The Centers for Medicare & Medicaid Services (CMS) recently sent a letter to state insurance commissioners, available here, setting forth five findings for departments of insurance to consider as they render final decisions on health insurance rates. The letter’s findings discuss cost and utilization trends as well as policy matters.
First, CMS notes that Marketplace enrollees in 2015 are, overall, lower utilizers than those who first enrolled for plan year 2014. The letter further expresses CMS’s expectation that enrolled populations will “continue to get healthier” as the pent-up demand for health care services is met. CMS’s second finding summarizes available data as indicative of overall medical cost growth remaining moderate. These two factors suggest that modest rate increases generally should be expected from issuers.
Third and fourth, CMS reiterates that, for 2014, the reinsurance rate will be 100% instead of only 80%, and that the agency expects payments into the Risk Corridors program to be sufficient to cover payments to issuers under the program. Preliminary information about payments under the Risk Corridors program is expected to become available soon—on August 14, 2015.
Finally, CMS notes that public hearings may be helpful in rate evaluations and encourages commissioners to ensure appropriate public scrutiny.