Aging Consumers without Subsidies Hit Hardest by 2017 Obamacare Premium & Deductible Spikes

10-26-16

Don't overpay for your Health Insurance.

Call Toll Free (800) 984-8015

InfoStat | 10-26-16

Aging Consumers without Subsidies Hit Hardest by 2017 Obamacare Premium & Deductible Spikes

2017 Obamacare premiums & out-of-pocket costsThe months preceding the release of 2017 rates and deductibles for Affordable Care Act plans have been filled with worrying reports of massive rate increases in some regions,1 the loss of health insurance companies from various government marketplaces,2 a significant increase in counties with only one insurer option,3 and the continued collapse of the CO-OP health insurance companies.4 It is against that background that HealthPocket examined the government’s release of 2017 Affordable Care Act (a.k.a. Obamacare) health plan data. HealthPocket’s analysis provides a detailed overview of market conditions facing consumers who have neither premium subsidies nor subsidies for healthcare out-of-pocket costs.

Averages By Metal Tier

Below is the comparison of 2017 average premiums across the United States. The averages are compiled according to the four standard metal tiers for Affordable Care Act health plans. Note that the premium and cost-sharing averages assume a nonsmoking individual insurance applicant and does not include any government subsidies that might be applied.

Comparative 2016 average premiums are based on the same type of government landscape data files that were used for the 2017 average premiums.5 Since market conditions are evaluated in this study rather than consumer behavior in response to those conditions, no weighting by enrollment was performed on the health plan data.

Individual and family averages are provided for deductibles as well as the annual limits on out-of-pocket costs for covered medical services delivered by in-network healthcare providers (labeled in the tables as “Max Out-of-Pocket Costs”). In 2017, the maximum allowable cost-sharing (including out-of-pocket costs for deductibles, co-payments, and co-insurance) is $7,150 for self-only coverage and $14,300 for families.6

Bronze Plans

Bronze plans are the entry-level plans within the Affordable Care Act offerings and have no special eligibility requirements as is the case with “catastrophic plans.” They have the lowest premiums and highest deductibles on average among the four standard tiers of Obamacare health plans. When compared to average premium nationwide for bronze plans in 2016, HealthPocket found that the average premium for 2017 has risen by 21%.The below table illustrates the average bronze plan premiums for nonsmoking individuals at different age profiles.

Individual Age Profile2017 Average Premium2016 Average PremiumIncrease
30 year-old$311.17$257.6821%
40 year-old$350.23$289.8821%
50 year-old$489.54$405.2821%
60 year-old$743.52$615.1521%

The average deductible for 2017 bronze plans marks the first time this average has crossed the $6,000 threshold. Compared to 2016’s average of $5,731, the 2017 average bronze plan deductible for individuals is 6% higher ($6,092). For families enrolled in bronze plans, the average deductible is over $12,000 in 2017.

Cost-Sharing Category2017 Avg. for Individuals2017 Avg. for Families
Deductible (Medical)$6,092$12,393
Max Out-of-Pocket Costs$6,904$13,810

Silver Plans

Silver plans are the most popular plan among consumers who receive premium subsidies on state-run health insurance exchanges. For the unsubsidized consumer, he or she has to decide if the lower deductibles of a silver plan is worth the higher premium given the consumer’s personal health care usage.

The average premium nationwide for 2017 silver plans is 17% higher than the year before. In terms of actual dollars spent annually on health insurance, a 40 year-old nonsmoker, for example, will pay over $716 more on premiums in 2017 if her premium amount matched the annual trends for the last two years.

Individual Age Profile2017 Average Premium2016 Average PremiumIncrease
30 year-old$364.91$312.0017%
40 year-old$410.73$351.0217%
50 year-old$574.10$490.7517%
60 year-old$872.01$744.9917%

The average 2017 deductible for silver plans experienced more than double the rate of year-over-year cost increase as compared to the increase observed for bronze plans. The 2017 average deductible for individuals ($3,572) is approximately 15% more expensive than 2016’s average of $3,117. Likewise, the average family deductible is up to $7,474 in 2017 as compared to $6,480 in 2016.

Cost-Sharing Category2017 Avg. for Individuals2017 Avg. for Families
Deductible (Medical)$3,572$7,474
Max Out-of-Pocket Costs$6,449$12,952

Gold Plans

Gold plans had the highest year-over-year increase in average premium. Compared to 2016, the 2017 gold plans’ nationwide average premium was 22% more expensive.

Individual Age Profile2017 Average Premium2016 Average PremiumIncrease
30 year-old$464.19$380.9822%
40 year-old$522.45$428.5122%
50 year-old$730.28$599.1622%
60 year-old$1,109.14$909.2222%

The 2017 gold plan deductible for an individual was only 3% higher than the average observed among gold plans for 2016.

Cost-Sharing Category2017 Avg. for Individuals2017 Avg. for Families
Deductible (Medical)$1,197$2,745
Max Out-of-Pocket Costs$4,889$10,168

Platinum Plans

Platinum plans offer the lowest out-of-pocket costs for covered medical services among the four types of Obamacare plans. Not surprisingly, their average premium is the highest. Nationwide, the average premium for platinum plans is 15% higher than the average in 2016.

