 7% 5% -12% -5% 8% 4% 9% -18% 2% 4% 1% 9% -1% -7% 5% 7% 4% 6% 1% 9% 9%
© Avalere Health LLC
November 14, 2014 Page 3
TABLE 2: SECOND LOWEST SILVER BENCHMARK PREMIUMS 2014 VS. 2015
State FFM
AK AL AR AZ DE FL GA IA IL IN KS LA ME MI MO MS MT NC ND NE NH NJ OH OK PA SC SD TN TX UT VA WI WV WY
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
2014 383 532 359 408 319 404 388 458 353 343 450 304 431 470 371 397 509 355 418 396 339 404 444 381 295 292 385 404 283 331 326 382 418 370 566
Average SLS Premium 50 year-old, non-smoker 2015 $ 395 $ 683 $ 373 $ 393 $ 336 $ 420 $ 429 $ 396 $ 344 $ 352 $ 438 $ 323 $ 444 $ 467 $ 373 $ 425 $ 413 $ 335 $ 456 $ 417 $ 364 $ 345 $ 441 $ 387 $ 314 $ 305 $ 386 $ 370 $ 300 $ 350 $ 334 $ 397 $ 418 $ 404 $ 595
% Change 3% 28% 4% -4% 5% 4% 11% -14% -3% 3% -3% 6% 3% 0% 1% 7% -19% -6% 9% 5% 8% -15% -1% 2% 6% 4% 0% -9% 6% 6% 2% 4% 0% 9% 5%
% of Regions with Same SLS Plan for 2015 13% 0% 38% 0% 29% 100% 3% 6% 0% 8% 0% 29% 0% 50% 0% 30% 67% 25% 19% 0% 75% 0% 0% 24% 20% 22% 4% 0% 13% 0% 0% 0% 0% 100% 0%
© Avalere Health LLC
November 14, 2014 Page 4
Methodology Premium data based on the 2014 HHS Individual Market Landscape file, updated as of August 2014, and the 2015 HHS Individual Market Landscape file, updated as of November 14, 2014. Analysis includes 34 FFM states. Analysis excludes state-based exchanges, including those states that use healthcare.gov for their exchange portal (NM, ID, OR, NV). All premiums are based on a 50-yr old non-smoker. Analysis of regions with new second lowest silver plan relies on plan ID to determine change from year to year. Avalere Health is a strategic advisory company whose core purpose is to create innovative solutions to complex healthcare problems. Based in Washington, D.C., the firm delivers actionable insights, business intelligence tools and custom analytics for leaders in healthcare business and policy. Avalere's experts span 180 staff drawn from Fortune 500 healthcare companies, the federal government (e.g., CMS, OMB, CBO and the Congress), top consultancies and nonprofits. The firm offers deep substance on the full range of healthcare business issues affecting the Fortune 500 healthcare companies. Avalere’s focus on strategy is supported by a rigorous, in-house analytic research group that uses public and private data to generate quantitative insight. Through events, publications and interactive programs, Avalere insights are accessible to a broad range of customers. For more information, visit avalere.com, or follow us on Twitter @avalerehealth.
© Avalere Health LLC
Average lowest-cost Bronze premium by state: 2014 vs. 2015 and percent change Average lowest-cost Silver premium by state: 2014 vs. 2015 and percent change Average second-lowest Silver (SLS) premium by state: 2014 vs. 2015 and percent change Percent of regions by state where the SLS benchmark plan has changed for 2015
Avalere Insights 2015 Exchange Premiums Changes in 2015 premiums vary widely by geography and regional market dynamics. When considering premium impact, note that approximately two-thirds of federal exchange consumers picked Silver plans in 2014. Of those, 43 percent picked the lowest-cost option, while only 22 percent chose the SLS or benchmark plan. “The bottom line is that exchange enrollees’ 2015 premiums will vary widely based on geography,” said Elizabeth Carpenter, director at Avalere Health. “Consumers should be wary of reports detailing national or state-wide premium changes and should instead focus on the details of their particular plan.” Changes in Benchmark Plan Changes in the SLS or benchmark plan will impact the value of subsidies in 2015. Specifically, consumers have to pay the difference if they enroll in a plan more expensive than the benchmark. Therefore, consumers who do not switch plans in 2015 may have to pay more than the limits established by the Affordable Care Act. Moreover, plans participating in the federal exchange have broad latitude to renew customers automatically in the same exchange plan in 2015, decreasing the likelihood that 2014 exchange enrollees with shop and compare again in 2015. “While automatic renewal could increase continuity of care for many consumers, many enrollees will be better off shopping and comparing again in 2015,” said Caroline Pearson, vice president at Avalere Health. “In particular, people who do not undergo a redetermination during the open enrollment period could end up paying more than they need to for insurance.”
