- COVID-related enrollment window runs through August 15, 2021 (no qualifying event necessary); open enrollment for 2022 coverage starts November 1, 2021
- 2021 rates and plans: Most insurers increasing average premiums modestly; most counties have at least three participating insurers.
- Enrollment increased 2% in 2021, and is continuing to increase due to the COVID-related enrollment window.
- Short-term health plans can be sold in Ohio with initial plan terms up to 364 days.
Ohio exchange overview
Ohio has a federally facilitated exchange, which means residents in Ohio use HealthCare.gov to enroll in exchange plans. But Ohio is one of seven states that participates in plan management and the qualified health plan (QHP) certification process.
201,069 people enrolled in plans through Ohio’s exchange during the open enrollment period for 2021 coverage, and enrollment is continuing to increase during the COVID-related enrollment window that continues through August 15, 2021.
Ohio expanded Medicaid under the ACA, due in large part to the efforts of then-Governor, John Kasich, a Republican who opposed the ACA in general but supported Medicaid expansion. Ohio residents can enroll in QHPs or Medicaid via the exchange, with eligibility dependent on income. Enrollment in Medicaid runs year-round.
When can I enroll in health insurance in Ohio?
Enrollment is normally limited to the fall open enrollment period (November 1 to December 15) or to special enrollment periods triggered by individuals’ qualifying events. But due to the ongoing COVID pandemic and the premium subsidy enhancements created by the American Rescue Plan, there is an extended one-time enrollment window available in 2021.
This window continues through August 15, 2021, and a qualifying event is not necessary in order to use it. Plans selected during this window will take effect the first of the month following enrollment. Any Ohio resident eligible to use the marketplace can enroll or make a plan change during this window. That includes people who are uninsured, people who have non-ACA-compliant coverage, people enrolled in off-exchange plans who need to switch to the exchange in order to take advantage of the newly improved premium subsidies, and people who are already enrolled in an exchange plan but want to pick a different one. That might be the case, for example, if a person selected a bronze plan during open enrollment but can now much more easily afford a more robust silver plan.
After August 15, Ohio residents will once again need a qualifying event in order to enroll or make a change to their coverage for 2021 (the qualifying event requirement also applies outside the exchange, for people who want to enroll directly with an insurance company; that can only be done during open enrollment or a special enrollment period). Open enrollment for 2022 coverage will begin November 1, 2021, for coverage effective January 2022.
2021: Fairly modest rate changes, and most counties have at least three participating insurers
The Ohio Department of Insurance published a summary of the proposed rate and plan changes for 2021, noting that residents in some areas would have more coverage options than they had for 2020. There are still ten insurers offering coverage in the exchange, but residents in all but ten counties (out of 88 in the state) have a choice of at least three insurers for 2021, and residents in those ten counties can select from among two different insurers (as opposed to 2020 – described below – when only Logan County had just a single participating insurer, and 29 counties had just two).
According to SERFF, the following average rate changes were approved for Ohio’s insurers for 2021:
- AultCare: 4.99% decrease (5,726 members)
- Ambetter (Buckeye Community Health Plan): 1.3% increase (40,681 members)
- CareSource: 9.3% increase (47,073 members)
- Community Insurance Company (Anthem BCBS): 3.22% decrease (5,715 members)
- Medical Health Insuring Corp. of Ohio (Medical Mutual): 2.3% increase (57,312 members)
- Molina (expanding coverage area to one additional county for 2021; for a total of 40): 0.8% decrease (18,899 members)
- Oscar Buckeye State Insurance Corporation: 0.9% decrease (6,760 members in Columbus area)
- Oscar Insurance Corporation of Ohio: 6.7% increase (10,467 members in Cleveland area)
- Paramount: 8.94% increase (2,548 members)
- Summa: 2.49% increase (3,543 members)
When the rates were filed, the Ohio Department of Insurance noted that “Premiums for 2021 are projected to stay relatively stable from 2020 — though individual companies’ rates will vary from the average. Weighted average annual premiums for the individual market for 2021 is projected to be $5,670.63. In 2020 weighted average annual premiums were $5,690.26 — a decrease of .4%.”
