Announcing 2019 Health Insurance Rates / HealthChoice

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good morning thanks all for being here this morning can everybody hear me okay great I'm Jessica lumen I'm the Commissioner at the Minnesota Department of Commerce and joining me today our Commissioner Jan Malcolm from the Minnesota Department of Health and Nate Clark the CEO of mnsure the state's health insurance exchange today we are here to announce the 2019 health insurance rates for Minnesota's individual and small group markets and provide consumers guidance on how best to shop for insurance during the annual open enrollment period that begins on

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November first before we get started let me take a few moments to thank the Commerce staff who worked on this year's rate review process 15 employees from our insurance division were involved in the review they were led by Fred Anderson our Acting Deputy Commissioner for insurance and Kristi bone our chief health actuary I also want to thank the staff at the Minnesota Department of Health who partnered with us in this important effort all of these people are dedicated public servants and we appreciate their hard work on behalf of the people of the state of Minnesota as

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an overview and then we'll get into some details first the individual and small group markets remain stable in Minnesota second on average rates are going down in the individual market because of lower utilization rates lower costs per service Minnesota's reinsurance program and a strong Minnesota economy every county in the state for 2019 has at least one carrier offering health insurance in both the individual and small group markets and individuals will

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have access to at least two carriers in 83 counties and at least 14 health plans in all 87 counties and all of the health plans that have been approved with rates today continue to provide the following consumer protections comprehensive health coverage and no exclusions for pre-existing conditions I'd like to offer a little background on the rate review process as you know the Commerce Department does not set the insurance rates we with rate review we carefully

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evaluate the proposals submitted by insurance companies to ensure that they comply with actuarial standards and with state and federal law we look to see that the rates proposed by insurers will be adequate to pay for expected medical claims and expenses on behalf of policyholders we also ensure that these rates are not excessive in addition the Minnesota Department of Health reviews the insurers proposed plans to make they sure they comply with requirements for the adequacy of health care provider networks I also want to

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thank the health insurance companies for their participation and work during the rate review process today we are announcing the final approved rates for the individual insurance market and the small group insurance market let me turn first to the small group health insurance market these health plans provide coverage for businesses and organizations with two to fifty full-time employees Minnesota's small group health insurance market is considered to be stable in terms of insurance participation market size and

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rates ten companies will be offering plans in 2019 no insurers leaving the market and one insurer is entering the market the overall size of Minnesota's small group market can is growing going from about two hundred and fifty thousand and two hundred 2016 to just over three hundred thousand by the end of 2017 about five and a half percent of all Minnesotans are in the small group market during the past few years most small group insurers have had relatively modest rate increases this is also the

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case this year the final average rates for 2019 range in the small group market from two point three seven percent decrease to an eleven point nine three percent increase most rates will see a single-digit increase small group and individual rates continue to be more closely aligned in every rating area the small group rates and the individual rates are closer together than they were in 2018 moving to the rates that are being approved today in the individual health insurance market as of April this

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year the individual market included about a hundred and fifty five thousand enrollees or about three percent of all Minnesotans these the people who buy their own coverage for themselves and their families they don't get their insurance through an employer or a public program like Medicare Medicaid or Minnesota care for 2019 the schedules for all five carriers are showing rate decreases as you can see in the poster here the individual health insurance market decreases range from seven point four percent to twenty seven point seven percent please note that

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these average changes are over all plans being offered in the individual market by each carrier the actual rate change a consumer will experience can vary from the average based on the specific plan they select where they live and how old they are these rate changes do not reflect the impact of federal premium tax credits for eligible Minnesotans who purchase their coverage through mnsure Minnesota care can excuse me Minnesotans who get their tax credits are largely insulated from the big rate increases in 2016 and 2017 and we'll see less impact

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from these rate reductions now the greatest positive impact will be for Minnesotans who are not eligible for tax credits and who must pay the full cost of their own premiums these people should see significantly lower premiums available to them when they shop for their health plans during open enrollment at this fall in terms of actual premium costs I want to provide you a few examples of what someone might pay to get the second-lowest silver plan through mnsure for example a 40-year old in the Twin Cities would pay $300 per

