Obamacare Texas Rates 2018

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The Department of Health and Human Services published preliminary rate requests on Tuesday, and many states showed steep increases. Media outlets look at the marketplaces in California, Alaska, Illinois, Maryland, Minnesota, Arizona, Texas, Connecticut and New Hampshire.

The Wall Street Journal: Some Insurers Seek ACA Premium Increases Of 30% And Higher
Major health insurers in some states are seeking increases as high as 30% or more for premiums on 2018 Affordable Care Act plans, according to new federal data that provide the broadest view so far of the turmoil across exchanges as companies try to anticipate Trump administration policies. Big insurers in Idaho, West Virginia, South Carolina, Iowa and Wyoming are seeking to raise premiums by averages close to 30% or more, according to preliminary rate requests published Tuesday by the U.S. Department of Health and Human Services. Major marketplace players in New Mexico, Tennessee, North Dakota and Hawaii indicated they were looking for average increases of 20% or more. But, big changes in store with child age adjustments

Health Net HMO is 5% approximately, not including child age adjustments.

Details on Cigna HMO AZ = 30% increase listed, but not whole story:

Cigna estimates that 2,900 customers will be impacted by this rate increase. On average, customers will see an increase of 65%, excluding the impact of aging, with a range of increases from 62% to 147%. In addition to the factors described below, each customer’s rate increase depends on factors such as where they live, the plan in which they are enrolled, and whether they use tobacco products.

Changes to Federal Standard Age Curve: Per the final 2018 Notice of Benefit and Payment Parameters the default Federal standard child curve was revised to better reflect the actuarial risk of children and to provide a more gradual transition from child to adult age rating. This revised age curve results in a one-time material increase for children under the age of 21.

And they still plan on operating at a loss.

I can’t open the “redacted” issuer’s memo’s on the details page. Can you?


Scope and Range of the Rate Increase

We have determined an average rate increase of 9.43%, varying between 0% and 20%, is necessary for this filing. These increases will vary at the individual level due to changes in the Federal Age Factors. This increase is calculated from the most recently implemented rates which were effective January 1, 2017. This increase will be effective on January 1, 2018 and will affect 47,163 Arizona policyholders (as of February 2017).

Federal Age Factors

The Federal Age curve will change effective 1-18, with significant increases being applied to the 0-20 age bands, as well as the breakout of the 15-20 age band into single years. Overall, we would expect this to increase our average premiums, so an adjustment of -2.1% was made to ensure the average premium received is revenue neutral. The age curve change is driving most of the variation in rates, as evidenced by the fact that increases individuals will see range from -2.1% to 79.5% Without this change, our expected increases would be 0% for metal (bronze, silver, gold) plans prior to the cost share reduction adjustment discussed below and 20% for catastrophic plans.So, couples over the age of 40, who may have 15-20 year old children will get the biggest rate increases.

Can’t wait to see Centene’s rate increase details, since they are the carrier for the Phoenix area. Cigna HMO is a drop in the bucket. I sure wish BCBSAZ would offer IFP in the Phoenix area! But at least the BCBSAZ news is good for the rural areas.

Now, if Trump doesn’t drop the shoe on CSR funding, at least we will have 1 carrier in each county.

Insurance companies compete on price. Throw out or limit mental to 20 days and all of the people on pain meds don’t get treated. Eliminate maternity especially if you can limit coverage for premees and you save a bunch of money. Once the 1st carrier goes all others follow suit. Witness how many are paying commission on individual business.

Changes to child age ratings are throwing any premium forecasting out of whack. This in addition to any normal rate increases. It is meant to gradually level off the cliff experienced at age 21 right now. Up 50%

0-14 = 17% rate increase. (.65 to .765)
15 yr old = 28% (.65 to .833)
18 yr old = 40% (.65 to .913)


Appendix I – Federal default standard age curve
0-14 0.765 31 1.159 48 1.635
15 0.833 32 1.183 49 1.706
16 0.859 33 1.198 50 1.786
17 0.885 34 1.214 51 1.865
18 0.913 35 1.222 52 1.952
19 0.941 36 1.230 53 2.040
20 0.970 37 1.238 54 2.135
21 1.000 38 1.246 55 2.230
22 1.000 39 1.262 56 2.333
23 1.000 40 1.278 57 2.437
24 1.000 41 1.302 58 2.548
25 1.004 42 1.325 59 2.603
26 1.024 43 1.357 60 2.714
27 1.048 44 1.397 61 2.810
28 1.087 45 1.444 62 2.873
29 1.119 46 1.500 63 2.952
30 1.135 47 1.563 64 and Older 3.000

Child Age Rating
The final rule modifies current age rating requirements for children. The ACA permits premium rates to vary based on age only within a ratio of 3 to 1 for adults. Current age rating rules provide for a single age band for children ages 0 through 20. The default age factor for this group is .635. This single age factor not only does not accurately reflect claims costs for children (which are highest for children ages 0 to 4 and lowest for children ages 5 to 14), but has resulted in a significant jump in premiums (about 57 percent) when a child reaches age 21.