November 14, 2014 Page 2
TABLE 1: AVERAGE LOWEST BRONZE AND SILVER PREMIUMS 2014 VS. 2015 Average Lowest Bronze Premium 50-year old, non-smoker 2014 2015 % Change
State FFM AK AL AR AZ DE FL GA IA IL IN KS LA ME MI MO MS MT NC ND NE NH NJ OH OK PA SC SD TN TX UT VA WI WV WY
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
298 433 276 307 261 346 326 332 247 246 347 236 306 384 266 301 389 282 324 315 268 317 391 304 193 233 308 334 209 228 247 282 333 314 474
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
307 553 291 310 236 334 343 314 257 264 342 254 319 371 284 329 314 286 345 323 287 263 390 297 213 252 293 310 219 264 263 291 335 342 507
3% 28% 6% 1% -9% -3% 5% -5% 4% 8% -2% 8% 4% -3% 7% 9% -19% 1% 6% 2% 7% -17% 0% -2% 11% 8% -5% -7% 5% 16% 7% 3% 1% 9% 7%
Average Lowest Silver Premium 50-year old, non-smoker 2014 2015 % Change $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
365 532 340 391 311 399 370 394 317 323 434 304 414 451 337 386 456 348 407 392 324 403 430 357 285 270 380 386 272 316 309 370 399 370 538
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
381 683 357 387 280 415 410 384 329 335 425 285 419 446 362 407 403 331 438 408 354 332 440 371 289 295 376 359 287 339 320 391 403 404 583
4% 28% 5% -1% -10% 4% 11% -2% 4% 4% -2% -6% 1% -1% 7% 5% -12% -5% 8% 4% 9% -18% 2% 4% 1% 9% -1% -7% 5% 7% 4% 6% 1% 9% 9%
© Avalere Health LLC
November 14, 2014 Page 3
TABLE 2: SECOND LOWEST SILVER BENCHMARK PREMIUMS 2014 VS. 2015
State FFM
AK AL AR AZ DE FL GA IA IL IN KS LA ME MI MO MS MT NC ND NE NH NJ OH OK PA SC SD TN TX UT VA WI WV WY
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
2014 383 532 359 408 319 404 388 458 353 343 450 304 431 470 371 397 509 355 418 396 339 404 444 381 295 292 385 404 283 331 326 382 418 370 566
Average SLS Premium 50 year-old, non-smoker 2015 $ 395 $ 683 $ 373 $ 393 $ 336 $ 420 $ 429 $ 396 $ 344 $ 352 $ 438 $ 323 $ 444 $ 467 $ 373 $ 425 $ 413 $ 335 $ 456 $ 417 $ 364 $ 345 $ 441 $ 387 $ 314 $ 305 $ 386 $ 370 $ 300 $ 350 $ 334 $ 397 $ 418 $ 404 $ 595
% Change 3% 28% 4% -4% 5% 4% 11% -14% -3% 3% -3% 6% 3% 0% 1% 7% -19% -6% 9% 5% 8% -15% -1% 2% 6% 4% 0% -9% 6% 6% 2% 4% 0% 9% 5%
% of Regions with Same SLS Plan for 2015 13% 0% 38% 0% 29% 100% 3% 6% 0% 8% 0% 29% 0% 50% 0% 30% 67% 25% 19% 0% 75% 0% 0% 24% 20% 22% 4% 0% 13% 0% 0% 0% 0% 100% 0%
© Avalere Health LLC
November 14, 2014 Page 4
Methodology Premium data based on the 2014 HHS Individual Market Landscape file, updated as of August 2014, and the 2015 HHS Individual Market Landscape file, updated as of November 14, 2014. Analysis includes 34 FFM states. Analysis excludes state-based exchanges, including those states that use healthcare.gov for their exchange portal (NM, ID, OR, NV). All premiums are based on a 50-yr old non-smoker. Analysis of regions with new second lowest silver plan relies on plan ID to determine change from year to year. Avalere Health is a strategic advisory company whose core purpose is to create innovative solutions to complex healthcare problems. Based in Washington, D.C., the firm delivers actionable insights, business intelligence tools and custom analytics for leaders in healthcare business and policy. Avalere's experts span 180 staff drawn from Fortune 500 healthcare companies, the federal government (e.g., CMS, OMB, CBO and the Congress), top consultancies and nonprofits. The firm offers deep substance on the full range of healthcare business issues affecting the Fortune 500 healthcare companies. Avalere’s focus on strategy is supported by a rigorous, in-house analytic research group that uses public and private data to generate quantitative insight. Through events, publications and interactive programs, Avalere insights are accessible to a broad range of customers. For more information, visit avalere.com, or follow us on Twitter @avalerehealth.
© Avalere Health LLC