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month which is $27 per month less than last year a forty year old in Duluth would pay three hundred and thirty two dollars per month which is ninety four dollars less than last year a family of four in the Twin Cities would pay fourteen hundred and sixty four dollars per month which is a hundred and thirty four dollars less than last year and an family of four in Rochester would pay twenty three hundred and fifty six dollars per month which is five hundred and fifty two dollars less than last year now as a reminder these are examples and they also do not include the tax credits that folks could receive

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through the mnsure system the rate changes for 2019 are an indication that with state support the individual market has stabilized there are a combination of several factors to attribute stabilization to first medical claims costs are projected to be lower in 2019 in 2018 utilization rates and costs per services were reduced possibly because the individual market pool tends to be somewhat healthier than anticipated pent-up demand for health care may have been met access to

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preventive care may have made people healthier and carriers may have achieved some cost efficiencies second the states reinsurance program that began in 2018 and continues into 2019 is estimated to have reduced rates by about 20 percent from what they otherwise would have been without reinsurance third Minnesota's economy continues to be strong and a stronger economy contributes to a stable insurance market to explain a bit more about the state's reinsurance program for the individual market this program

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reimburses health carriers in the individual market for 80% of high medical claims costs Minnesota was only the second state in the nation to enact a reinsurance program with federal approval now there are seven states with reinsurance for 2019 and additional states are looking to do the same because about 2.2 percent of enrollees account for about half of the total claims cost in the entire individual market the reinsurance program allows insurance carriers to offset their high-cost claims 271 million dollars per

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year was appropriated for the reinsurance program in both 2018 and 2019 federal funds will offset a significant portion of the reinsurance costs these funds are based on savings from premium tax credits that the federal government would otherwise pay Minnesotans for higher rates without reinsurance this federal funding is anticipated to be about 131 million dollars in 2018 well Minnesota has focused on stabilizing the cost of health insurance were also pleased that there will be multiple plans offered in every County for consumers to choose

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from in the Commerce Department health rate summary report there are maps showing the individual market carriers that are offering plans in each county there's also a map showing the number of plans available in each county again the goal is to have as much consumer choice as possible so that consumers can choose the best option for themselves and their families mnsure open enrollment offers the opportunity for Minnesotans to shop for the plan that best fits their budget and health needs the Minnesota Department of Commerce and health are also ensure that

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all of the health plans in the individual market and the small group market include comprehensive coverage and do not exclude for pre-existing conditions essential health benefits are provided by all of the plans in these markets including emergency services hospitalization maternity and newborn care preventive and wellness care and substance abuse and mental health treatment in conclusion today's approved health insurance rates show that the individual and small group markets have stabilized however based on Minnesota's

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experience and that of other states across the country it is clear that state support is needed in order to create and maintain that stability particularly in the individual market in the past we have had a premium discount program and Minnesota currently has a reinsurance program in place to provide that stability further while the rates have stabilized in Minnesota the actual cost of health insurance continues to be a barrier for many families and small businesses continued focus on health outcomes cost drivers access and

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affordability are key components of continuing to have a strong insurance market in the future thank you I'd now like to turn it over to Commissioner Malcolm Thank You commissioner lumen and good morning John Malcolm from the state department of health we really appreciate the opportunity to join our partners at the Department of Commerce and mnsure this morning to talk about the importance from a public health perspective of today's good news for Minnesotans I really appreciate Commissioner illumines emphasis on the importance of

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the benefit coverage offered in Minnesota due to our strong consumer protections in the individual and small group markets as commissioner lumen mentioned one of the core responsibilities of the Health Department is to regulate certain aspects of HMOs and health plan provider networks the health plans offered in Minnesota by mnsure on the men strange are required to meet multiple certification standards including the benefits coverage that we've discussed the health department is also responsible for certifying provider

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networks including physicians specialist clinics hospitals and other providers overall in 2019 available provider networks will also remain very stable with only my changes in service areas here are the highlights no network service areas will be reduced 12 provider networks will be offered on mnsure for the individual market in 2019 compared to 11 networks offered with individual health plans on the exchange in 2018 most counties will