The approved rates were all the same or very similar to the rates the insurers filed. But the overall average rate increase seems to come to about 3.3 percent by our calculations, based on 2020 membership (at ACA Signups, Charles Gaba calculated a similar weighted average rate increase of 3.23 percent).
It’s not entirely clear how the Ohio Department of Insurance’s calculation differs, although it could have to do with wider coverage areas for some of the insurers and an average that’s based on projected membership in 2021 as opposed to rate changes for existing 2020 membership. As described below, there was a similar discrepancy for 2020 rates (for people who enrolled in coverage through the Ohio exchange for 2020, overall average pre-subsidy premiums did end up being lower than overall average pre-subsidy premiums had been in 2019, despite overall average rate changes than indicated increasing premiums).
2020: Ten participating insurers; nearly all Ohio residents could choose from among at least 2 insurers
Ten insurers offered plans in Ohio’s exchange for 2020, which was also the case for 2019. But there were some coverage area expansions for 2020, resulting in more choices for some residents. In 2018, there were 42 counties with only one insurer. That dropped to 16 counties as of 2019, and in 2020, Logan County is the only one of Ohio’s 88 counties with just a single insurer in the exchange. The number of counties with only two participating insurers also dropped, from 33 to 29. The rest of the state has at least three insurers offering plans for 2020 (this page lists the insurers offering on-exchange plans in each county in Ohio for 2020).
In 2016, every county in Ohio had plans available in the exchange from at least four carriers, but market upheaval in 2017 and 2018 resulted in insurer exits and concerns that some areas of the state might have had no participating exchange insurers. That never came to pass (details below), but Ohio has since turned a corner in terms of insurer participation in the exchange.
The following average premium changes were implemented for 2020:
- AultCare: 9.5 percent increase (7,249 policyholders)
- Ambetter (Buckeye Community Health Plan): 4.7 percent increase (23,752 policyholders)
- CareSource: 5.3 percent decrease (38,200 policyholders)
- Community Insurance Company (Anthem BCBS): 12.2 percent increase (4,577 policyholders)
- Medical Health Insuring Corp. of Ohio (Medical Mutual): 8.2 percent increase (54,128 policyholders)
- Molina (expanding coverage area to a total of 39 counties for 2020, up from 33 in 2019): 10.1 percent decrease (8,314 policyholders with a total of 11,409 members)
- Oscar Buckeye State Insurance Corporation: 7.3 percent increase (3,903 policyholders)
- Oscar Insurance Corporation of Ohio: 2.1 percent increase (6,859 policyholders)
- Paramount: 0.8 percent increase (3,720 policyholders)
- Summa: 6.94 percent increase (2,811 policyholders)
Two of the ten insurers, with a combined total of 46,514 policyholders, implemented average rate decreases. The other eight insurers, with a combined total of 100,140 policyholders, implemented average rate increases.
In August, ACA Signups’ Charles Gaba reported that the Ohio Department of Insurance had indicated that the average approved rate change would be a 7.7 percent decrease. Gaba had also noted earlier in the summer that the Ohio Department of Insurance had curiously noted that insurers’ proposed overall average rate change was a 7 percent decrease, and questioned how that could be possible.
Given the market share of the insurers and their average rate changes, it appeared that average premiums in Ohio were increasing for 2020, rather than decreasing. It’s possible, however, that insurers introduced new (lower-cost) plans for 2020, and that the average premiums, including the rates for those plans, ended up being lower than the average premium was in 2019. Indeed, once plan selections for 2020 were finalized, the overall average pre-subsidy premium amount in Ohio’s marketplace was $518/month in 2020, down from $533/month in 2019. This reflects actual plan selections for the new year, however, as opposed to how rates would have changed if everyone had kept their existing coverage from one year to the next.