Individual Age Profile2017 Average Premium2016 Average PremiumIncrease
30 year-old$553.15$482.8715%
40 year-old$622.84$543.6815%
50 year-old$870.42$759.8115%
60 year-old$1,322.69$1,154.5115%

While the average deductible for individual coverage by platinum plans has increased 74%, it should be noted that the average platinum plan deductible in 2016 was only $233. Moreover, the 2017 average of $405 is still one fifteenth the amount of the average deductible for 2017 bronze plans.

Cost-Sharing Category2017 Avg. for Individuals2017 Avg. for Families
Deductible (Medical)$405$809
Max Out-of-Pocket Costs$2,159$4,318

The Aging Unsubsidized

Though previous studies by HealthPocket have called attention to the affordability challenges of Obamacare plans faced by unsubsidized populations, they have not examined how enrollee age contributed to this issue. In most states, Affordable Care Act health plans adjust premiums higher for adult enrollees. However, this age adjustment is not linear. Premiums increase more dramatically for enrollees in their 50s and 60s as compared to enrollees in their 20s and early 30s.7 The Affordable Care Act limits age-based premium adjustments so that the premium for a 64 year-old cannot be more than 300% the premium of a 21 year-old. 8

HealthPocket found that the percentage of monthly income needed to pay the average unsubsidized Obamacare premium can present considerable financial challenges to older adults. For example, when examining an individual who makes $48,000 annually (just above the $47,520 cut-off for individual premium subsidy eligibility in 2017) 60 year-olds would need to spend 22% of their income to afford the average silver plan premium while 30 year-olds would only need to spend 9%.

Individual Age Profile2017 Average PremiumPremium as Percentage of Monthly Income for Person Making $48,000
30 year-old$364.919%
40 year-old$410.7310%
50 year-old$574.1014%
60 year-old$872.0122%

Conclusion

With respect to 2017, it is immediately evident that the market conditions facing the unsubsidized are getting considerably worse. The percentage increase in average premium for each category of Obamacare nationwide is in the double-digits. Deductibles among bronze and silver plans, the plans more likely to be purchased by people without subsidies, are still considerably beyond what the average family has saved for medical bills. A recent Bankrate survey found that only 37% of Americans had $500 to $1,000 in savings to cover an unexpected emergency bill.9 Against that fiscal reality, the average bronze plan deductible of $6,092 and silver plan deductible of $3,572 blur the lines between being insured and uninsured. While for years the plight of the unsubsidized population was largely ignored, HealthPocket’s 2016 study10 estimating their size in the tens of millions has begun to sensitize journalists11 to the insurance affordability challenges they face. Hopefully, in turn, these journalists can widen future political dialogue about health care reform to include their plight.

Methodology

Data records for 2017 Affordable Care Act health insurance plans offered in 39 states were obtained on October 24, 2016. The government’s Landscape files contained health plan records for the following states: AK, AL, AR, AZ, DE, FL, GA, HI, IA, IL, IN, KS, KY, LA, ME, MI, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, SC, SD, TN, TX, UT, VA, WI, WV, and WI. HealthPocket obtained health plan information from the 2017 QHP Landscape Individual Market Medical data files provided by the Department of Health & Human Services at https://data.healthcare.gov/dataset/2017-QHP-Landscape-Individual-Market-Medical-Excel/k2hw-8vcp. All plans investigated in this study belong to the individual & family insurance market. Medicare, Medicaid, short-term health insurance, and group health insurance plans were not analyzed as part of this study. Comparative 2016 data on Affordable Care Act plans were also obtained from government landscape files. See the Methodology section in the following report: Kev Coleman and Jesse Geneson. “2016 Affordable Care Act Market Brings Higher Average Premiums for Unsubsidized.” HealthPocket.com. (November 2, 2015). https://www.healthpocket.com/healthcare-research/infostat/2016-obamacare-premiums-deductibles. Last accessed October 25, 2016.

Premium averages assume an individual nonsmoking adult for the following age profiles: 30, 40, 50, and 60 year-olds. Deductibles represent medical deductibles. Deductibles from Cost-Sharing Reduction (CSR) versions of silver plans available to people making under 250% FPL were not included as part of the average due to their special eligibility criteria. Drug deductibles were not examined in this study.

All analysis assumes the accuracy of the underlying government data. While every effort was made towards a representative collection of plans, HealthPocket makes no representation that every plan within the individual insurance market or in an individual state was included in this study. Percentages are rounded according to standard industry practices. No weighting of premium or deductible averages by health plan enrollment was performed.

Author

This analysis was written by Kev Coleman, Head of Research & Data at HealthPocket. Correspondence regarding this study can be directed to Mr. Coleman at kevin.coleman@healthpocket.com.

