"This is where there's no place for insurers to hide," Lee said. "(COVID-19) is touching every American; it's going to touch every insurer. These costs have to be paid; the question is how are they going to be paid." Peter Lee, Executive Director of CoveredCA, California's individual exchange.
As Congress and state governments moved to mandate no-cost Coronavirus COVID-19 testing and treatments for Americans, providers and insurers are fighting a new battle: the $103 billion-dollar bill for COVID-19 testing and treatments this year, according to a projection from Covered California's office of an actuary.
According to the same study, commercial insurers like Blue Cross Blue Shield, Aetna, Humana, Cigna, and Oscar Health could increase premiums between 4% to 40% for 2021.
A Twitter user's Notice of Proposed rate with a 20% increase in premiums for 2021
Why are health insurance carriers increasing premiums for 2021?
There are a few factors at play, but most importantly, the cost of COVID-19 testing and treatments.
Cost of testing: COVID-19 testing varies depending on the type of insurance and the geography, ranging from $61-$240 per patient per test.
Cost of treatments: for those who need hospital care, an episode ranges from $30,000 for Medicare to $72,000 for commercial insurance.
"Plans in 2021 will price not only to cover losses they did not plan for this year but to cover anticipated costs next year," said Peter Lee, executive director of Covered California.
People are voicing concerns via Twitter.
We conducted a quick analysis of Twitter and found that hundreds of people already received letters from insurance carriers saying that premiums will increase at a 20% on the lower end and up to 48% in selected cases. For high deductible plans, which already have a high cost-sharing level, increasing premiums could further push more employers to ration health benefits and push individuals into becoming uninsured.
Among individual health plans in NY, Oscar Health proposed the highest increase at 19.1%. For small groups (employer-sponsored plans), Oscar Health proposed an increase of 29.1%, followed by Emblem at 20.9%.
The average monthly premium of a non-subsidized Bronze plan in New York is ~$550. That means the same plan could cost $660 a month at a 20% increase or $770 a month at a 40% increase.
We also researched deductible levels and found no significant change between the current year and 2021.
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NY health insurance premiums increase 2021‚ Individual Health Plan (ObamaCare)
According to the NY Department of Financial Services, as of June 5th, 13 insurance carriers had filed a proposed rate change for 2021. The department has the discretion to accept, modify, or deny the adjustment based on the justification for a rate change.
|Individual health plan||2021 Rate change|
|Fidelis (New York Quality Healthcare Corp)*||18.80%|
|HealthPlus HP, LLC (Formerly Empire)*||16.60%|
|UnitedHealthcare of New York Inc*||13.80%|
|MVP Health Plan*||6.70%|
|Healthfirst PHSP, Inc.*||2.40%|
|Healthfirst Insurance Company, Inc.||1.80%|
|Healthnow New York*||-1.90%|
NY Health Insurance Premiums Increase 2021 – Small Group Plans
|Small group||2021 Rate Change|
|Empire Healthchoice Assurance*||16.10%|
|Oxford Health Insurance Inc*||13.60%|
|UnitedHealthcare Ins Company of New York||10.90%|
|MVP Health Services Corp.*||6.10%|
|Healthfirst Insurance Company, Inc.*||5.50%|
|Healthnow New York||5.40%|
|MVP Health Plan*||4.10%|
SOURCE: Department of Finance Services
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Virtual primary care, urgent care, and behavioral health visits are only $25 with a Mira membership.
Are there any more affordable options?
Yes. If you are forced to downgrade your plan due to premium rising, you can add Mira as supplemental benefits to help you get affordable copays for primary care, urgent care, and essential lab tests (STD and blood test) before hitting the deductible. Mira is similar to a turbo boost option to supercharge your health plan.
For example, you used to get a $50 copay for lab tests with a Gold Plan ($800-900/month), now you are forced to downgrade to a Bronze Plan ($500-$600/month) due to cost, you can add Mira for $25/month to access those essential healthcare services at an upfront affordable copay vs. paying 100% full price before hitting deductible.
If you are low-income (<$20K), you could qualify for state-based Medicaid.
If you are under 30 and make less than $48K, you may qualify for a federal subsidy for the same plan on the exchange, but it would still cost more than last year.
Khang T. Vuong received his Master of Healthcare Administration from the Milken Institute School of Public Health at the George Washington University. He was named Forbes Healthcare 2021 30 under 30. Vuong spoke at Stanford Medicine X, HIMSS conference, and served as a Fellow at the Bon Secours Health System.