© 2024 Maine Public | Registered 501(c)(3) EIN: 22-3171529
Play Live Radio
Next Up:
0:00
0:00
0:00 0:00
Available On Air Stations
Scroll down to see all available streams.

Market Instability, Costs Driving up Health Insurance Rates for Maine Individuals

Health insurers for Maine’s individual market are requesting average premium increases from 20 to 40 percent next year.

High usage and market instability are driving the increases, and some insurers say they may leave the market altogether unless Washington takes action to stabilize it.

Harvard Pilgrim Health Care is requesting the largest increase — an average of just under 40 percent. In a written statement, spokeswoman Mary Wallan says the rate is in line with the medical costs of its members in the marketplace.

Anthem is requesting about a 21 percent average increase. Spokesman Colin Manning says the request is driven by rising costs and higher usage by members.

And Community Health Options, which covers the bulk of Mainers enrolled in the individual marketplace, wants to raise its rates an average of about 20 percent. Spokesman Mike Gendreau said in an email that the increase is in anticipation of a smaller, sicker, pool of consumers.

Steve Butterfield of Consumers for Affordable Health Care says the smaller, sicker pool is the result of weak enforcement of the individual mandate.

“And the assumption of what that’s going to do — you know, where younger, healthier people will leave the market. It’s going to leave an older and sicker pool, and that’s why they’re increasing rates,” he says.

And those rates could rise even higher, Butterfield says. That’s because insurers requested these rates with the assumption that the federal government will continue to fund cost sharing reductions.

“If Congress or the courts haven’t taken action by June 23 to lock those subsidies in for next year, then insurers are going to be updating these rate requests. If those subsidies haven’t been locked in for next year, I would expect to see these increases go up even higher,” he says.

Some insurers could exit the market altogether. Harvard Pilgrim and Anthem both suggested they’ll leave unless Washington takes immediate action to provide stability.

Community Health Options says it’s committed to providing health plans on the market.

The rate requests must be approved by Maine’s Bureau of Insurance.