Annual US Health Insurance Market Update
As we approach the ACA/Obamacare open enrollment period for 2023 individual health insurance and the annual renewal for most small business group health plans, I am providing information regarding changes that are happening in the market in 2023 to help you get prepared to find the BEST possible health plan for your situation and needs.
I also know that if you are on an ACA/Obamacare individual plan you may have already received your current plan’s renewal information for next year, so I hope this also provides some context to the planned rate increases or decreases, plan changes and cancellations, etc. that you are seeing.
Below you will find updates and changes that are happening at the federal level as well as links to more information in the states where US Insurance Solutions is currently licensed. Click the link for your home state to get more information about what is happening where you live.
Please review this information and then, if you haven’t already done so, go to my online calendar (and at the bottom of this page) and set an appointment for us to talk about your options for next year.
***NEW SUPPLEMENTAL PLANS: Before I get in to all the updates for the coming year, I want to share this NEW supplemental program with you.
One of the most important types of insurance coverage available is disability insurance. Consider that 1 in 4 Americans experience a disabling injury or illness in their working years that prevents them from earning an income, and 70% of working Americans couldn’t last one month without a paycheck before experiencing financial hardship.
Unfortunately, disability insurance is also one of the least purchased types of individual coverage. Usually because it is considered to be TOO expensive. However, there are ways to build a long-term disability plan that is more affordable AND there are also short-term disability plans that can be very affordable and depending on your income can provide up to $1,000 per week in benefit for as short as 13 weeks to as long as 2 years. Individual disability coverage has many advantages over group disability. A major advantage is that benefit payments from group policies are taxed, while benefits from individual policies are TAX-FREE!
That's why I have partnered with Breeze, an online disability insurance solution that makes it easy to run quotes, review disability insurance options and apply for your own policy in as little as 10 minutes. If you're interested, you can get an instant quote and apply here:
https://www.meetbreeze.com/agent/rob-tavis
If you have questions and would like to discuss your options, please use my calendar link below to schedule a call with me.
General Update
In 2022 the focus of the current presidential administration has continued to be on expanding the ACA/Obamacare markets. That focus will continue in 2023.
A new law that was passed in August 2022 is called the Inflation Reduction Act (IRA). A provision in the IRA continues the enhanced subsidies and other provisions for ACA/Obamacare plans that was initially established in 2021 in the American Rescue Plan Act (ARPA). These subsidies and provisions are continued for 3 more years through 2025.
Here is how the enhanced subsidies work:
· All previously subsidy eligible people with incomes above the federal poverty level (FPL) and below 400% of the FPL receive higher subsidies than before.
· Removal of 400% of federal poverty level (FPL) maximum cap.
· Family incomes up to 700% of FPL could be eligible for subsidies depending on ages, family makeup, location, and plan choice.
· Nobody will pay more than 8.5% of their annual adjusted gross income (AGI) for the second lowest cost Silver level ACA/Obamacare plan in their zip code.
Special Enrollment Period (SEP): As part of ARPA, a monthly SEP allows consumers with a projected annual household income no greater than 150% of the federal poverty level to enroll in Marketplace coverage with low or no premiums after tax credits are applied.
Family Glitch - On October 11, 2022 the Biden Administration finalized the rule to fix the so called “Family Glitch” in the individual ACA/Obamacare market. The Family Glitch deals with families where at least one adult is offered health insurance from their employer and that coverage is considered affordable to that adult/employee. In that case, the rest of that family is NOT eligible for any tax credit subsidy to purchase an ACA/Obamacare plan. As noted in the article above, it is widely accepted that the Family Glitch can only be corrected by Congress and NOT by Executive Order. So, this Executive Order will likely go to the courts, and could be overturned. However, until any court challenges are made, beginning with this 2023 open enrollment, families previously affected by this may now qualify for a tax credit subsidy to purchase an ACA/Obamacare individual plan.
Alternative Health Plan Solutions Updates
As I noted in last year’s update, it is still possible that the President could try to reverse some of the expansion of options in the non-ACA alternative health insurance market. I have been hearing some rumbling about an Executive Order to limit the term of Short Term Medical plans to no more than 90 days nationwide. So, we will be watching closely for any efforts in this area.
