Oregon’s Biggest Insurance Companies Hike Rates Up to 37 Percent

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Tuesday, August 04, 2015

Rebecca Randall, GoLocalPDX Contributor

In 2016, the state’s two biggest health insurance providers, Moda Health Plan and Lifewise Health Plan, will increase rates between 24 and 37 percent.

It’s clear that higher enrollment is not leading to stable costs, according to an explanation of the decision, which was approved by the Oregon Insurance Division. In fact, insurance companies lost approximately $62 million in 2014 and losses are expected in 2015 as well. As a result, the Oregon Insurance Division felt the market needs to increase rates.

“Our ultimate responsibility to Oregon consumers is to ensure that rates cover the cost of health care,” said Insurance Commissioner Laura Cali.

Deliberate Secrecy

The rate hikes are not without complaint. During the state’s rate approval process, petitioners complained about steep increases by Moda and Lifewise. Public comments were entered online.

“In my cynical thinking, I can't help but wonder if Moda advertised relatively low premium rates for January 2014, knowing all along it would jack up premiums substantially once it got a good number of subscribers on board,” said E. Creed of Eugene.

Through the health exchange marketplace, Moda Health Plan had 42,633 members as of the end of June, while Lifewise had 27,128 members. Both companies also had large numbers of members who enrolled through traditional avenues used before the Affordable Care Act.

William Roberts of Portland, did not approve of Lifewise increases. “A proposed rate hike of anything over 10 percent on the rates I am already paying now will likely result in my family not being able to afford health insurance and will definitely cause my small business to close due to increased health care costs,” he said.  

A Cost Breakdown

Barring the use of advanced tax credits to cover a premium, for a Moda Silver Plan, insurance for a 60 year old non-tobacco user in Portland would cost $651 a month in 2016 compared to $520 this year. A Silver Plan for a 40 year old would cost $307 up from $245, and premiums for a 21 year old will cost $240 up from $192. With the exception of the Gold Plan, Lifewise premiums are slightly less expensive than Moda’s.

The highest increases, however, will be for Pacific Source members, of which there are only 2,164 on the exchange. Pacific Source will raise rates by 50 percent, meaning its most expensive plan will cost over $1,000 for a 60 year old to enroll in the Gold Plan.

In contrast, Providence has 15,820 members and will increase rates between 4 and 17 percent depending on age and the level of coverage. Kaiser Foundation, which only has about 6,000 members enrolled through healthcare.gov, is raising premiums by 10 percent across the board. While all of Regence BlueCross BlueShield’s members were enrolled off the market, the company does offer plans through the health care exchange market and is only increasing plans by 8 percent.

The OSPIRG Foundation was concerned in particular about the rate increases above 10 percent and suggested that the rate increases be rolled out over a longer, more gradual schedule.

“We share the concerns expressed through public comment about the affordability of health insurance in Oregon, and these final rates were approved in order to protect consumers from extreme rate increases in the future. Inadequate rates could also result in companies going out of business in the middle of the plan year, or being unable to pay claims," said Commissioner Cali.

The reality is that Oregon had some of the lowest premiums in the country in 2015—ninth lowest in the country— according to the Kaiser Family Foundation (KFF). Consider the high end of the scale: Alaska with $488 a month for a 40 year old to buy a Silver Plan before tax credits; Vermont at $436 and Wyoming at $401.

How this Affects Those with Tax Credits

The tax credits available through the marketplace do help reduce the amount of cost paid by a member based on their income. The KFF found that after tax credits are considered, across the country, everyone currently pays very close to the same amount ranging from $164 to $208 for the Silver Plan at age 40.

In Oregon, “It's important to remember that most Oregonians who purchase their insurance through the marketplace will be eligible for premium tax credits to help offset the cost of insurance,” said Cali.

In 2015, about 78 percent of those enrolled through healthcare.gov receive an average of $199 tax credit per month. OSPIRG argued, though, that with steep rate hikes, advanced tax credits will cover less of the premium cost next year.

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Related Slideshow: By The Numbers: How Oregonians Rate Their Healthcare Providers

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