Just to give you an idea, my kids are 15 and 18, and the rise in premium related to ONLY the age rating adjustment will cost me $159/mo more based on last years LCB at $221/mo for 0-20 age.

Add another 5% rate increase for whole family, and I’m looking at $1740/mo for the LCB Ambetter HMO in Phoenix for my family of 4. Which means I can make up to $255,780 and not owe the penalty due to affordability exemption. I’m telling people to put students on the college plans. In TX, its $175ish a month for a nice BCBS PPO with a $500 deductible. You can’t beat it. Where is your daughter attending? I know that the University of Texas has something because I put a clients kid on it last year.

The final rule increases the current age factor for children up to age 14 from .635 to .765 and then gradually increases the age factor year by year from age 15 to age 20 to create a smooth transition to age 21. This makes coverage somewhat more expensive for children and less expensive for adults. The rule is effective for plan years beginning on or after January 1, 2018. States continue to be able to set their own age rating curves if they chose to do so; CMS released on December 16 a separate guidance explaining the age rating curves and forms for states to disclose their own rating requirements.

Throw plan design back to the states and it will mostly fall to the carriers because no one else has the data and knowledge. As far as old males or fat old ladies paying for maternity, they really don’t because at some level, ALL premiums are a reflection of expected claims. We had this discussion and someone pointed out that old rates were a multiple of younger rates. Maternity multiplied is the same as paying for maternity. In that case, illnesses of being an old male gets pushed back through the system. It don’t matter in the end. Allocation of a cost is by definition arbitrary.

And TX didn’t file until after the bill passed. Every hospital, doc and even the damn drug manufacturers ramped up for the transplants. We sat in those damn meetings with the carriers and it was very blunt: “2014 is going to be ugly. We know it and we are ready for it” Then the total debacle of OEP 2014 started. I am not asking that certain coverages be done away with. Was just musing if limited, by choice, plans would be more attractive to “healthy” people. However, the lower premiums for just a partial plan wouldn’t offset the people who need more services on a “regular” ACA plan.

I still have to admit that it is frustrating to watch people pay more each year for a plan and not use it. Lucky them for their good health. I have a few couples who one went to Medicare and the remaining spouse paid only $20 less for a plan just for them.Payment of commission on individual business is a joke. I only do ACA as a springboard to keep them for Medicare, Disability and Life, which works pretty well.

There are groups of people freaking out about their EHB being tampered with, lots of signage, standing around claiming that the current admin & reps are trying to kill them.

Just a random thought that I am having more frequently, let the carriers offer policies with varying ESB? I was talking to a friend that really needed his hospitalization and ER and meds this past year, but was not happy about having to pay to keep his maternity care…he’s 54 years old and gay, and he would need that why?

So offer policies that include maternity care, and some that don’t. Younger people don’t want to pay for Rx, they don’t need any maintenance drugs yet. So offer policies that allow for people to pay for what they are most interested in having. I have a very active 5-year old boy; I want ER and UC coverage!

Yes, I realize it goes back to the people buying the lowest coverage and wanting to increase it if they become seriously ill or injured. I don’t have all the answers, just random thoughts and questions. It doesn’t take an economic degree to figure out that if a company is losing money on a product, it will stop offering/making that product. Anyone shocked that insurance carriers are ceasing to carry ACA plans?

I have known people who crowed about the wonderful things that they were getting on their “free” insurance and are now eating that same crow. They are paying premiums and also having to pay for their services too!

 I’m arguing that the 2014 rates were based on the reinsurance cash. Everyone knew what was going to happen (especially the transplants) and how high the claim dollars were going be. Then in August, carriers got shafted. And since this is America, the carriers passed along the loss to the consumers, which gave us the 2015 increases.

Of course, I actually expect them to govern and all Congress did was spend the last 4 years writing and passing bills they KNEW were going to get vetoed, instead of working on actual solution to the train wreck.

Apparently only the few that have dealt with large groups understand how rates are composed. I’ll give them the a huuuge (Per Trump) benefit of the doubt and ass/u/me that the people coming up with the laws don’t. Otherwise, the only possible conclusion is that they are intentionally screwing healthcare up more than it already is.

Barry got rid of pre-ex. That’s a plus in my book because of all of the people I’ve seen with money and no coverage. The mandate didn’t work and the 3 month grace period is ridiculously harmful. Carriers wanted the mandate and the grace period was probably the Dems. Free wellness was at the request of the carriers and probably reduces claims and gives carriers data which is needed for rates.

The Repubs kicking required benefits back to the states essentially gives the decision back to the carriers to strip the high claim coverage’s out and pretend to give people coverage.