Barring any changes to Short Term Medical plans, in many states we are continuing to see expansion of CHOICES for US individuals and small businesses than the one-size-fits-all ACA/Obamacare plans.
Health Insurance Buffet - Alternative Individual Plans
As noted on our US Insurance Solutions home page, if you are looking for a better, more affordable individual/family health plan and make too much money to get a tax credit subsidy from the government, one of our NAHP alternative individual health plan solutions may be just what you need. Our Health Insurance Buffet program consists of the following:
Primary (Main Course) plans - In addition to Short Term Medical*** plans that are available for up to 36 months in select states, our two main Fixed Benefit plan companies, Philadelphia American and Manhattan Life have each made significant upgrades to their plans in many states.
***Article: Short-Term Health Beats Individual Major Medical
Supplemental (Side Dish) plans - We also have expanded plan offerings and enhancements to available accident, critical illness and hospital indemnity plans. You can see many of these on our US Supplemental Coverage page.
Your Health Insurance "Plate" - We always work to provide you with the most comprehensive coverage we can offer to fit in your budget. We do that by combining the available Primary and Supplemental plans in your state into the best available package.
IMPORTANT NOTE: All non-ACA/Obamacare alternative plans are available year-round. For both individuals and small groups. There is NO limited (open enrollment) period for these options.
NOTE: All plans in our health insurance buffet require some level of health underwriting to be approved for coverage. For those who are approved, they do not cover pre-existing conditions for a minimum of 12 months after the enrollment date. Therefore, these plans are best suited for people without serious, ongoing health issues. We always evaluate each person’s situation to ensure we are recommending the best possible coverage.
Alternative Small Group Health Plans
If you own (or work for) a small business with under 50 employees, and meet certain criteria, one of our NAHP alternative group health plans could be a better option than an ACA/Obamacare, fully insured group health plan.
NOTE: We are seeing more companies that have traditionally offered fully insured small group plans offering alternative, Level Funded small group plan options.
Again, click on the link for your home state (below) to learn more about the alternative health plan changes and updates where you live.
On the other hand, for individuals who are eligible for a tax credit subsidy to help pay their premium and/or have significant health issues I can help find the best ACA/Obamacare individual plan.
Also, for small businesses who don't have enough people for an alternative plan and/or have people with significant health issues in their group, I can help find the best fully insured ACA/Obamacare small group plan. Please review the following…
Federal ACA/Obamacare Changes
The following are some of the main changes and updates happening with ACA/Obamacare plans.
Individual Plans
Insurance companies participating in ACA/Obamacare individual markets:
As I have mentioned in previous annual updates, ACA/Obamacare markets are continuing to expand. Some of the main reasons you are seeing this expansion is that premiums and deductibles are now HIGH enough and provider networks are now SMALL enough for insurance companies to make money on individual ACA/Obamacare plans. The one notable exception to this expansion is Bright Health. Please see the note on them below.
The following is information on the 2023 markets for most companies we represent.
Aetna – In 2023 Aetna will expand their list of states where they offer ACA/Obamacare plans. The current states are: NV, MO, TX, GA, FL, NC, VA and AZ. The new states will include California, Delaware, Illinois and New Jersey. They are also expanding in their existing markets, including more counties in Arizona, Florida, Missouri, and Texas.
Ambetter – For 2023, Ambetter Health is expanding into over 400 counties nationally, including the state of Alabama. They are now in 28 states representing 80% of the addressable market.
Bright Health - On October 11, 2022, Bright Health announced that they will not offer Individual and Family health plans in ANY states in 2023. The states they are leaving are Illinois, Nebraska, New Mexico, Oklahoma, South Carolina, Utah or Virginia, Alabama, Arizona, Colorado, Florida, Georgia, Nebraska, North Carolina, Texas, and Tennessee.
Cigna – In 2023 Cigna is expanding into three additional states. They are Texas, Indiana and South Carolina — and 50 new counties in the existing markets of Georgia, Mississippi and North Carolina. They will now be in 17 states. Check out the counties in each state where Cigna will offer coverage.
