For the second year in a row, Premera Blue Cross Blue Shield of Alaska said it needs rate increases of more than 35 percent in the individual health insurance market, in large part because it had 37 customers in the first quarter this year who had $4.1 million in claims among them.
The company filed for rate increases in mid-May averaging 38.7 percent for plans aimed at complying with the Affordable Care Act requirements. It said that with 8,484 customers in the individual market, it is losing money in that part of its business because of the high medical bills from 1 percent of its customers.
They accounted for about 39 percent of the $10.6 million in claims generated by the entire group of 8,484. In the first six months of 2014, Premera said, it had 33 members whose medical claims topped $7 million.
"These members suffer from chronic conditions like end-stage renal disease, congestive heart failure, various types of cancer and other high cost conditions. Without a change to the way this pool is funded, the treatment of these chronic conditions will continue to significantly impact the rates all Premera's individual members pay," the company said.
With the end of the high-risk insurance pool in Alaska, people with serious and chronic conditions have purchased insurance from the individual market under the health law, but the economics aren't working, the company said.
"The lack of a large enough pool to spread the cost of care for those individuals is the overwhelming key driver of this rate increase," Premera told regulators in its justification for the increase.
The company said the state needs a mechanism to "provide long-term stability to the individual market" and repeated its call for the establishment of a supplemental state reinsurance program. That would be a way to spread the costs of caring for the sickest people across the entire insurance market.
During the first quarter, the company said, it received an average monthly premium of $713 but paid out an average of $919 per customer in claims. In 2014, it paid out $878 per member.
"Since 2014 when ACA metallic plans were introduced, the cost of individual plans has increased by 91% year over year. This situation is unsustainable as health plans across the market are unable to incur these recurring losses in the individual market," it said in a filing with the state.
The company instituted rate increases earlier this year and says it is not close to breaking even "for this line of business"
"However, we cannot continue to operate at a loss year after year. In 2014, Premera lost more than $9 million serving our individual metallic members in Alaska. Based on data from Jan. 1 through March 31, 2015, Premera currently projects a $9.3 million loss serving individual market customers on metallic plans in 2015. There is no foreseeable end to these losses without the creation of a state-based program to address the challenges this market faces. In 2016, our rates are based on the need for this line of business to break even," it said.