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have two or three available provider networks and associated qualified health plans only two counties in our state will have only one available provider network that is Lake of the Woods in Meeker County we often talk about the challenges posed to public health by the rising cost of health care and health insurance we know how important having access to quality health care is for people's health it matters whether you can go to go to the doctor for preventive care and when you first see signs of a troubling condition we also

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know that the financial burden of health healthcare costs and health insurance matters tremendously to family's sense of well-being and fan shalls' financial stability but it's true that rising costs have placed coverage out of reach for many Minnesotans and rising costs will continue to threaten coverage in the future in fact analysis soon to be published by the Health Department indicates that health care spending is projected to nearly double again in the next decade key drivers of health care costs include

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our aging population and a systemic tendency in our health care system to focus almost all of our resources on treating people after they've already fallen ill rather than doing more to help them stay healthy obviously people need quality health care and they need affordable insurance to get access to that care but that's not enough on its own even with the most advanced health care capabilities in the world we cannot simply treat our way out of these costs and we can't prevent chronic disease

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without focusing on what causes them in the first place health care costs are being driven overwhelmingly by chronic conditions like diabetes more than one-third of Minnesotans today have at least one chronic condition and we know that spending is eight times higher for someone with a chronic condition than for someone without so to prevent chronic disease and to manage it once again we need to pay attention to the quality of insurance coverage as commissioner lumens so well described which means no exclusions for

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pre-existing conditions and the inclusion of essential benefits like mental health and substance abuse coverage and further we need to use our public health tools to identify and address the root causes of illness and to move further upstream which includes doing more to invest in the community conditions that either enable healthier choices or make them more difficult which is why it's so important that Minnesota continue with its leading efforts through the statewide health improvement partnership to work with

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local communities on those community conditions for prevention for actual health improvement we look forward to continuing to be part of these solutions to Minnesota's ongoing health care cost and quality challenges and continuing our close collaboration with the Department of Commerce and with mnsure to ensure that the health care system and insurance markets work for everyone in Minnesota in every corner of our state with that I will hand it off to the mnsure CEO mr. Clark Thank You

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commissioner Malcolm and Commissioner lumen I am nate Clark good morning everyone I am the CEO of mnsure as in previous years there's been a lot of noise around the Affordable Care Act and there are three important facts Minnesotans searching for coverage should keep in mind first mnsure is open for business and ready to help Minnesotans enroll in comprehensive health coverage it's important that Minnesotans helped and their finances are protected second tax credits are

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still available to help Minnesotans save money off their monthly premiums but you can only access those tax credits on mnsure org and third we have free in-person application and enrollment assistance available from trained experts who live in your community so mnsure is still here we can save you money and there is free help if you want it a few words about saving money mnsure is the only place where Minnesotans can take advantage of it

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premium tax credits these credits act like instant discounts that reduce the monthly out-of-pocket costs Minnesotans pay for their health insurance some Minnesotans mistakenly believe the credits are only available to low-income individuals this isn't true this year an individual earning up to forty eight thousand five hundred and sixty dollars a year we're a family of four earning up to 100 thousand four hundred dollars a year can't qualify for help last year about two-thirds of

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Minnesota mnsure enrollees qualified for tax credits these tax credits can make a real difference for Minnesotans last year the average tax credit was more than $7,000 dollars per year many Minnesotans are often pleasantly surprised to learn that they're eligible for some kind of Faysal some kind of financial assistance and we need to get the word out about this last year half of the Minnesotans who are eligible for tax credits didn't take advantage of them and taken together they missed out

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on millions of dollars in help so yes the rates are important news today but it's also important to remember that the financial assistance is available that's a very important part of this story consumer should come to mnsure.org and see if they qualify when it comes to premium costs for the vast majority of the Minnesotans we help the price they see in today's rate reliefs will not be the price they ultimately pay to get the financial help available to them

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Minnesotans should fill out an application at mnsure.org starting on November 1st these tax credits make the final price tag more affordable and they can only be accessed by shopping through mnsure finally I want to highlight the consumer assistance I mentioned earlier while such outreach funding has been cut for other states mnsure still has free in-person assistance in every corner of Minnesota to help people enroll we know that