2021 enrollment: Up 2% from 2020, but still well below peak enrollment in 2016
201,069 people enrolled in private plans through the Ohio exchange during the open enrollment period for 2021 coverage. That was up about 2% from the year before, but still well below the Ohio exchange’s peak enrollment, when more than 243,000 people enrolled in 2016.
Enrollment is continuing to grow in 2021, due to the ongoing COVID-related enrollment period, which continues through August 15, 2021. CMS reported that 11,675 people enrolled in coverage through Ohio’s exchange between February 15 and March 31, 2021. That was roughly double the enrollment pace during the same timeframe in previous years, when a qualifying event would have been necessary in order to enroll (again, no qualifying event is necessary during the COVID-related enrollment window, and enrollment is likely to increase even further due to the enhanced premium subsidies that are available as a result of the American Rescue Plan).
Here’s a summary of sign-ups during open enrollment each year:
- 2014: 154,668 people enrolled
- 2015: 234,341 people enrolled
- 2016: 243,715 people enrolled
- 2017: 238,843 people enrolled
- 2018: 230,127 people enrolled
- 2019: 206,871 people enrolled
- 2020: 196,806 people enrolled
- 2021: 201,069 people enrolled
This mirrors the general trend that we’ve seen in states that use HealthCare.gov, with enrollment declining from 2016 through 2020 and then increasing in 2021. (states that run their own exchanges have been much more likely to see increased enrollment during at least one of those years from 2016 through 2020).
Numerous factors contributed to the decrease in enrollment: In 2017 and 2018, premiums were sharply higher for people who don’t get premium subsidies. For 2018 and 2019, the Trump administration sharply reduced funding for enrollment assistance and exchange marketing. For 2019, the individual mandate penalty was eliminated and the Trump Administration expanded access to short-term health plans and association health plans as alternatives to ACA-compliant individual market coverage. But rates have been much more stable over the last few years, insurers have joined or rejoined the exchanges in many states, and enrollment began to rebound nationwide in 2021.
Community Insurance Company (Anthem) and Oscar Buckeye joined the exchange for 2019
Anthem exited the exchange in Ohio at the end of 2017, but returned for 2019 in 25 counties. Oscar Insurance Corporation of Ohio joined the exchange in 2018, but the company expanded into the Columbus area for 2019, with a new entity called Oscar Buckeye State Insurance Corporation.
According to the Ohio Department of Insurance, average premiums in Ohio’s exchange increased by 6.3 percent for 2019 (down from a preliminary estimated rate increase of 8.3 percent). But average benchmark premiums (on which premium subsidies are based) increased by just 3 percent in 2019.
Ohio wants to eliminate the individual and employer mandates
Ohio passed legislation in 2015 that requires the state to propose a 1332 waiver that would, if federal permission is granted, allow the state to eliminate the ACA’s individual and employer mandates. In March 2018, the state submitted a 1332 waiver to HHS, requesting the elimination of the individual mandate in Ohio as of January 1, 2019. But HHS deemed the application incomplete, and the state would have to revise it in order to have it reconsidered (that has not happened as of mid-2020).
The federal government has already eliminated the individual mandate penalty as of January 1, 2019, but not the mandate itself (this was done via the Tax Cuts and Jobs Act that GOP lawmakers passed in December 2017). So under federal law, people are still technically required to maintain coverage, but the penalty, if they fail to do so, is now $0. Ohio went ahead and submitted their (ultimately incomplete) 1332 waiver proposal to HHS, requesting the elimination of the mandate itself in Ohio, as of 2019. But the waiver proposal noted that the impact would be negligible since the penalty is $0 in 2019 and beyond.
