Blue Cross Blue Shield of Texas requests premium rate increase for 2017

HOUSTON – Texans who have health insurance through Blue Cross Blue Shield of Texas could be in for a big surprise when it's time to renew coverage through the Affordable Care Act.

The company filed the required notice with the federal government, requesting increases next year.

The notice comes as the Episcopal Health Foundation in Houston just revealed more Texans than ever are actually covered thanks to the Affordable Care Act. The number of Texans who now have health insurance is at a new high, up 30 percent since Obamacare began three years ago.

“The main thing the ACA has done is open up the health insurance marketplace through which 1.3 million Texans have bought insurance plans,” Elena Marks, president and CEO of the Episcopal Health Foundation revealed.

But for 600,000 Texans who are covered by Blue Cross Blue Shield of Texas, premiums could go up dramatically in 2017.

The company notified the federal government it wants to increase rates for three separate individual plans by nearly 60 percent.

Policy holders who get government subsidies for coverage would be protected, but those who pay out of pocket on their own would feel the effects.

“And while Blue Cross Blue Shield may be raising their rates and others may pull out of the market, others are coming in all the time, and the marketplace in Texas is robust,” Marks added.

Marks says if you fall into the category of policy holders who will face a premium increase, don't panic.

“There are still many, many companies in the market and there are actually new plans coming in the market each year,” Marks said.

Marks says premium increases since the marketplace began have generally been less than 10 percent, which is in line with what many employer sponsored plans experienced. Some premiums have even gone down. The bottom line, Marks says, you will have options.

“If the market next year is like it has been for the last three years, there will be many plans who can complete and who can fill that gap and who will happy to take those customers."

Blue Cross Blue Shield of Texas spokesperson Edna Perez-Vega, sent Channel 2 this statement:

While we have submitted rates and pricing for next year, it’s important to remember that no final decisions have been made regarding our 2017 offerings.

The rates we have submitted for review and approval, are supported by strong actuarial principles, science and data. The rates that health insurers currently charge vary and are based on several factors including medical care costs for a region, pharmaceutical cost and utilization, among other variables. The anticipated health risk of the people in any given market is the largest component of determining rate changes.  Additionally, rates may also differ based on whether an individual is purchasing insurance directly or through his or her employer.

Any discussion of average rate increases (proposed or approved) can be misleading to the consumer, since that average may not be indicative of an individuals’ or a groups’ rates. There is no incentive to overprice our plans. Consumers have layers of protections at the state and federal levels (to ensure appropriate and reasonable pricing) including:

• If individual consumers/members deem plan prices are too high they can choose another plan or choose another health insurer.

• State rate review of plan and rate filings, including rate hearings and consumer comments.

• Federal MLR requirements and potential rebates if a specified amount of premiums do not go to medical costs or activities that improve the quality of care.

Rates should also be viewed within the context, or net of, any premium assistance for those individuals who may be subsidy eligible. Individual actual out-of-pocket costs will differ based on the financial assistance they receive from the government to offset their total monthly premium cost.