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Health insurance rates could soar

State filing show New Jersey carriers eyeing double-digit hikes

By: Michael L. Diamond
Asbury Park Press
USA today Network - New Jersey

..... Health insurers selling plans in New Jersey's Affordable Care Act market are proposing double-digit rate increases for 2026 because of rising health care costs and the expected end of federal subsidies, according to filings with the New Jersey Department of Banking and Insurance.
..... Horizon Blue Cross Blue Shield of New Jersey, the biggest insurer in the marketplace, is proposing an average increase of 17%. AmeriHelath Insurance Company, the second-biggest, is proposing an average rate hike of 15.5% UnitedHealthcare Insurance Company is proposing an average increase of 18.4%.
..... The premium increases coupled with the anticipated loss of federal subsidies means "people are going to get hit with a double whammy, really,' said Dane Mihlon, a Shrewbury-based health insurance agent.
..... The premium increases in New Jersey's Affordable Care Act marketplace, called Get Cover NJ, would affect some 513,000 New Jerseyans. And it could reverse a spike in consumer getting health insurance through the individual market.
..... The price hikes are the latest sing that heath care inflation is returning to levels last seen before the Great Recession in 2008, forcing New Jersey residents to dig deeper to pay for health insurance.
..... Among them is Peggy Driscoll. The 63-year-old Hazlet resident pays $536 a month this year [2025] for a silver-level plan through Horizon - after getting $834 in subsidies and a $100 struggles to keep up with the payment, noting she tires to avoid doctor visits when she can because of out-of-pocket costs.
..... With federal subsidies to expire at the end of the year, [2025] Driscoll's premium could more than double. But she has little choice other than to buy the coverage; she said has gone without health insurance before and knows it;s not a risk she wants to take again.
..... "I'm afraid to know [how much it will be], tot ell you the truth," Driscoll said.
..... the market place was cerated as part of the Affordable Care Act in 2014, giving consumers who were not covered by an employer, Medicare or Medicaid a place to shop for plans. It was managed by the federal government until Governor Phil Murphy cerated a state-operated exchange in 2020. enrollment has increased by 108% since then, the Department of Banking and Insurance said, thanks in part to federal subsidies included in the American Rescue Plan Act of 2021 and the Inflation Reduction Act of 2022 that lowered premiums in some cases to less than $10 a month.
..... New Jerseyans are required to have helaht insurance or pay a penalty. Still, health care industry officials say the enrollment gains seen in the Garden State will reverse course if consumers decide that premiums are too expensive.
..... In addition to Horizon,, AmeriHealth and UnitedHealthcare, WellCare Health Insurance of New jersey has proposed an average increase of 17.1% and Oscar Garden State Insurance Company has proposed the lowest average increase, 4.6%. Aetna, which sold plans for 2025, said it is exiting the Affordable Care Act market in New Jersey and nationwide.
..... The rate changes aren't subject to approval by the Banking and Insurance Department. State regulators can disapprove if they find the filing are incomplete. Analysts said the rate hikes mirror the overall cost of health care. Medical cost in 2026 are projected to increase 8.5% nationwide for the second consecutive year, said a report by PwC, a consulting company.
..... What is fueling the increase in health insurance premiums?
* Inflation: Health care providers' operational costs from labor shortages, wage increases and the cost of supplies has outpaced household inflation.
* Behavioral Health. Consumers are seeking more treatment for behavioral health care such as anxiety, depression and developmental disorders. Outpatient claims from January 2023 to December 2024 rose 45%., while inpatient claims rose nearly 80%.
* Utilization. health plans report more patients are bing admitted to hospitals, and they often are sicker, requiring more intensive care.
* Prescription drugs. Helaht plans report seeing double-digit growth in medication known as GLP-Is, which regulate blood sugar and promote weight loss. The medication include Ozempic and Wegovy.
..... The loss of federal subsidies, set to expire at the end of the year, [2025] also would increase premiums.
..... Consumers who had been eligible for $0 premium silver plans could see annual premiums increase between $312 and $935, PwC said.
..... New Jersey rate filings show it would add 3 percentage points to premiums, mainly because insures expect the sharp increase to prompt some younger, healthier consumers to forgo health insurance."
..... "It essentially brings us back to the cost growth levies of 2007," said Derck Skoog, who leads PwC's Health Actuarial and Economics practice. "In other words, we're now in the middle of a sustained, high-cost environment that erases over a decade of relative moderation."

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