Ohio has not yet submitted a proposal to eliminate the employer mandate in the state. That change, if proposed and approved, would certainly have an impact on federal revenue, since nothing has changed about the employer mandate penalty, and the federal government is still collecting it. In order to receive federal approval for the elimination of the employer mandate in Ohio, the state would have to demonstrate a way to do so that would be budget-neutral for the federal government. That’s unlikely, given the reduction in employer mandate revenue that would result, along with the likely uptick in the number of people seeking subsidized individual market coverage if their employers were to stop offering coverage.
It’s noteworthy that there are a few states that are taking the opposite approach when it comes to the individual mandate, and have implemented state-based individual mandates — with state-based penalties — to replace the federal individual mandate penalty: New Jersey, Massachusetts, California, Rhode Island, and DC all have individual mandates with penalties for non-compliance (Vermont also has an individual mandate, but the state has not instituted a penalty for non-compliance). Those states are driven by the understanding that an insured population is a healthier population, and that a stable risk pool requires as many healthy enrollees as possible.
Humana, Anthem, and Premier exited at the end of 2017; Oscar joined
Humana announced in early 2017 that they would exit the individual market altogether, nationwide, at the end of 2017. Humana was one of the insurers that offered plans in the Ohio exchange in 2017. But at the end of 2016, Humana sharply reduced its individual market footprint, nationwide. They remained in 11 states (down from 19 in 2016), but only offered plans in a total of 156 counties across those 11 states (for reference, there are 88 counties in Ohio alone).
Anthem also pulled out of the exchange in Ohio, and their individual market offerings in 2018 consisted of a single off-exchange plan in Pike County. This prevented a full market exit in Ohio, allowing them the option to re-enter the state in 2019 — which Anthem did, with plans available in 25 counties. A full statewide exit would have prevented them from returning to Ohio’s individual market for five years, under long-standing HIPAA rules.
There were 67,000 people in Ohio with Anthem coverage who needed to select new plans for 2018. Eleven insurers offered plans in Ohio’s exchange in 2017, but their participation was localized. And in 20 of Ohio’s 88 counties, Anthem was the only participating exchange insurer in 2017 (Anthem was the only insurer in Ohio that offered exchange coverage in every county in 2017).
Premier Health Plan also exited the Ohio exchange at the end of 2017. They continued to offer one bronze plan outside the exchange (in the same 16 western Ohio counties where they offered coverage for 2017), but coverage under that plan ended on March 31, 2018. The rate filing indicated that only 40 members were expected to have coverage under Premier in 2018. Average rates for the remaining bronze off-exchange plan increased by an average of 34.63 percent in 2018, and anyone who had that plan in the first quarter of 2018 needed to purchase a new plan with coverage effective April 1, 2018. Premier noted in their rate filing that “members who choose to stick with a Premier plan until the exit date are likely to be sicker members who need the plan.”
Premier is no longer offering any coverage in Ohio. Premier members who had off-exchange coverage in the first quarter of 2018 were eligible for a special enrollment period through May 30, during which they could pick a new plan from another insurer. Any amount that these members paid towards their deductible and out-of-pocket maximum under the Premier plan in January – March 2018 did not transfer to the new plan, and those members’ had to start over with their annual cost-sharing under the new plan.
Initially, 20 counties had no plans filed for 2018. But other insurers agreed to cover them.
When Anthem announced that they would exit the exchange at the end of 2017, there were 20 rural counties — which had more than 11,000 exchange enrollees in 2017 — that did not have any insurers slated to offer exchange coverage. But on July 31, 2017, Ohio’s Department of Insurance announced that five existing exchange insurers had agreed to offer coverage in 19 of the 20 bare counties. Buckeye Health Plan, CareSource, Medical Mutual, Molina, and Paramount Health Care agreed to offer coverage in those counties.
Only Paulding County, in northwest Ohio, was still without any insurers slated to offer coverage at that point. State regulators continued to work with insurers to devise a solution for Paulding County, and On August 24, the Ohio Department of Insurance announced that CareSource had agreed to offer coverage in Paulding County. CareSource offered plans in 51 Ohio counties in 2017, and their 2018 rate filing indicated that they would expand to offer coverage in 59 counties in 2017, although the recent additional expansion further increases that number; CareSource agreed in late July to cover eight of the bare counties, and added a ninth with Paulding.
