Health Exchange Premiums Being Published

The long-awaited first step toward evaluating the true impact of health exchanges has finally been taken in several states, including Oregon, Washington, and Colorado.  For those of you keeping track, the eagerly anticipated health exchange open enrollment period begins on October 1, 2013.  Hospitals, physicians, employers, and patients have been preparing for this date.  However, there has been one major missing piece to the puzzle; the premium rates that payors will charge for the health exchange products.  The wait is now over for states that have started to publish preliminary rate information.

Publication of the rates will likely cause several responses:

  • Employers can begin to evaluate the financial implications of continuing or declining coverage of employees.
  • Individuals without employer-sponsored coverage can consider the costs and subsidies associated with the various products.
  • Brokers can provide clarity for individuals and small groups seeking insurance coverage.
  • Providers can finalize outstanding network contract negotiations and provide clear guidance to patients and employers that may turn to them for advice in making coverage decisions.

Providers, particularly hospitals and systems in regions with high levels of uninsured patients, have started to conduct outreach within their communities.  Several of our health system clients are functioning as extensions of the state health exchange navigators by educating individuals and small employers about the exchanges to alleviate confusion and encourage expanded insurance coverage among the uninsured.  The publication of these rates provides a critical piece of information for these efforts about the cost of insurance on the exchanges compared to other options.

While the premium rates are not as high as predicted, they are consistently higher than plans available outside of the exchanges, as summarized in the table below.  All three of the states examined to date exhibit premiums between 24% and 27% higher than those outside of the exchange.  Because the premium at a given metal level differs by family size, age, and region, the corresponding rate variance will vary depending on those factors.  The average rates in Table 1 below are based on an individual plan – with similar characteristics to a silver plan – for a 40-year-old nonsmoker.

Table 1_Health Exchange Plan Monthly Premium VarianceNote that these rates are subject to review by the state insurance commissioners and may change.

In addition to the premium variance, the consumer will also consider the subsidy provided when buying a plan on the health exchanges.6 For example, buying on the exchange in Oregon could result in a significant savings to the low-income consumer if the subsidy is factored into the cost, as shown in Table 2.

Table 2_Monthly Premium Variance With Premium Subsidy_OregonAlthough premiums may change before October, this first glimpse into the financial implications of enrolling in plans on the exchanges will allow the interested parties across the nation to make key decisions for 2014.  Many more states will follow over the summer months.  Check back here for updates as additional states publish and finalize premiums.


1In each state, three to five plans were selected for premium comparisons based on benefit structure and membership.  The plans with the largest membership and a comparable benefit structure were selected in each case.  The benefit characteristics used to match the plans were deductible, coinsurance, primary care physician office visit copay, and annual out-of-pocket maximum.  Plan premiums were published on
2Average premium inside the exchange reflects all individual silver plans available for a 40-year-old.
3Geography selected for Washington was King County.
4Geography selected for Oregon was Multnomah County.
5Geography selected for Colorado was El Paso County.
6Premium subsidy is not provided for plans purchased outside of the exchange or purchased on a commercial insurance exchange.

This entry was posted in Affordable Care Act, Healthcare Reform and tagged , , , by Jason C. Lee. Bookmark the permalink.

About Jason C. Lee

Jason is a member of the Healthcare practice at ECG. He has over a decade of consulting experience in strategic planning, hospital/physician alignment, and commercial contracting. His current practice focuses on managed care contract analysis and negotiation, development of hospital/physician financial relationships, and assessment of physician productivity. His projects have resulted in financial and operational success for a myriad of clients. He has a master of public health degree from San Diego State University and bachelor of arts degrees in both human biodynamics and molecular and cell biology from the University of California, Berkeley

One thought on “Health Exchange Premiums Being Published

  1. Pingback: A Fond Farewell to 2013. | ECG Management Consultants, Inc.

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