RICHMOND, Va. (WVEC) -- Many insurers are requesting double digit increases on premium rates for plans offered under the Affordable Care Act for 2016.
It turns out, new enrollees are more sick than what many expected. This has lead to high claims. According to Healthcare.gov, for individual plans in Virginia, Humana is requesting a 14.22 percent increase. Aetna is requesting a 13.68 percent increase and Coventry Healthcare, 18.93 percent.
John DeGruttola, Senior Vice President of Sales and Marketing of Optima Health says insurers have had to set rates based on an ACA clientele about whom they're unfamiliar.
"The problem with the ACA is that we're being asked now more than ever to set our rate before we know what the actual results are." He says Optima is requesting a rate just shy of double digits at nine percent.
In North Carolina, one of the largest increase requests comes from Blue Cross Blue Shield.
The average increase for individual plans is 25.7 percent. Spokesperson Ryan Vulcan says there are several reasons behind the jump. Of the 397,000 customers in the ACA group, many reported they have chronic health conditions.
In 2014, enrollees incurred high medical costs in inpatient care, mainly in treatment of cancer, heart conditions and specialty prescription drugs.
Vulcan says they also saw a high number of customers who sought care in emergency rooms, highlighting a need to get enrollees to understand the full range of services offered.
Healthcare blogger, Charles Gaba, also the creator of acasignups.net says everyone needs to calm down over what are only "requested" rates at this time. They have to be approved by state regulators. "Last year, in a lot of states, the final approved rates were actually significantly lower, " says Gaba.
In Virginia, a public hearing on the rates proposals will be held on July 22nd before the Bureau of Insurance in Richmond. Insurers will have to explain the reasons behind their rate filings. Final rate announcements should be made by fall.
Gaba also says consumers should consider the weighted average by provider market share. Figuring out the average requested rate increase in a particular state assumes that each insurer has an equal number of enrollees.
His most important advice is that enrollees need to shop around. Insurers offer several plans. Not all necessarily have an increase. Those who automatically renew plans could miss out on a bargain with another insurer on the marketplace.
Health and Human Services stressed that the rates are only proposals.
A statement emailed to 13News Now from HHS spokesperson Wesley Thompson says "Proposed rates provide an early look at insurance companies' initial estimates, but rates often decrease significantly before becoming final. Because of the Affordable Care Act and rate review processes set up in states, consumers have an opportunity to weigh in on proposed increases of 10% or greater before the rates are finalized. After state and consumer rate review, final rates often decrease significantly."
In Virginia, HHS says 83 percent of Marketplace consumers received a premium tax credit. As a result, the average premium paid by consumers was $89 in 2015, with a savings of $259.
Allison Flowers is one of the Virginia customers who receives a tax credit. She pays 60 dollars a month for healthcare coverage. As a Graves' disease patient, she says the insurance is a big relief. She enrolled in Obamacare after losing her job.
She recently found part-time employment but is still watching her budget. News of rising rates is not what she wants to hear. "Everything is going up. Nothing seems to be going down. So, it's going to be a challenge."
Now that she has disease under control, she uses her insurance to keep up with wellness visits to catch any problems before they get out of control.
Gaba predicts that over the next few years, more healthy and young people will enter the ACA pool which will balance the risk pool and stabilize rates.
DeGruttola says as the industry begins to prioritize a focus on preventative care, the rise of healthcare costs will begin to slow down. "We see more and more movement towards incentive based programs to try to get people to be more engaged and more aware of their health and wellness. We as a company actually offer fitbits to people if they would take a personal health assessment."