Friday Health Plans – The only change for Friday will be dropping out of New Mexico in 2023.
Medica – Medica currently offers their individual/family plans in 10 states. Here is the information on Medica’s 2023 plans.
Molina Healthcare – Molina currently offers their individual/family plans in 11 states. As of mid-September we have not heard about any expansion plans for 2023.
Oscar Insurance Corp – Oscar currently offers their individual ACA plans in the following states**: AR, AZ, CA, CO, FL, GA, KS, IA, IL, MI, MO, NJ, NC, NE, OH, OK (OKC), TN, TX, and VA. However, they plan to leave Arkansas and Colorado in 2023.
United Healthcare – In 2022 the company offers plans in AL, AZ, CO, FL, GA, IL, LA, MA, MD, MI, NC, NV, NY, OK, TN, TX, VA and WA. In 2023, their footprint is expanding to four new states: Kansas, Mississippi, Missouri, and Ohio.
Changes to out-of-pocket limits and deductibles:
For the TENTH year in a row, the maximum deductible and out of pocket limits for ACA/Obamacare compliant plans are on the rise! The government sets a limit on how much these maximums can be. Family maximums can be twice as high as the maximum amount in a plan covering just one person (a “self-only plan”).
For 2023, the self-only maximum deductible and out of pocket limit can be up to $9,100 and the family maximum, up to $18,200.
For high-deductible plans that are compatible with Health Savings Accounts (HSAs) they are lower with limits up to $7,500 for individuals and $15,000 for families.
The maximum contribution limits to an HSA are $3,850 for an individual and $7,750 for a family. As always, there is an additional $1,000 “catch up” contribution amount for each individual age 55 and above.
IMPORTANT NOTE: These ever increasing deductibles and out of pocket maximums on ACA/Obamacare plans are a great reason to consider adding one or more supplemental plans from our Health Insurance Buffet (above) to help minimize your out of pocket costs for many healthcare services. If you qualify for the enhanced tax credit subsidy, you can use some of that subsidy to cover the premium on the supplemental plans.
Standardized Plans Required on Federal Marketplace:
In 2023 CMS is requiring all carriers offering plans on the Federal Marketplace to include four standardized plans. There will be two Bronze, one Silver and one Gold standard plan. This is only for states utilizing the Federal Marketplace. State based exchanges are not subject to this requirement.
Higher rate increase percentages on individual plans around the country:
Initial average rate increase requests on individual ACA/Obamacare plans are coming in much higher than in the past few years.
There are several factors that may be playing into these larger requested increases. One of those factors is that the insurance companies may have built in a cushion in anticipation that the enhanced subsidies under the ARPA law (see above) were supposed to expire and that would result in a significant number of people canceling their coverage. The question is now that the enhanced subsidies have been extended under the IRA law, will insurance companies reduce their requested increases?
Small Group Plans
While it looks like there are companies having small increases or small decreases in rates in the ACA/Obamacare small group market there seem to be more companies with rate increases near or over 10%. With a few targeted exceptions, you are also NOT seeing expansion of companies offering small group ACA/Obamacare plans.
The reason you are not seeing expansion is that while fully insured, small group health plans must comply with ALL the same ACA/Obamacare rules and coverage mandates as the individual plans, group plans typically still offer larger PPO networks, which are more costly to insurance companies.
Another issue effecting the fully insured small group health plan market is that the extension of the enhanced subsidies for individual plans is causing small businesses to consider dropping their group plans and having their employees get coverage through the federal marketplace and state-based exchanges.
NOTE: In the State Changes section below I have outlined all the proposed rate changes I could find in your state for both individual and small group health insurers.
State by State Changes and Updates
As noted above, please click on the link for your state for more details on what is happening with both the Alternative Health Plans market and ACA/Obamacare plans where you live.
U.S. Insurance Solutions is here to help
Remember, you are NOT in this alone…I am here to help! As your Personal Health Insurance Advisor, my goal is to make your life easier by taking the hassle out of finding the right health plan for your situation and needs.
To discuss your health insurance options and make sure you have the best possible health plan for your situation, please go to the link above with the image that says CALL ME and schedule a call with me on a day and time that works for you, and I will call you to review your options.