The largest health insurance carriers in each Affordable care Act marketplace had a 75% higher premium increase from 2014 to 2015 compared with other same-state carriers.
The largest health insurance carriers in each Affordable care Act (ACA) marketplace had a 75% higher premium increase from 2014 to 2015 compared with other same-state carriers, according to a recent study of individual health insurance carriers in 34 federally facilitated and state-partnership health insurance exchanges. The study was published in Technology Science by Eugene Wang and Grace Gee, founders of HoneyInsured.com.
The study sought to find out whether the ACA’s exchanges are keeping anticompetitive pricing behavior of dominant carriers in check—something the act was designed to do through changes intended to ensure fair premium pricing, even among carriers with dominant market shares. The ACA’s reforms sought increased transparency in premium pricing behavior by requiring that premium changes be reviewed through Rate Filing Justification documents, and carriers disclose claims, utilization, taxes/fees, and other expenses to justify premium changes. Beyond the rate review process, carriers must also ensure that a minimum proportion of the collected premiums (medical loss ratio) must be spent on medical expenditures and premiums in excess of the minimum must be rebated to consumers.
The study followed health insurance plans in 34 state exchanges for pricing changes from 2014 to 2015. Their data show that the largest insurance carrier in each marketplace had a 75% higher premium increase compared with other same-state carriers (P = .03). On average, the largest carriers raised rates by 23.9%, whereas the other carriers only raised rates by 13.7%. The largest carriers’ premium increases affect a larger proportion of plans (P = .008) and do not seem justified from the standpoint of incurred claims-to-premium ratio (P = .31), the authors conclude.
In conclusion, the researchers found evidence that even after the implementation of the ACA, the largest health insurance carriers on the exchanges may be in a better position to practice anti-competitive pricing compared with their same-state counterparts. “This evidence should be prudently considered in any antitrust debate,” they concluded.
Standard Criteria for Loss of Ambulation Needed in DMD
April 19th 2024A recent study suggests the differences between ambulation definitions for patients with Duchenne muscular dystrophy (DMD) can impact the identification of ambulant vs nonambulant individuals, and standard criteria across settings are needed.
Read More
Navigating Health Literacy, Social Determinants, and Discrimination in National Health Plans
February 13th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the February 2024 issue of The American Journal of Managed Care® about their findings on how health plans can screen for health literacy, social determinants of health, and perceived health care discrimination.
Listen
An Overview of Health Care and Pharmaceutical Trends, 2023-2024
April 19th 2024Douglas M. Long, BA, MBA, was featured as the keynote speaker on the closing day of The Academy of Managed Care Pharmacy 2024 annual meeting, with a session dedicated to surveying the health care and pharmaceutical trends of the last year.
Read More
Drs Raymond Thertulien, Joseph Mikhael on Racial Disparities in Multiple Myeloma Care Access
December 28th 2023In the wake of the 2023 American Society of Hematology Annual Meeting and Exposition, Raymond Thertulien, MD, PhD, of Novant Health, and Joseph Mikhael, MD, MEd, FRCPC, FACP, chief medical officer of the International Myeloma Foundation, discussed health equity research highlights from the meeting and drivers of racial disparities in multiple myeloma outcomes.
Listen
Real-World Study Reveals Key Insights Into DLBCL Treatment Patterns, Outcomes
April 18th 2024A recent study offers valuable insights into the characteristics, treatment patterns, and outcomes of diffuse large B-cell lymphoma (DLBCL) in patients across different lines of therapy, providing a look into the landscape of DLBCL management.
Read More
Standard Criteria for Loss of Ambulation Needed in DMD
April 19th 2024A recent study suggests the differences between ambulation definitions for patients with Duchenne muscular dystrophy (DMD) can impact the identification of ambulant vs nonambulant individuals, and standard criteria across settings are needed.
Read More
Navigating Health Literacy, Social Determinants, and Discrimination in National Health Plans
February 13th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the February 2024 issue of The American Journal of Managed Care® about their findings on how health plans can screen for health literacy, social determinants of health, and perceived health care discrimination.
Listen
An Overview of Health Care and Pharmaceutical Trends, 2023-2024
April 19th 2024Douglas M. Long, BA, MBA, was featured as the keynote speaker on the closing day of The Academy of Managed Care Pharmacy 2024 annual meeting, with a session dedicated to surveying the health care and pharmaceutical trends of the last year.
Read More
Drs Raymond Thertulien, Joseph Mikhael on Racial Disparities in Multiple Myeloma Care Access
December 28th 2023In the wake of the 2023 American Society of Hematology Annual Meeting and Exposition, Raymond Thertulien, MD, PhD, of Novant Health, and Joseph Mikhael, MD, MEd, FRCPC, FACP, chief medical officer of the International Myeloma Foundation, discussed health equity research highlights from the meeting and drivers of racial disparities in multiple myeloma outcomes.
Listen
Real-World Study Reveals Key Insights Into DLBCL Treatment Patterns, Outcomes
April 18th 2024A recent study offers valuable insights into the characteristics, treatment patterns, and outcomes of diffuse large B-cell lymphoma (DLBCL) in patients across different lines of therapy, providing a look into the landscape of DLBCL management.
Read More
2 Commerce Drive
Cranbury, NJ 08512