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enrolling and health coverage isn't always easy and that's why we have 1500 certified assisters these are brokers and navigators and they're ready to help by providing free in-person assistance these assisters could help individuals complete an application and they can present them with their covers options and they do this at no cost Minnesotans anxious to start the enrollment process should go to our website they can find a broker or a navigator in their community and they should schedule an appointment starting

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November 1st so remember tax credits are available to consumers only through mnsure org and in-person assistance is available throughout the state for those who would like it in closing let me just say this Minnesota has the fourth lowest uninsured rate in the nation and that's not an accident access to affordable care coverage through mnsure has been critical to helping Minnesota achieve historically low uninsured rates this

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open enrollment mnsure will be focused on helping more Minnesotans protect themselves by shopping and comparing plans through mnsure and enrolling in comprehensive health coverage thank you so we'd be happy to say it takes four questions if anybody has them so again

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there's a couple of factors that that that play into that so as we say the individual market is now at about a hundred and fifty five thousand enrollees we do hope that as the rates continue to go down and the market continued to stabilize that people will be able to move back into that market if they have left that market how else however we're also seeing as we indicated an increase in the small group market and so we're seeing people move into other markets oh it's out of the individual market and fostering authorities just premiums

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exclusive so the what you see here is a combination of all of the plans that are offered by the individual carrier so they're going to include all of the different pricing value plans so it's everything from catastrophic plans up to gold and plans are all built into these averages we can get you the detailed information about what the individual plans have and the deductible values and all of those kinds of things in more detail so this is the average premium of

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all the different types of plants not with this it's just the value of each plan is factored in this this average yeah thank you thanks for clarifying for 2019 on saying silver plan versus 2018 we can sure get that information for you it's super detailed for each plan yeah level the Trump administration is promoting short term health plans and Association health plans so are they gonna are those gonna be big factors in these markets next year so the federal

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actions have been somewhat mitigated in Minnesota by the premium subsidy plan that we have and the reinsurance plan of had and the reinsurance plan that we have now we also very strong regulations in Minnesota around both Association health plans and short-term limit duration plans and so we think in some ways that actually insulates us from some of the impact of federal regulations that said these rates do reflect the carrier's expectations in understanding around the 2019 impact of those changes in federal regulations

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real quick than that no I'm a short-term I thought state law would make the short-term changes the irrelevant in Minnesota but maybe that's too strong so we have a law in Minnesota that regulates short-term limited duration plans and in Minnesota we have about six of those plans being actively marketed and other plans that have been approved but in Minnesota those plans are only bridge plans that help folks for up to six months to move from one comprehensive plan to another comprehensive plan and we really see people using those short-term plans at least in Minnesota to help them get to

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the next open enrollment like we're seeing in November first but if a carrier wanted I mean that they think the scenario nationally is that the carrier could extend that to 364 days or something like that could carrier do that in Minnesota in Minnesota we are their short term limited duration plans are limited to six months so it's less of a issue and as an alternative coverage we see less of an impact of that change yes Association plans is there much change in the status quo for Minnesota or there is not much change in the status for

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Minnesota agains we have a strong law in Minnesota that regulates Association health plans and so we don't anticipate that there'll be significant changes in that however there may be opportunity for more fully insured Association health plans to move into the large group market but we're not in - we haven't seen that yet program runs out of money sure so the new governor and the legislature will have to determine what form of state support that the individual market has in 2020 in order to continue this stabilization we do

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recognize and the data proves out that through the premium subsidy plan in 2017 and then the reinsurance plan for 2018 and 2019 those were very strong factors in the stability that we're seeing today come up with a new type of stabilization plan in the next session so that the rates don't presumably what we we do think it's really important that the new governor and the legislature take a really hard look at how to continue to

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provide the state support necessary for a stable individual market would there be options other than the status quo to the conventional reinsurance and so well I think that there's a lot of ideas under discussion and again I look forward to the conversation that the the next governor in the legislature have about this issue commissioner Malcolm's looking more broadly at healthcare offerings in Minnesota as a whole the legislature and governor next year will have to figure out not only whether to

