Wisconsin Health Care

                HOME                NEWS                GUEST BOOK               SITE MAP                ABOUT US


In 2014, the LAW requires everyone to have Health Insurance or pay a penalty.

Obamacare subsidies are for the needy and unemployed.                                                                  
For the rest of us, Insurance companies pay Obamacare 3.8%

OR compare numerous policies for your best rates, CLICK  

WI health insurers file rates for Obamacare; cost impacts coming

By M.D. Kittle | Wisconsin Reporter

MADISON – The health insurer filing blitz is on in Obamacare, and the rush has made life harried at the state Office of the Commissioner of Insurance, according to an OCI official.  The agency on Tuesday announced it has completed its review of rates and forms filed by insurers looking to participate in the federally facilitated health care exchange, under the Affordable Care Act.  Just how ‘affordable’ insurance rates will be won’t be known for another couple of weeks, OIC spokesman J.P. Wieske told Wisconsin Reporter.



OBAMACARE RATES AWAIT: Several health insurers have filed their rate information and forms with the Wisconsin Insurance Commissioner, but an agency official said it will be a couple of weeks before the cost impacts to consumers will be known.

A Society of Actuaries report earlier this year projected Wisconsin’s underlying claims costs could soar by as much as 80 percent by 2017, second only to Ohio, which could see an 80.9 percent hike.

The Ohio Department of Insurance last week announced last week that individual consumers on the federal government exchange will see insurance premiums, on average, rise 41 percent in 2014, the first year of implementation of Obamacare, compared to this year’s rates. Exchange plans for Ohio’s small businesses will climb by an average of 18 percent.

The agency also confirmed previously released preliminary calculations that insurance companies’ costs to provide individual health coverage will climb 83 percent.

“Ohio has traditionally had a more competitive health insurance market than other states with a wider range of prices and choices – from simple, high deductible coverage to comprehensive, full service plans,” said Lt. Gov. Mary Taylor in a statement.  “That level of diversity is essentially outlawed under Obamacare so Ohio’s rates and premiums are going up significantly, and going up more than in other states where prices were already high.”

Insurance experts say the Buckeye and Badger states are similar in the competitiveness of their health insurance markets.

Ohio, does, however, offer a glimmer of hope to Wisconsin.

A report commissioned in 2011 by the Ohio Department of Insurance projected individual premiums could rise by as much as 55 percent to 85 percent in 2014, not including medical trend, typically running at about 7 percent.

The Wisconsin OCI commissioned a report in 2011 that projected insurance rateincreases of 31 percent for nearly 60 percent of the individual market.

OCI has reviewed filings from 13 insurers who have requested their plans to be certified in the federal exchange as a qualified health plan, or QHP, in the individual market and nine insurers who have filed plans to participate in the small employer SHOP exchange.

In order to be eligible for the federally facilitated exchange, insurers must meet all state standards and file their rates and forms with the state of Wisconsin, according to the agency. Insurers began filing insurance policies with the state in April. Wisconsin reviewed the rate and form filings to ensure the policies are in compliance with all laws and regulations.

“This is only the first step in the process,” state Insurance Commissioner Ted Nickelsaid in a statement. “Insurers wishing to participate in the federal exchange will need to complete an additional federal review process and sign a contract to participate on the exchange.” That process is expected to be wrapped up in September.

Wieske said the pace at the agency this summer has been frenetic as staff have worked to meet the deadline imposed by the federal government. The OCI spokesman said the new administrative demands of Obamacare won’t cost the agency any more money, but it did compress the usual workflow.

“These are filings we would have to do at some point, but normally we would do them much later in the year,” Wieske said. “It creates some moving around of priorities in order to get what carriers need done in a timely manner.”

The following health insurers have submitted rate and form filings to OCI:

Individual Market Insurance Companies

Common Ground Healthcare Cooperative

Compcare Health Services Insurance Corporation

Dean Health Plan, Inc.

Group Health Cooperative of South Central Wisconsin

Gundersen Health Plan, Inc.

Health Tradition Health Plan

Medica Health Plans of Wisconsin

MercyCare HMO, Inc.