Kev Coleman on Google+

Sources:

1 “Insurer withdrawals from some markets and rate hikes of more than 50% in some areas prompted fears that some insurance marketplaces were at risk of collapsing. Carriers that have raised premiums significantly include Blue Cross Blue Shield in New Mexico, which raised premiums by 83%, and Crystal Run Health Insurance in New York which raised premiums by about 80%.” Jacquie Lee & Jayne O’Donnell. “Regulators Approve Higher Health Premiums to Strengthen Obamacare Insurers.” USAToday.com. ((October 19, 2016). http://www.usatoday.com/story/news/politics/2016/10/18/regulators-approve-higher-health-premiums-strengthen-obamacare-insurers/92286590/. Last accessed October 24, 2016. See also Louise Radnofsky. “Rate Increases for Health Plans Pose Serious Test for Obama’s Signature Law.” Wall Street Journal. (October 18, 2016). http://www.wsj.com/articles/rate-increases-for-health-plans-pose-serious-test-for-obamas-signature-law-1476822335. Last accessed October 24, 2016.
2 Jayne O'Donnell, Ken Alltucker, Laura Ungar and Tony Leys. “As Obamacare choices dwindle, feds face consumer, political backlash.” USAToday.com. (August 30, 2016). http://www.usatoday.com/story/news/politics/2016/08/29/obamacare-choices-dwindle-feds-face-consumer-political-backlash/89403698/. Last accessed October 24, 2016.
3 Reed Abelson and Margot Sanger-Katz. “Obamacare Options? In Many Parts of Country, Only One Insurer Will Remain.” New York Times. (August 19, 2016). http://www.nytimes.com/2016/08/20/upshot/obamacare-options-in-many-parts-of-country-only-one-insurer-will-remain.html. Last accessed October 24, 2016.
4 Ali Meyer. “Another ObamaCare CO-OP Folds, Leaving Only 6 Remaining.” FoxNews.com. (September 13, 2016). http://www.foxnews.com/politics/2016/09/13/another-obamacare-co-op-folds-leaving-only-6-remaining.html. Last accessed October 24, 2016.
5 Kev Coleman and Jesse Geneson. “2016 Affordable Care Act Market Brings Higher Average Premiums for Unsubsidized.” HealthPocket.com. (November 2, 2015).https://www.healthpocket.com/healthcare-research/infostat/2016-obamacare-premiums-deductibles. Last accessed October 25, 2016.
6 Centers for Medicare & Medicaid Services. “FAQS ABOUT AFFORDABLE CARE ACT IMPLEMENTATION PART 31, MENTAL HEALTH PARITY IMPLEMENTATION, AND WOMEN’S HEALTH AND CANCER RIGHTS ACT IMPLEMENTATION.” (April 20, 2016). p.8. https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/FAQs-31_Final-4-20-16.pdf. Last accessed October 24, 2016.
7 https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/Downloads/state-specific-age-curve-variations-08-09-2013.pdf
8 This assumes both individuals live in the same region and have the same smoking status. Justin Giovannelli, Kevin W. Lucia, and Sabrina Corlette. “Realizing Health Reform’s Potential.” The Commonwealth Fund. (December 2014). .p.2. http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2014/dec/1795_giovannelli_implementing_aca_state_premium_rate_reforms_rb_v2.pdf. Last accessed October 25, 2016.
9 Maggie McGrath. “63% Of Americans Don't Have Enough Savings To Cover A $500 Emergency.” Forbes. (January 6, 2016). http://www.forbes.com/sites/maggiemcgrath/2016/01/06/63-of-americans-dont-have-enough-savings-to-cover-a-500-emergency/#37719a7d6dde. Last accessed on October 25, 2016.
10 Kev Coleman. “Millions in Unsubsidized Health Insurance Market Face Uncertain 2017” HealthPocket.com. (March 17, 2016). https://www.healthpocket.com/healthcare-research/infostat/unsubsidized-health-insurance-market. Last accessed October 24, 2016.
11 Paige Winfield Cunningham. “Meet the People Who Aren’t Getting Subsidies to Help with Obamacare Costs.” Washington Examiner. (September 26, 2016). http://www.washingtonexaminer.com/meet-the-people-who-arent-getting-subsidies-to-help-with-obamacare-costs/article/2602567. Last accessed October 24, 2016. Sarah Kliff. “The Obamacare Problem that Democrats Don’t Want to Talk About.” Vox.com. (October 11, 2016). http://www.vox.com/2016/10/11/13189132/obamacare-problem-democrats. Last accessed October 24, 2016.

 

 

Speak with a licensed agent

(800) 984-8015

(800) 984-8015

LEARN MORE​ 
{"globalPhoneNumber":"8009848015","helpInfo":{"leadCopy":"Speak with a licensed agent","phone":"8009848015","analyticsInfo":{"pageType":"content","productLine":"global","phone":"8009848015"}},"bannerData":{"link":"Click Here for Affordable Term Health Plan Options","href":"https://www.agilehealthinsurance.com/?xsell=1&utm_source=healthpocket&utm_medium=leader_board&utm_campaign=ifp_seo_page_banner","text":"Missed the Obamacare Enrollment Period? "}}