Nineteen of the 20 counties continued to have just a single insurer offering exchange plans, although Hancock County has 2018 plans available from both Medical Mutual and Molina. Each of the five insurers agreed to offer coverage in a handful of the bare counties (including one additional coverage area expansion announced later by CareSource), and the combined result is that every country in Ohio has at least one insurer offering coverage for 2018.
This happened in other states too, but insurers stepped in to fill the bare spots. Previously “bare” counties in Tennessee, Washington, Kansas, Missouri, Indiana, Wisconsin, and Nevada were all ultimately filled, and all areas of the country had plans available in the exchange in 2018.
In a July 2017 statement, the Ohio Department of Insurance noted that they “will continue working with the industry, but those efforts are heavily dependent on market stability and clarity from Washington. We encourage Congress to work on ways to stabilize our health insurance markets.” Insurers repeatedly stated in 2017 that the best way to stabilize the insurance markets would be for Congress to allocate funding for cost-sharing reductions (CSR) and enforce the individual mandate. But instead, the Trump Administration has cut off CSR funding and refused to commit to robust enforcement of the individual mandate — both of which contributed to a substantial portion of the rate increases that insurers implemented for 2018 plans.
But things were different in 2018 in terms of market stabilization efforts. Insurers in most states, including Ohio, added the cost of CSR to silver plan premiums for 2018, which ended up creating larger premium subsidies and making coverage more affordable for many enrollees. With that strategy, known as “silver loading,” people who don’t qualify for premium subsidies can purchase non-silver plans in order to avoid having to pay the extra premiums that were added to cover the cost of CSR, or can shop off-exchange for silver plans if the state allowed insurers to add the cost of CSR only to on-exchange silver plans (Ohio did allow this, so consumers were well protected for 2018). So while federal funding for CSR was at the top of the list in terms of market stabilization proposals in 2017, that is no longer the case. As long as insurers can continue to add the cost of CSR to silver plan premiums, the lack of federal funding for CSR will not destabilize the market or cause insurers to exit the market.
2018 rate changes: revised rates add the cost of CSR to silver premiums
The seven remaining exchange insurers initially filed 2018 rates based on the assumption that CSR funding would continue in 2018, but the Ohio Department of Insurance later directed them to refile new rates based on the assumption that CSR funding would not continue, and with the cost of CSR added to silver plan premiums for 2018. The Ohio Department of Insurance also allowed insurers to create off-exchange-only silver plans with the same benefits as the on-exchange silver plans, but without the cost of CSR added to the premiums (in areas where such plans are available, they present a good option for people who don’t qualify for premium subsidies, but who want to purchase a silver plan; for people who do qualify for premium subsidies, the additional premiums are offset by larger premium subsidies in the exchange).
In the following list, the approved rate increases are listed first, but the previous filing is also listed to provide perspective in terms of how much the lack of CSR funding drove up premiums for 2018.
Note that rate changes are calculated before premium subsidies are applied; for those eligible for premium subsidies — which included 76 percent of Ohio exchange enrollees in 2017 — the subsidies grew to keep pace with the new rates, and enrollees actually have to pay slightly less for the second-lowest-cost silver plan in 2018
The following average rate increases were approved for 2018:
- AultCare: 29.3 percent. Initially, AultCare had proposed a 10.3 percent increase, and revised it to 13.8 percent in June (the initial filings were based on the assumption that CSR funding would continue in 2018). But in August, they revised it again to an average of 29.3 percent. This was based on the assumption that CSR funding would not continue in 2018, and includes an additional 20 percent premium increase added to on-exchange silver plans. AultCare had 5,848 members.