Molina Healthcare of Wisconsin, Inc.

Physicians Plus Insurance Corporation

Security Health Plan of Wisconsin, Inc.

Unity Health Plans Insurance Corp.

Arise (WPS Health Plan, Inc.)

Small Employer Group Market Insurance Companies

Common Ground Healthcare Cooperative

Group Health Cooperative of South Central Wisconsin

Gundersen Health Plan, Inc.

Health Tradition Health Plan

Medica Insurance Company

MercyCare HMO

MercyCare Insurance Company

Security Health Plan of Wisconsin, Inc.

Arise (WPS Health Plan, Inc.)

Contact M.D. Kittle at mkittle@wisconsinreporter.com

Watchdog.org. Find out more

Obamacare costs soaring in recent rate checks

By   /   June 10, 2013  

Ask Ohio how affordable the Affordable Care Act will be.

Buckeye State insurers expect to see the cost of essential health care benefits for individual coverage in Ohio’s exchange to soar on average 88 percent next year, according to a new analysis from the Ohio Department of Insurance.

The department analyzed individual market plan proposals from insurers against a Society of Actuaries report earlier this year that found Ohio and Wisconsin hold the dubious honor of ranking No. 1 and No. 2, respectively, on the list of states expected to be hardest hit by claims cost increases under Obamacare.

Badger State insurance rates are predicted to climb as high as 80 percent by 2017, while Ohio could see an 80.9 percent hike in insurance costs, according to the Actuaries.

A total of 14 insurance companies filed proposed rates for 214 different plans with the department, according to the Ohio Depaertment of Insurance.  Projected costs from the companies for providing coverage for the required essential health benefits ranged from $282.51 to $577.40 for individual health insurance plans.

“We have warned of these increases since a state-specific study in 2011 indicated Ohio would be significantly impacted by the ACA,” Lt. Gov. Mary Taylor said in a statement.



SINKING FEELING: Ohio projects the cost of  health care coverage will rise 88 percent under the Obamacare exchange, according to the Ohio Department of Insurance.

Ohio’s current average cost to cover medical expenses for an individual health insurance plan is $223, according to the Society of Actuaries study.  Based on the proposals submitted to the Department of Insurance, the average to cover those costs in 2014 would be $420 — representing an increase of 88 percent when compared to the Society of Actuaries study, according to the department.

The proposed rates still are subject to the department’s review process.

“During this process, rates may change before becoming effective,” the regulator said in its news release.

Wisconsin, like many states, still is taking filings for insurance rate proposals under what will be a federally run health care exchange in the Badger State. The  Wisconsin Office of the Commissioner of Insurance won’t release details on the rate cases until they have been updated.

J.P Wieske, public information officer and legislative liaison for the office, told Wisconsin Reporter the commissioner hopes to have an analysis of the costs by late July.

Wieske said Wisconsin is starting to get more answers from the federal government, but, “We’re not so sure they are all the answers we would have expected.”

“The proof of the pudding is in the eating,” he said. “The question is going to be administratively, how is this going to work? We still think there are going to be a lot of complications going forward. This is large, fundamental change for a lot of people.”

America’s Health Insurance Plans, the national trade association representing the health insurance industry, points to a report by actuarial services giant Milliman Inc., which  examines the multitude of changes that will affect health insurance consumers. As the report notes, Obamacare’s scope of covering pre-existing conditions, requiring broader benefit packages and covering uninsured Americans who have gone without medical care will benefit millions of people, but it also will increase the cost of health care coverage. Obamacare’s health insurance tax and other fees also will increase premiums, Milliman notes.

Other provisions of the law, however, will ease costs, including premium and cost-sharing subsidies, according to the study, although taxpayers will pick up the tab for federal insurance assistance.

Cost impacts of individuals are expected to vary, in some cases significantly, depending on the individual’s age, gender, location, health status, income level and the kind of coverage the consumer has today.

“(Y)oung, healthy males could see substantial increases due to the combination of the overall rate change and the age/gender rating requirements,” while “older, less healthy individuals could see rate reductions,” according to the Milliman study.