Adding pre-ex, limiting RX to $3,000, excluding mental & nervous and maternity eliminates a lot of claims. The problem with maternity isn’t the birth but premees. I talked to 1 person today who uses a lot of drugs. The drug company makes so much money off him that they pay his $6,400 out-of-pocket. I forget the condition but he needs the meds to live. Before ACA, he had a bunch of freebees cobbled together ad still paid out many dollars for meds.

With contracts like that my standard response becomes “pay me 1/2 of the premiums. I won’t pay any claims either but at least you’ll keep some of your money.”

All enrolled. All pay. Anyone that wants to can have a HDHP and HSA to $10,000. The poor get a plan with copays and also access to clinics. Give the lower income people access to HSA‘s regardless of plan design. We want them to try accumulating and to stay out of the ER. We know it would be tax neutral because only those with money save. Fixing the ACA is fraught with so many issues. No matter what one group or another is going to be pissed off. It was a mistake to claim repeal and replace, did they not do their due diligence on how difficult this will be? I predict very subtle change will be made in 2017 and then EVERYONE will have to face the music in 2018. I don’t believe any of our politicians from either party.Quite a few ride the December grace period and don’t pay unless they have claims. That’s one way to save ~8% on premiums that’s going away. Anyone planning to bail to an underwritten plan had better do it early. UHC was taking ~ 2 months on some individual business even when med records and everything was submitted with the app.

I haven’t seen anything that reduces premiums and no good alternatives for those over subsidy level which includes most of my friends and clients. I’m mostly following along to take care of myself nest year. This part of the business currently doesn’t pay anything.

The Centers for Medicare & Medicaid Services (CMS) issued the final Market Stabilization rule to help lower premiums and stabilize individual and small group markets, and to increase choices for Americans.

Individuals obtaining coverage in the Marketplace created by the Affordable Care Act have faced double-digit premium increases, fewer plans to choose from, and a market that continues to be threatened by insurance issuer exits. The CMS rule is designed to provide some relief for patients and issuers. We would also like to introduce to everyone the kenyan non profit charity, it is a charity focused on working with Kenyan communities to help children, families and communities have equal access to primary care and focused specialty care. Primary care allows the opportunity for every Kenyan to realize the possibilities lying inside of each individual. Each Kenyan life is the greatest asset of the Kenyan nation. Equal value lies in each Kenyan life. You can visit our site for more information.

“CMS is committed to ensuring access to high quality affordable healthcare for all Americans and these actions are necessary to increase patient choices and to lower premiums,” said CMS Administrator Seema Verma. “While these steps will help stabilize the individual and small group markets, they are not a long-term cure for the problems that the Affordable Care Act has created in our healthcare system.”

The final rule makes several policy changes to improve the market and promote stability, including:

2018 Annual Open Enrollment Period: The final rule adjusts the annual Open Enrollment period for 2018 to more closely align with Medicare and the private market. The next Open Enrollment period will start on November 1, 2017 and run through December 15, 2017, encouraging individuals to enroll in coverage prior to the beginning of the year.

Reduce Fraud, Waste, and Abuse: The final rule promotes program integrity by requiring individuals to submit supporting documentation for special enrollment periods and ensures that only those who are eligible are able to enroll. It will encourage individuals to stay enrolled in coverage all year, reducing gaps in coverage and resulting in fewer individual mandate penalties and helping to lower premiums.

Promote Continuous Coverage: The final rule promotes personal responsibility by allowing issuers to require individuals to pay back past due premiums before enrolling into a plan with the same issuer the following year. This is intended to address gaming and encourage individuals to maintain continuous coverage throughout the year, which will have a positive impact on the risk pool.

Ensure More Choices for Consumers: For the 2018 plan year and beyond, the final rule allows issuers additional actuarial value flexibility to develop more choices with lower premium options for consumers, and to continue offering existing plans.

Empower States & Reduce Duplication: The final rule reduces waste of taxpayer dollars by eliminating duplicative review of network adequacy by the Federal Government. The rule returns oversight of network adequacy to states, which are best positioned to evaluate network adequacy.

CMS also made a number of other announcements regarding the process that issuers must follow to meet the law’s requirements for the 2018 plan year. The additional guidance released includes updates to make the guidance consistent with the final rule and provide information needed by issuers in order to have their plans certified for 2018, including: Key Dates for 2017; Issuer Guidance on Uniform Rate Review Timeline; Good Faith Compliance Guidance; QHP Certification Guidance for States; and Final Actuarial Value (AV) Calculator for 2018 and Methodology.

*Recent statistics related to the Affordable Care Act:

•Approximately one-third of counties in the U.S. have only one insurer participating in their exchange for 2017.

•Five states have only one insurer participating in their exchange for 2017.

•The premium for the benchmark second-lowest cost “silver plan” on HealthCare.gov increased by an average of 25 percent from 2016-2017.

•Approximately 500,000 fewer Americans selected a plan in the exchange open enrollment in 2017 than in 2016.

•Many states saw double digit increases in their insurance premiums including:

– AZ: 116%
– OK: 69%
– TN: 63%
– AL: 58%
– PA: 53%

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