- Ambetter (Buckeye Community Health Plan): 48.9 percent to 49.7 percent, depending on whether the product includes dental and/or vision coverage. Initially, Ambetter proposed a 29.1 percent average increase, which was based on the assumption that CSR funding would continue. They filed the larger average rate increase in August, based on the assumption that CSR funding would not continue. The cost of CSR has been added to on- and off-exchange silver plans. Ambetter/Buckeye had 15,138 members.
- CareSource: 34.15 percent increase for CareSource HMO Basic; 25.06 percent increase for CareSource HMO Enhanced; 43.41 percent increase for Product 3. The initial proposed average rate increase had been 23.9 percent. CareSource had 51,590 enrollees, and plans are available in 59 counties for 2018.
- Medical Health Insuring Corp. of Ohio (Medical Mutual): 24.5 percent. The previous proposed average increase was 19.8 percent. Medical Mutual noted in their revised filing that they opted to create four new off-exchange-only silver plans with benefits that mirror the on-exchange plans, but without the cost of CSR added to the premiums. Medical Mutual had 23,120 members.
- Molina: 37.7 percent increase for Molina Marketplace; 40.5 percent increase for Molina Marketplace Options. The initial proposed average increase was 23.9 percent increase, but the revised filings had substantially higher premiums for silver plans, to cover the cost of CSR. Molina had 20,948 members, and is not marketing products outside of the exchange.
- Paramount: 35.92 percent increase. The initial proposed rate increase, based on the assumption that CSR funding would continue, was 20 percent. The cost of CSR has been added to on-exchange silver plans, and Paramount’s revised filing noted that they would offer off-exchange silver plans without the cost of CSR added to the premiums if federal regulators allowed it. Paramount had 3,713 members.
- Summa: 41.1 percent increase. The initial filing had an average proposed increase of 26.6 percent. In the revised filing, the cost of CSR has been added to on-exchange silver plans, and Summa notes that they expect to see an increase in the number of people who purchase silver plans outside the exchange (those plans don’t have the cost of CSR included in the premiums, so they’re a good fit for people who want a silver plan but who don’t qualify for premium subsidies to offset the higher rates). Summa has 4,152 members.
- Oscar: New to Ohio’s exchange for 2018, available in five northeastern counties
16 counties had no gold plans available for 2018
There are 16 counties in Ohio where gold plans were not available in the exchange for 2018 (Auglaize, Coshocton, Crawford, Erie, Hancock, Hardin, Hocking, Holmes, Knox, Marion, Mercer, Ottawa, Putnam, Richland, Williams, and Wyandot). In all of those counties, a single insurer offers coverage (either Medical Mutual or Paramount).
The lack of gold plans in 16 counties is despite the fact that the 2018 Benefit and Payment Parameters, finalized by HHS in late 2016, calls for all insurers in the federally-facilitated exchange to offer at least one gold plan and one silver plan in all parts of their service areas.
The ACA itself requires exchange insurers to offer at least one silver plan and one gold plan, but it doesn’t specify that they must do so in all parts of their service areas. As a result, there were 209 counties (in Iowa, Missouri, Nebraska, and Tennessee) where there were no gold plans available in the exchange in 2016. The rule change for 2018 was an effort to address this issue and ensure that all enrollees have access to at least silver and gold plans.
However, CMS clarified that Ohio has some flexibility on this issue because they’re a plan-management exchange (ie, the state retains plan management functions and certifies plans as qualified health plans to be sold in the exchange). As such, Ohio regulators allowed Medical Mutual and Paramount to offer gold plans in only part of their service areas. Both insurers do offer at least one gold plan in at least some areas of the state, thus satisfying the underlying statute of the ACA.
2017 carriers: InHealth Mutual, Aetna, and All Savers exited the exchange at the end of 2016
Three insurers that offered exchange plans in Ohio in 2016 — InHealth Mutual, Aetna, and All Savers/UnitedHealthcare — did not offer plans in 2017.
And HealthSpan was purchased by Medical Mutual; HealthSpan’s individual market plans ended on December 31, 2016, and were replaced with Medical Mutual coverage — but enrollees had the option to pick a different carrier instead.