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re extend or somehow extend a premium subsidy or reinsurance but also Minnesota care how troubling is that for you as as this administration ends and a lot of questions are on the line well we're we're grateful that there has been heightened attention drawn to the fact that the Health Care Access Fund which supports not only the Minister of Minnesota Care Insurance Program but many other things we do in Minnesota to support rural health care to support provider availability and to support

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prevention are all funded by the Health Care Access Fund which relies on the provider tax and it's not the healthcare access fund that goes away under state under the sunset that's it's just specifically the provider tax funding mechanism so I think we have to two distinct policy conversations that need to be had next year one is the funding source for the healthcare access fund and what that access fund should support so absolutely this is going to be an

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urgent item for the 2019 legislature as programs will start to be impacted in 2019 by the by that provider tax sunset if that if that stays in place your claim that Minnesota care can be funded through federal resources specifically solely and the provider tax is not needed to fund Minnesota care what's your response to that claim well I would want to defer to my colleagues in terms of the specifics of the the intricacies of the funding mechanism and it's

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complicated how provider tax and and federal supports interplay but again I would just call attention to the fact that there are things in that health care access fund that we believe are powerfully important for keeping care affordable and keeping Minnesotans healthier which have nothing to do with the federal reimbursement for for Minnesota care per se that all the supports that we give to rural health care availability helping to support provider access around Minnesota and prevention I can't stress enough how backwards our funding strategy is for

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health in Minnesota when we fail to invest upstream and prevention and those things are funded not by the federal government by the state mechanism - not by ACA insurance instead by something a catastrophic plan that doesn't mean you know essential health benefits and doesn't you know qualify for an ACA plan is there ever an argument to be made that some people might be best to make that decision in the current environment I'm gonna let

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mr. silver talk as well but I think our mr. Nate talk I'm just but I think the short answer is that we really encourage people to shop for the right plan for themselves and I think that that what's what we show here in the in the scope and breadth of the plans that are being offered all the way all across the state that it's really important that people do shop see if they have tax credits available and see what the right plan for themselves and their family is so I think you know the great thing about the individual market is it really is

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individualized and each one of the hundred 55,000 people that's currently participating in the market can find the right plan for themselves we actually don't anticipate that there's going to be a big impact in this smart in the individual market because of the people that are currently participating in the market we actually hope that they'll be an increase in participation because these rates are going down somewhat well when we saw the proposed rates earlier in this in the

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spring and then we were able to do the evaluation and ensure that they actually balanced with the actuarial standards as well as state and federal law the these are pretty they are a decrease but we were not that surprised by them because we knew that the impact of the reinsurance program was going to have some impact on that and then we're also seeing these trends lower with the utilization and costs one thing tell me if I'm seeing this right the the decreases are are bigger it looks like

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an out state in Greater Minnesota then in terms of dollars they're greater the premiums in the greater Minnesota would have been higher to begin with um it might seem that right and what what what explains that not sure gonna be able to answer you on a specific question County like the benchmark premium view page eleven thirteen of them page thirteen yeah Olmstead this benchmark goes down it's hard to read but I think it says one hundred and

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thirteen dollars whereas in Hennepin it goes down twenty-seven dollars I think and I think if I'm seeing it right it looks like most of the sort of out state counties have a greater decline so I didn't know if you could talk about I don't want to speculate on each individual County so I can certainly get you some more information on that but what we are seeing is there is some variety and variation and again in which benchmark plan it is and also the the change over time I want to follow up on what my

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colleague talked about it specifically I think commissioner Malcolm said a couple of counties Meeker and Lake of the Woods have only one provider available so kind of along the line of what he was asking the counties that have fewer provider networks available are they generally going to see less of a decrease or more of a decrease than counties where there's you know more market options for people do you have any do you have the data cut that way at all can you tell us anything about that I don't have that data cut right now but we can certainly