In most states, there is a a 5-to-1 age ratio built in to health insurance, meaning the older and less healthy in the insurance pool typically pay five times more for coverage than younger, healthier consumers. That age scale under Obamacare moves to 3-to-1, meaning older health care consumers save, while rates go up for many younger insurance holders.

ACA advocates say studies like the one from the Society of Actuaries omit or ignore key expectations that will help drive down costs, such as improved health care delivery, tax credits and increased competition among insurers.

“The health care law will bring down costs and save money for your people and families. It’s misleading to look at only some of the provisions of the law because, taken together, the law will reduce costs,”  U.S. Department of Health and Human Services spokesman Fabien Levyhas repeatedly told Wisconsin Reporter.

California last month issued a news release trumpeting the cost savings coming from Covered California — the name of the Golden State’s version of Obamacare’s health insurance exchange.

“These rates are way below the worst-case gloom-and-doom scenarios we have heard,” Peter Lee, executive director of the nation’s largest exchange, proudly declared in a statement.

The problem is, Covered California’s triumphant release compared the individual market to small business health insurance.

In a piece contesting the sunny California outlook, Forbes contributor Avik Roy does some comparison shopping and finds Covered California’s assumptions of significant rate savings in the individual market don’t add up.

“… (T)he ‘bronze’ comprehensive plan (the second cheapest plan in Obamacare), costs $205 a month. But in 2013, on eHealthInsurance.com …, the median cost of the five cheapest plans was only $92,” Roy writes.

“In other words, for the typical 25-year-old male non-smoking Californian, Obamacare will drive premiums up by between 100 and 123 percent.”

The price rises for older health care consumers.

“In California, the median price of a bronze plan for a 40-year-old male non-smoker will be $261. But on eHealthInsurance, the median cost of the five cheapest plans was $121. That is, Obamacare will increase individual-market premiums by an average of 116 percent,” Roy notes.

Same goes apparently for Ohio, where the lieutenant governor predicts trouble ahead for businesses and individuals under the Obamacare exchange.

“The Department’s initial analysis of the proposed rates show consumers will have fewer choices and pay much higher premiums for their health insurance starting in 2014,” Taylor said.

Contact M.D. Kittle at mkittle@wisconsinreporter.com

Group Health Insurance in Wisconsin
  • If eligible, no one can be denied coverage or charged extra due to a health problem.
  • The entire employee group must be covered under group insurance.
  • Because of life changes involving family or employment, special opportunities for group coverage may be made available.
  • An employer may require a waiting period before offering group health insurance to a new employee.
  • A new HMO may require an affiliation period.
  • Group insurers may review six months of prior medical history for pre-existing conditions of new applicants.
  • An exclusion period of up to 12 months may be required.
  • If continuous coverage has been maintained without a break longer than 63 days, creditable coverage is available.
  • Contact your employer for more details.

Small Business Health Insurance in Wisconsin

  • Employers of less than 50 employees may not be denied small group health coverage due to sickness in the employee group.
  • Coverage can’t be cancelled because of sickness in the employee group.
  • There are limits on premiums and the renewals of coverage.

Self-Employed Health Insurance in Wisconsin

  • The self-employed may not purchase group insurance.
  • Contact the Wisconsin Commissioner of Insurance for regulations dealing with business and professional associations offering insurance.

Office of the Commissioner of Insurance 
121 East Wilson Street 
Madison, WI 53703

Individual Health Insurance in Wisconsin

  • Individual health insurers may deny coverage based on health problems.
  • Pre-existing conditions may be excluded from coverage for up to two years.
  • Providers may attach an elimination rider to the policy.
  • Pregnancy may be considered a pre-existing condition; genetic information may not.
  • No creditable coverage is available.
  • Insurance can not be cancelled due to illness.
  • Should the company stop providing individual coverage, coverage will be cancelled.
  • Premium prices may be based on health and other factors.

Wisconsin Health Care Programs

Wisconsin Health Insurance Risk Sharing Plan, Medicaid, Badgercare, and Well Women Program are financial assistance programs available to low income residents.

Location Status of State Exchange Decision Medicaid Expansion Decision Executive Activity
Wisconsin Default to Federal Exchange Opposes