The rest of the carriers that offered coverage in the Ohio exchange in 2016 continued to offer plans for 2017. At ACA Signups, Charles Gaba calculated a weighted average rate increase of 17.33 percent for the individual market in Ohio. This was lower than the national average that year, which was about 25 percent.
InHealth Mutual CO-OP liquidated in 2016
InHealth Mutual (Coordinated Health Mutual Inc.) was one of the 23 CO-OPs that were created by the ACA. By the end of 2015, 12 of those CO-OPs had closed, although InHealth Mutual was among the 11 that continued to provide coverage in 2016.
But in May 2016, the Ohio Department of Insurance announced that InHealth would be liquidated, and that 21,800 Ohio residents — most of whom had individual plans — would need to select new coverage. The DOI announced that there would be a 60-day special enrollment period (through July 26, 2016) during which InHealth Mutual members would be able to select new plans.
For members who did not select new plans, InHealth Mutual coverage technically remained in place until the end of 2016. But the state guaranty association stepped in to pay claims, which meant that the coverage was no longer considered minimum essential coverage, and had a benefit cap of $500,000. So a member who continued to pay premiums for InHealth Mutual throughout the rest of 2016 was not in compliance with the ACA’s individual mandate, potentially ending up with a penalty as a result. They also lost eligibility for any subsidies through Healthcare.gov. The Ohio DOI estimated that there were still about 7,800 people with InHealth Mutual coverage as of early August, 2016.
Ironically, InHealth Mutual may have avoided the first round of CO-OP shut-downs because of the fact that they didn’t get their Ohio license in time to offer subsidized plans in the exchange in 2014. As a result, they had to rely on small group enrollments outside the exchange for 2014, and only ended up with 11 percent of their projected enrollment by the end of the year.
But that first wave of 2014 enrollees turned out to be sicker than expected, and nationwide, carriers lost money. Since InHealth Mutual hadn’t been able to offer plans in the exchange, they were spared the high claims that the other CO-OPs experienced, and ended up with a net income of negative $6 million for 2014 (that’s obviously still not good, but only four other CO-OPs did better that year).
By mid-2015, InHealth’s membership had more than tripled, to 22,000 people. But they still had a loss of $9 million during the first half of 2015, and were placed under enhanced regulatory oversight.
For 2016, InHealth had proposed an average rate increase of 7.7 percent, but later revised their request to 15 percent. The final approved average rate increase for their plans was 14.8 percent. However, regulators noted that in order to stem their losses, InHealth would have needed a rate increase of about 60 percent for 2017 if they had remained operational.
2016 carriers and rate changes: Overall rates up about 13%, but benchmark plans were slightly less expensive in 2016
In late October 2015, HHS released an overview of benchmark premium changes in the states that use Healthcare.gov. It was admittedly of limited value, since the benchmark plan isn’t necessarily the same plan from one year to the next. But it did give a good idea of how subsidies would change in 2016, and a general feel for the overall rate change trend in many states. Of the 37 states included on the list, only four had an average decrease in their benchmark premiums — and Ohio was among them. The average second-lowest-cost Silver plan in Ohio was 0.7 percent less expensive in 2016 than it was in 2015.
And a Kaiser Family Foundation analysis of second-lowest-cost Silver plan premiums in the Cleveland area found an average decrease of 5.3 percent.
But according to the Dayton Daily News, overall rates in the Ohio exchange increased by an average of about 13 percent for 2016. However, it’s important to look not just at rate changes, but the rates themselves. According to a Kaiser Family Foundation analysis, a 40-year-old in Cleveland could buy the second-lowest-cost Silver plan for $234/month in 2016, before any subsidies were applied. The analysis examined a major metropolitan area in every state plus DC, and Cleveland, Ohio had the 7th lowest average benchmark price among the 51 exchanges.
