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BlueCross will lower Individual/Marketplace rates for 2019

Update, Aug. 22:

Our approved average rate decrease is 14.8 percent for 2019 individual health plans. We’re pleased we’re able to lower our rates beyond our original proposal after evaluating the impact of risk adjustment.

Original story, July 12:

We’re just over halfway through 2018, but yesterday we submitted our proposed 2019 rates for individual health plans to the Tennessee Department of Commerce and Insurance.

If you’re one of the Tennesseans who buy health coverage for yourself – rather than through your job, or TennCare or Medicare – we have good news for you.

BlueCross has proposed 2019 Individual/Marketplace plan rates with an average decrease of 10.9% from our 2018 rates. 

We’re pleased we can offer lower rates next year.

In fact, we were prepared to propose an even larger rate decrease until new uncertainty entered the picture. Based on a court ruling, the Centers for Medicaid and Medicare Services (CMS) placed an indefinite suspension on risk adjustment transfers between insurers.

These transfers help balance the risk levels taken on by insurers in a given market if one insurer ends up with significantly more or less healthy members than its competitors. Ending these transfers would make it harder to estimate the medical costs we’ll incur for our members next year.

How were we able to reduce our rates for 2019 plans?

This has been a challenging market, but we’ve tried to make it work as well as possible for Tennesseans. We struggled in the first three years to find the right balance between what we charged and what we paid out for our members’ health care needs – losing $400 million in the process.

BlueCross had some of the lowest rates in the country in 2014, but they didn’t align with the medical costs for the people covered by these plans. The members served had more significant health needs than we expected, and fewer healthy people enrolled in individual plans.

For 2017 and 2018, BlueCross also had to increase rates to account for uncertainty from possible legislative or regulatory changes. BlueCross factored in this uncertainty into pricing sooner than many health plans across the country, which are continuing to raise their rates for 2019.

We reached a sustainable rate structure for 2017 that covered medical and operating costs for this line of business. And the negative cost impact of legislative and regulatory changes we priced for were not as great as we originally anticipated.

Even as a not-for-profit, we need each line of business to generate a modest margin to be sustainable. We did that for the first time in 2017.

Overall, the market remains somewhat uncertain, especially with the news about the risk adjustment program, and our pricing each year reflects market conditions when we file our rates. (We only have claims data for 3-4 months from the current year when we have to set rates for the following year.)

But based on our experience in 2017 and so far in 2018, we can offer lower rates for Individual/Marketplace rates in 2019 and still maintain sustainability.

Stay tuned for more information before enrollment begins

Next, the Tennessee Department of Commerce and Insurance will review our proposed rates – along with detailed data on the medical claims costs we’ve covered for members. And we’ll continue monitoring legal and regulatory changes at the federal and state level before we finalize our plans in late September.

The regions highlighted in blue show where we intend to offer individual plans for 2019.

Open enrollment is Nov. 1 through Dec. 15. If you need help selecting a plan, you can contact our sales team at 888-995-7786, a certified application counselor, an enrollment assistor, or a licensed broker or agent.

And if you receive federal premium subsidies to help pay for your plan, make sure you visit this fall to update your application and see how much financial help you qualify for in 2019.

About Kelly Paulk, Vice President, Product Strategy and Individual Markets

A photo of the authorKelly oversees product strategy for employer group and individual customer markets, provides leadership to operations, sales and strategic marketing areas and serves as the point person for regulatory, compliance and audit processes for the individual product line.

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