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2019 Individual Health Insurance for Indiana

The remaining two individual health insurance companies participating in the Indiana market have filed their rate for 2019. We now have two insurance companies offering personal health in 2019.

CareSource and Celtic Insurance Company aka AM Better

The good news is these two companies have decided to continue to offer individual health insurance coverage to Hoosiers.  There was the real concern with the amount of risk that these carriers will pick up with Anthem exiting the individual market in 2018.

The average rate increase for CareSource is 10.2% 

The average rate increase for Celtic aka AM Better is a decrease of 0.50 %

These are the averages; each county is assessed with a different rate.

CareSource has a minimum rate change -7.7% with a Maximum rate increase of 33.6%.

Celtic has a minimum of -15.2% with a Maximum rate increase of 5.4%.

CareSource is going to be available in 79 counties and offering 3 bronze, 6 silvers, & 2 gold plans.

Celtic is going to be available in all 92 Indiana counties offering 1 bronze, 9 silvers, & 1 gold plans.

If you are interested in crunching the details of their filings continue reading.

2017 Ambetter insured 49,522 members on the exchange in Indiana. They collected $210,687,579 in premium and pay out $191,692,232 in claims.

2019 Ambetter project they will cover 39,574 members with projected premiums of $214,239,747 and projected claims $172,934,517, but they anticipate a risk adjustment payment of almost $11 million. After taxes and operating costs, they estimate a 3.89% profit margin.

2017 CareSource insured 34,722 members on the exchange in Indiana.  $167,483,560 in premiums with $163,169,826 in allowed claims.

2019 CareSource is estimating to insure 75,194 members collecting $397,028,890 in premiums with $367,341,867 in projected claims, they estimate $58,850,419 in risk adjustment payment. Operating on a profit margin of 5.38%.

For 2019 both Insurance companies are banking on the risk adjustment payment to be profitable in Indiana.  If there are only two companies left in the individual market for Indiana and both anticipate risk adjustment receivables, who pay these funds?

Rates Per County:

Ambetter is decreasing rates on most of their plan designs except silver in Rating Area 10 which includes Boone, Hamilton, Hendrix, Marion, Morgan, & Shelby County.  Area 10 receiving a 3%-5% rate increase on the one silver plan offerings.

CareSource is rating up almost every county. They are increasing their gold plans costs by 15%-29%, which indicates those plans were underpriced from the start.  With the rest of the counties having an increased, their premiums will be higher than Ambetter.  Which could create a situation that this carrier is not used too?

If they have based their distribution model on being the lowest costing, can they continue to attract preferred risk?  Will they even come close to the estimated 75K members they anticipate insuring?

The fact that both carriers filed rates for 2019 is a positive because there was uncertainty if the companies would continue to participate.  When the ACA was originally launched the CBO predicted that by 2019 Indiana would have almost 1 million members receiving coverage from the marketplace.  It’s fair to say that projection was way off as the two insurance companies left are projecting combined just over 100,000 members.

CareSource and Ambetter are primary Medicaid providers, and they have extended those networks to the individual exchange plans.  It appears that this strategy has the highest chance of success in the individual market.  Other Insurance company’s like Anthem, Humana, UHC, Assurant, IU Health, MDwise etc. left the Indiana individual market because they could not be profitable.