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ACA Rates Q&A

Q: Why were approved rates for some companies higher than the companies asked for?

A: Two insurers, Aetna and United, announced earlier this year they were pulling out of the federal health care exchange and wouldn’t be selling individual health plans in Pennsylvania through the healthcare.gov website.  This created a great deal of uncertainty among the remaining insurers participating in the federal healthcare exchange in Pennsylvania.

Some of these insurers were concerned about getting many more customers who had been with Aetna or United previously, and were concerned some of these customers would be very sick and have high health care bills the insurer would have to pay.  Therefore, it was difficult for these insurers to know how to price their plans for 2017. 

In order to make sure all Pennsylvanians had an opportunity to buy individual health plans on the healthcare.gov website, the only place where people can get a health plan and qualify for subsidies to help pay premiums and in some cases other out-of-pocket expenses, we needed to approve rates for insurers that would keep them in the Pennsylvania market, by allowing them to cover projected costs with new customers.


Q: The average approved rate increase is 32.5 percent.  That’s a very high increase.  Do you really think people can afford this kind of increase?

A: Most people buying individual health plans in Pennsylvania won’t pay anything near a 32.5 percent increase.  One reason is that currently, 78 percent of people with individual health plans get subsidies to help pay their premiums, and in some cases depending on their income, deductibles and other out-of-pocket expenses, too.  Generally, as premiums rise, subsidies will rise, too.

The federal government estimates 75 percent of Pennsylvanians who buy individual health plans through the federal exchange at healthcare.gov, will pay less than $100 a month in premiums for 2017.

To be eligible for a subsidy, an individual can have an income up to $47,480, and a family of four can have an income up to $97,200.

In addition, in some parts of Pennsylvania, some insurers are offering plans “off exchange”, or sold by agents or directly from the company, and not through the healthcare.gov website, that have lower premiums than on exchange plans.  If a consumer does not qualify for a subsidy, one of these off exchange plans may be a better deal, so consumers should check into this option.

A list of plans by county is on the Insurance Department website, www.insurance.pa.gov, on the Health page, under Approved 2017 ACA Rates by Rating Area, near the bottom of the page.  The link says 2017 Individual Market Plans by County.


Q: Where can people find the plans available where they live, and is there help for people trying to figure out what plan is best for them?

A: For plans on the federal exchange, people can go to www.healthcare.gov .  This lists on exchange plans available in a given area.  Only plans sold through the healthcare.gov site are eligible for subsidies.

All individual plans available in a county are listed at www.insurance.pa.gov, under Approved 2017 ACA Rates by Rating Area, at the bottom of the page.  This lists both on and off exchange plans.

People called navigators are available to help consumers sift through available plans.  A list of navigators in Pennsylvania by county is on the Insurance Department website’s Health page, near the bottom at this bullet:  If you are a consumer looking for a health insurance navigator, click here.

Insurance agents may also be able to help find the right coverage.


Q: What should I look for when shopping for a health insurance plan?

A: Premiums aren’t the only cost with a health insurance plan.  Plans also have other out-of-pocket costs—deductibles, co-pays, and so on.  Generally, plans with higher monthly premiums have lower deductibles and other out-of-pocket costs.

Something else very important to consider is the list of doctors and other health care providers that are in a given insurance plan’s network.  Each insurance company has a list on the website for each health plan it offers, called a provider directory, of what doctors and other health care professionals are in that insurer’s network. 

Using an in-network provider lowers consumers’ costs—when a provider agrees to be in an insurer’s network, they agree to accept the insurance payment for services, so consumers owe less out-of-pocket.

Insurers also have a list of prescription drugs that are covered—this list is called a formulary.  If you take prescriptions you will also want to look at this list.


Q: Are there ways I can get help shopping for health insurance?

A: The Insurance Department has a few short videos, each about four to five minutes in length, to help consumers shop for coverage.  These are on the Insurance Department’s website, on the Health page.