Here are the approved average rate changes for the 15 carriers offering plans in Ohio’s exchange for 2016 (some were considerably higher than the carriers proposed):
- Aetna: 13.2 percent increase
- AultCare: 5.47 percent increase
- Buckeye Community Health Plan: 5.31 percent and 7.68 percent increases, depending on whether plan includes vision
- CareSource: 1.2 percent increase
- Community Insurance Company (Anthem BCBS): 4.05 percent increase
- Coordinated Health Mutual (InHealth): 14.8 percent increase (InHealth is being liquidated and is no longer offering plans as of May 2016)
- HealthSpan Integrated Care: 18.22 percent increase
- HealthSpan: 31.96 percent increase
- Humana: 19.25 percent increase
- Medical Health Insuring Corp. of Ohio: 14.47 percent increase
- Molina: 5.78 percent decrease
- Paramount: 9.94 percent increase
- Premier Health Plan: 0.68 percent decrease
- Summa: 0.89 percent and 9.64 percent increase, depending on plan type
- UnitedHealthcare: 1.75 percent increase (United is exiting the individual markets in most states at the end of 2016, including Ohio).
2015 rates and carriers
After reviewing plans and rates, the Ohio Department of Insurance announced in the fall of 2014 that the average rate increase for 2015 would be 12 percent in the individual market, although this was not a weighted average (which likely would have indicated a lower overall average increase).
Fifteen carriers sold 2015 individual plans in the Ohio exchange, up from twelve in 2014. All except Time/Assurant returned to the exchange for 2016. Ohio was tied with Michigan for having the most carriers of any exchange in the country for 2015.
Medicaid expansion in the Buckeye state
Former Ohio Governor John Kasich was not an ACA proponent, but he actively pushed for Medicaid expansion in Ohio, which was approved in late October 2013. Eligible residents were able to begin enrolling in expanded Medicaid on December 9, 2013. Net enrollment in Ohio’s Medicaid program has grown by 23 percent since the fall of 2013.
However, opponents of Medicaid expansion brought a lawsuit against the Ohio Department of Medicaid and the state’s Controlling Board because the General Assembly was bypassed in the decision to expand Medicaid. The plaintiffs hoped to block the state from expanding Medicaid, but on December 20th, 2013 the Ohio Supreme Court sided with Governor Kasich and kept Ohio Medicaid expansion on track. The Court’s ruling came less than two weeks before expanded Medicaid took effect.
Exchange history in Ohio
In November 2012, Governor Kasich formally announced that Ohio would not implement a state-run health insurance exchange. In the same letter, Kasich indicated that Ohio would retain control of plan management activities and determining eligibility for the state’s Medicaid and Children’s Health Insurance Plan (CHIP). Ohio is one of seven states that use the marketplace plan management model.
Ohio residents can compare plans, determine subsidy eligibility and enroll in coverage at Healthcare.gov.
Leadership’s opposition to the ACA
In June 2013, the Ohio Department of Insurance issued a press release announcing that 14 insurers filed plans to offer more than 200 options for individual insurance, and seven insurers would offer 84 options for small businesses (ultimately, two carriers backed out, leaving 12 in the exchange in 2014). Then-Lt. Gov. Mary Taylor, who also directed the state’s insurance department until 2017, stated in the press release that “consumers will have fewer choices and pay much higher premiums for their health insurance starting in 2014.”
Both opponents and supporters of the Affordable Care Act jumped on the press release. Opponents claimed Ohio was the latest example of “rate shock.” Supporters dismissed the announcement for making “apples-to-oranges” comparisons and pointed out that both Kasich and Taylor had been outspoken about their opposition to the ACA.
Laws were enacted in Ohio to make it more difficult for navigators to be certified, which means that the state has fewer people available to assist applicants, and there was a delay in getting them started as navigators after the exchange opened in October 2013.
Ohio health insurance exchange links
State Exchange Profile: Ohio The Henry J. Kaiser Family Foundation overview of Ohio’s progress toward creating a state health insurance exchange.