OKLAHOMA CITY – Oklahomans who buy health insurance on the federal marketplace could be in for sticker shock this year.
The Department of Health and Human Services is estimating premiums will jump 35 percent on average for the one company returning to the exchange this year: Blue Cross Blue Shield.
“Last year, Blue Cross Blue Shield didn’t charge enough in premiums and actually lost money. You have all these new people coming into the market, and a lot of them are sick and need a lot of services,” said Kelly Dexter, a spokesperson for the Oklahoma Insurance Department. “For every dollar in premium they collected, they paid out $1.15, so they lost money. And, you want companies to make a reasonable profit, so they can stay in business, and you can have more competition, which is better for the consumer.”
The federal healthcare exchange on HealthCare.gov opens Nov. 1 and runs through Jan. 31.
According to HHS, last year, more than 126,000 Oklahomans took their pick of plans from four different companies: Blue Cross Blue Shield, Community Care, Global Health and Assurant.
This year, three of those companies dropped out, and only one – United Healthcare – stepped in to replace them.
“Well, it was hard for them to make money,” Dexter said. “Global Health and Community Care originally filed the rates and said they were going to provide plans on the exchange. But, once they started crunching the numbers, they realized financially it didn’t make sense for them. So, they dropped out.”
Dexter said Global Health and Community care were originally anticipating raising rates by seven percent, which would have brought Oklahoma’s numbers closer to the premium increases other states are seeing.
A spokesperson for Blue Cross Blue Shield said the company is always focused on providing to the best value for customers, noting the company has worked to reduce its administrative expenses.
Plus, Public Relations Manager Ashley Hudgeons said, despite the premium increases, the company isn’t pricing its customers out of its product.
“Keep in mind that the actual out-of-pocket cost to a consumer will differ based on any subsidy amount that a consumer qualifies for,” she said. “Subsidies help offset the total monthly premium cost. About eight in 10 customers received a subsidy in 2015.”
The Oklahoma Insurance Department estimates about 80 percent of marketplace users will receive a subsidy again this year, limiting their payments to $80-100 a month.
Last year, according to HHS, 79 percent of Oklahoma consumers qualified for an average tax credit of $206 per month through the marketplace.
And, though there is less competition than before, Dixon said less is still much better than nothing.
“What’s important to us is making sure Oklahoma is a competitive market for insurance companies,” she said. “We want to make sure companies can continue to do business here. You have to have an environment where insurance companies can make a reasonable profit, because you don’t want them to go out of business and have only one company to choose from.”
Dixon said it is once again important to shop around when choosing a plan, paying special attention to deductibles.
“You don’t want to get into one of those high-deductible plans if you can’t afford to pay five or $6,000 out of pocket before the insurance company starts paying 80 percent,” she said.
Also important: double-check to make sure your doctor is still in your new plan’s network.