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get it to you again what we're really grateful for is that there is a provider in every single County in Minnesota a carrier excuse me in every single County in Minnesota and that the number of plans to choose from is at least fourteen and in most in most counties is greater than that you know my question isn't I don't like in the woods or Meeker are they gonna be paying a a lot more premium or see less of a decrease and other but you know you don't have that information I don't have that you we can take a look at the chart on page 13 and

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ask answer specific questions yeah sure um one thing for commissioner Malcolm may be on networks so one of the big issues in the past has been for folks who live outside a southeast can they buy a plan in this market where the Mayo Clinic is in-network and the answer has been no is there any change on that this year there's really no change in that dynamic I would like to just emphasize that we're blessed in Minnesota with a number of high quality providers and

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markets all around the state and it is I appreciate the question because it's really important that folks do pay attention to how their provider networks are structured with respect to access to specialty care the the two plans and this is not surprising that that feature more in network coverage for mail are the plans in the southeast access to mail and other highly specialized providers in the other in the other plans and the other products around the state would vary by type of service and so it's just always important for

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enrollees to know the specifics of their network and particularly how to how to access really some of that that tertiary and quaternary specialty care that's that's something that is important for consumers to know and does vary quite a bit from plan to plan and aside from Mayo are there any network when it's very detailed but I mean when you all look at the details are there any like pleasant surprises people are gonna find the network so wow it's a lot bigger or is it kind of the same I hear to it with

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respect to provide our availability it's a story of the market being relatively stable and there being a provider access that meets our standards for Geographic access and coverage of specialty types in each of these networks so it does remain a good news story that provider access was generally good around the state the commissioners or mr. CEO what could next year blow this up I assume that if if the legislature decides not to do read to provide reinsurance an extension

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of that now we'd be talking about 2020 then at that point that most of these reductions would go away we correct in that what other things on the federal level or otherwise might switch us around to the other mode where we were having significant increases instead of significant decreases can you give us any thoughts anecdotally or otherwise on that I think that we have as we've discussed we have an opportunity moving forward in the next legislative session to really address

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how we continue this stabilization in the individual market and I think that we also we have very sophisticated carriers in this state and we also have very sophisticated consumers and I think that we all continue to look at the impact of federal regulations and change at the federal level as well as the goals we're trying to achieve of providing access to affordable health care for all Minnesotans and those are the areas that we need to continue to focus on moving forward fair to say that if reinsurance isn't there that it would have a significant impact in 2020 we

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need to have a plan in place for plan year 2020 and again I think there's a real opportunity to think about what that looks like in the next legislative session without reinsurance does it create real problems some of your colleagues were nodding their heads I think we need a plan and I think that reinsurance has been the plan for 2018 and 2019 the premium subsidy plan was in play program was in place for 2017 and I think we need to continue to look at what we're going to do moving forward federal support accounted for over 100

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million of the reinsurance funding what's the future of that I mean it's not something that you can keep Minnesota can count on and you keep going forward or is that who knows so in order to operate the reinsurance program the Commerce Department I had to apply for a waiver from the Department of Health and Human Services and that waiver is in place and each year we we'll need to go back to the department and talk about what our experiences have been what our projections are and firm

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up exactly what that reimbursement rate will be again it's it's based on prior experience and so we anticipate because we have the approval of 1332 waiver that we the federal approval does continue it's just the amount of money that we will actually receive as federal subsidy might may change over the years year 2020 when would you need authorization from the legislature in order to get everything in place Rosana : next year again we think that this is something

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that really needs to be addressed in the beginning of the next legislative session around what the plan is going to be if it's going to be a reinsurance plan it's going to be a premium subsidy plan if it's going to be another plan again the state support for the individual market is as we said a very important factor in ensuring that the stability of this market continues as is the utilization rates and the cost reduction and the stability of our overall insurance market so we think that there's a real opportunity for the legislature new governor to take a look

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at this soon insurance bill created the AG coops do you have any information about how big a factor they've played in the individual or the small group market we don't have any information on that specifically we can certainly get you some information about that or refer you to them directly

Announcing 2019 Health Insurance Rates

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SMALL BUSINESS

SENIOR PRESCRIPTION COVERAGE

DENTAL COVERAGE

SENIOR VISION COVERAGE