Health Insurance Rate Requests and Trends in Maine 2022
Exploring the 2022 individual and small group major medical rate requests in Maine, this report highlights average rate changes, market trends, and the impact on individual and small group health insurance over recent years. Insights into rate increases, estimated enrollment distribution, and plan benefits are provided, shedding light on the evolving landscape of health insurance in Maine.
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Public Informational Meeting 2022 Individual and Small Group Major Medical Rate Requests July 26, 2021 Eric Cioppa, Superintendent Marti Hooper, Life & Health Actuary Maine Bureau of Insurance
2022 Individual Market Rate Requests Avg Rate Change Companies Min Max Anthem -12.3% 4.9% -3.0% Harvard -3.2% 7.8% 1.1% Maine Community Health Options -8.9% -1.0% -5.4% 2
2022 Small Group Market Rate Requests Avg Rate Change Companies Min Max -11.5% 6.0% 3.7% Aetna-PPO -2.0% 12.2% 6.6% Aetna-HMO -7.5% 10.0% 2.4% Anthem 1.4% 6.1% 2.8% Harvard Maine Community Health Options -0.8% 3.5% 2.1% 8.1% 13.6% 11.3% United 3
Individual Health Insurance Average Rate Increases 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% Trend 0.0% -5.0% -10.0% -15.0% 2014 2015 2016 2017 2018 2019 2020 2021 -11.3 2022 -2.3% Individual 13.8% -0.8% 0.6% 22.0% 27.1% -0.5% -2.1% 2022 average increase is an estimate based on expected enrollment distribution. Cumulative impact of rate increases from 2014 - 2022 is 46.5% 4
Small Group Health Insurance Average Rate Increases 14.0% 12.0% 10.0% Trend 8.0% 6.0% 4.0% 2.0% 0.0% 2014 2015 3.3% 2016 3.5% 2017 12.5% 2018 9.8% 10.0% 6.9% 2019 2020 2021 4.3% 2022 3.4% Series1 6.7% 2022 average increase is an estimate based on expected enrollment distribution. Cumulative impact of rate increases from 2014 - 2021 is 60.5% 5
Clear Choice Plans Bronze $7,500 Bronze $8,700Bronze $7,000 Bronze $5,900 HSA 64.70% $5,900 $7,050 Silver $3,500 HSA 70.51% $3,500 $7,000 Silver $4,500 HSA 66.38% $4,500 $7,000 Benefits Catastrophic Silver $3,500 Silver $5,500 Gold $1,500 Gold $2,500 Platinum HSA 64.60% $7,000 $7,000 Estimated AV Value Deductible Maximum OOP Coinsurance N/A $8,700 $8,700 0% 64.19% $7,500 $8,700 50% 64.56% $8,700 $8,700 0% 70.53% $3,500 $8,700 40% 70.52% $5,500 $7,500 30% 80.14% $1,500 $5,000 30% 77.48% $2,500 $6,000 30% 88.54% $500 $3,000 20% 6 $50 for 2nd &t 3rd visits then deductible PCP and Behaviral Health Office Visits* $40 $50 $30 $30 $25 $25 $20 50% Coins. After Ded. Specialist Visit $100 $60 $60 $50 $50 $40 Free Standing Urgent Care Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Outpatient Surgery and Physician/Surgical Services Inpatient Hospital Services and ER Inpatient Physician, Rehabilitation and Surgical Services Ambulance All other benefits RX - Tier 1 Generic $60 $40 $40 $40 $40 $25 0% Coins. After Ded. 50% Coin. After Ded. 10% Coins. After Ded. 20% Coins. After Ded. 50% Coins. After Ded. 40% After deductible 30% after deductible 30% Coins. After Ded. 30% Coins. After Ded. 20% Coins. After Ded. 0% 0% Coins. After Ded. $25 $25 $25 $25 $25 $5 / $25 $0 RX - Tier 2 Preferred Brand $50 $50 $50 $50 $50 $15 0% After Deductible RX - Tier 3 NonPreferred $100 $100 30% $100 30% up to $300 $100 RX - Tier 4 Specialty $250 $250 50% $250 50% up to $600 $250
MLR 2020 Rebates 7 Required minimum medical loss ratio (MLR) 80% for individual health insurance MLR is the percent of medical claims to premium Rebates are required if minimum averaged over 3 years is not met to return premium overcharged. Carriers are estimating a total of $29 million in MLR rebates for 2020 Those amounts will be finalized 7/31/2021
2022 INDIVIDUAL MAJOR MEDICAL PLANS BY NETWORK TYPE, METAL LEVEL & CARRIER 8 Insurance Carrier Bronze Silver Gold Catastrophic Network Types Platinum 4 plans including HSA Deductibles: $5,700-7,800 MOOP: $7,000-8,700 6 plans including HSA Deductibles: $2,250-5,900 MOOP: $7,000-8,700 1 plan Deductible: $2,500 MOOP: $6,000 HMO Anthem Blue Cross Blue Shield (800) 547-4317 www.anthem.com Deductible & MOOP $8,700 5 plans including HSA Deductibles: $5,700-8,700 MOOP: $7,000-8,700 5 plans including HSA Deductibles: $2,500-5,500 MOOP: $6,000-8,700 2 plans Deductible: $1,500- 2,500 MOOP: $5,000-6,000 1 plan Deductible: $500 MOOP: $3,000 HMO Maine Community Health Options (MCHO) (855) 624-6463 www.maineoptions.org PPO 6 plans including HSA Deductibles: $5,900-8,700 MOOP: $7,000-8,700 5 plans including HSA Deductibles: $2,700-6,200 MOOP: $7,000-8,700 1 plan Deductible: $1,500 MOOP: $5,000 HMO Harvard Pilgrim Health Care/ (888) 333-4742 www.harvardpilgrim.org
MGARA Reinsurance Changes 10 Change from prospective to retrospective Reimburses Member Insurers based on the total eligible claims paid during a calendar year for each insured individual within certain reinsurance thresholds at a specified coinsurance rate Attachment points proposed for 2022 $76,000 to $250,000 at 100%, nothing above Insurer s assumptions for rate reductions due to reinsurance 10.4%- 17.5%
Other Benefit Plan Design Changes Highest Maximum Out of Pocket allowed increased to $8,700 for 2022 Network Tiering Benefits First dollar coverage in Clear Choice plans for some office visits and prescriptions 11
