Carriers serving individual market split on requested rate increases, decreases

Wisconsin health carriers that serve the individual market are split when it comes to whether they’re pursuing average rate increases or decreases for next year.

But none are reporting the average double-digit increases that plans pursued a few years ago.

“We’ve seen this market stabilize,” said Marty Anderson, chief strategy and business development officer at Group Health Cooperative of South Central Wisconsin.

Group Health Cooperative is seeking a 1.1 percent increase. Anderson said the state’s 2021-23 budget has helped keep rates low by boosting the reinsurance program by $30 million, to $230 million.

Security Health Plan is seeking an average decrease of 12.2 percent, in part due to a decrease in medical trend, operational cost reductions, increased state funding for the reinsurance program and a cut in Healthcare.gov fees.

“This will be welcomed rate relief for our members,” Erin Long, director of products, said in a statement.

WPS Health Insurance is seeking a 6.2 percent decrease for its off-exchange plan. WPS Health Plan is planning a 3.7 percent decrease.

“The overall individual market continues to stabilize, which has allowed us to decrease pricing,” said Jeremy Ott, vice president of health insurance economics at WPS Health Insurance.

HealthPartners spokeswoman Emma Pederson said their proposed 2.1 percent rate increase accounts for annual changes in Affordable Care Act parameters, expected healthcare use and benefit changes and “future medical inflation and utilization changes, such as rising medical costs.”

Mark Rakowski, chief operating officer at Children’s Community Health Plan, said their requested 2.8 percent increase is “based on a combination of factors, including enrollment growth from 2020 to 2021, related changes to member demographics and 2021 claim experience.”

“Year-to-year rate changes are based upon our recent history of medical claims paid, estimates of medical inflation and other product and market changes,” Medica spokeswoman Keely Brenno said about their 6.9 percent rate increase.

Brenno said Medica is growing its footprint in Wisconsin, adding coverage in Barron, Clark, Rusk and Marathon counties.

Dean Health Plan, which is planning a 0.6 percent rate decrease, will offer plans in Chippewa and Eau Claire counties.

“We base our requested rates on the projected care needs of our members and delivering on our mission as a healthcare organization,” Dean spokesman Scott Culver said.

Network Health Plan, which is planning a 9.1 percent rate decrease, will expand to Waushara and Waupaca counties.

“Network Health annually updates its pricing based on underlying cost structure, claims experience and forward expectation,” spokeswoman Jessica Fischer said.

Other plans that have announced service area changes include Quartz and Common Ground Healthcare Cooperative.

Per the rate review website:

Anthem Blue Cross and Blue Shield: 3.9 percent decrease, ranging from 15.4 percent to 2 percent.
Aspirus Health Plan: 3.5 percent increase, ranging from a 39.5 percent decrease to a 5.2 percent increase.
Children’s Community Health Plan: 2.8 percent increase, ranging from 1.2 percent to 5 percent.
Common Ground Healthcare Cooperative: 5.6 percent decrease, ranging from an 8.4 percent decrease to a 0.9 percent increase.
Dean Health Plan: 0.6 percent decrease, ranging from a 9.2 percent decrease to a 4 percent increase.
Group Health Cooperative of South Central Wisconsin: 1.1 percent increase, ranging from a 6.6 percent decrease to a 31.5 percent increase.
HealthPartners: 2.1 percent increase, ranging from an 8.7 percent decrease to a 4.1 percent increase.
Medica: 6.9 percent increase, ranging from 1.5 percent to 12 percent.
MercyCare: 2.2 percent increase, ranging from 1.2 percent to 3.7 percent.
Molina Healthcare: 2.7 percent increase, ranging from a 1.1 percent decrease to a 3.6 percent increase.
Network Health Plan: 9.1 percent decrease, ranging from 30.1 percent to 1.3 percent.
Quartz: 8.8 percent increase, ranging from a 5.2 percent decrease to a 14.6 percent increase
Security Health Plan: 12.2 percent decrease, ranging from 19.5 percent to 9.6 percent.
WPS Health Insurance: 6.2 percent decrease, ranging from 6.3 percent to 6.1 percent.
WPS Health Plan: 3.7 percent decrease, ranging from 6.7 percent to 2.8 percent.