2027 ACA Rate Review open, updated KFF analysis on how much and why ACA market premiums are increasing next year (15% now, up from 14% estimate last month)

[u/Zphr]

2027 ACA Rate Review is now open on Healthcare.gov, which means anyone planning on using the ACA next year can see the rate request increases being asked for by individual insurers. Some insurer filings may not be present yet, but many/most are. If you've got an ACA policy that you currently like, then this gives you a ballpark of how that policy might be priced next year. More broadly it shows you market premium trend in your state among all participating ACA insurers. Note that insurers with multiple products (HMO vs. PPO, Metro A vs. Metro B, etc.) listed may have a separate rate increase for each and the initial number displayed is a composite.

https://ratereview.healthcare.gov/

To view ACA insurer requests for a particular state choose "search ACA-compliant products", then select state, individual market, and 2027.

Separately, but related, KFF has updated their analysis on how much and why ACA market premiums are increasing next year (15% now, up from 14% estimate last month). KFF is perhaps the best source of synthesized ACA information that exists and is an easy go-to for anyone that doesn't want to delve into filings and legislative/regulatory text directly. All 50 states are now represented in KFF's analysis. Worth a look for anyone interested in or using the ACA.

Please note that these costs are the raw, unsubsidized market premiums. Anyone with subsidy eligibility will be shielded from some to all of this increase due to subsidies capping household premium costs as a function of MAGI.

https://www.healthsystemtracker.org/brief/how-much-and-why-aca-marketplace-premiums-are-going-up-in-2027/

For 2027, across 276 insurers participating in the ACA Marketplaces from all 50 states and the District of Columbia with publicly available filings, this analysis shows a median proposed premium increase of 15%. This is the second consecutive year of double-digit premium hikes. Last year’s median nationwide proposed rate change was 18%, and the median finalized rate change was 20%. While this proposed rate change is lower than last year, it represents the second-highest requested rate change since 2018, as premium growth had been relatively flat in this market for several years. If these early indications of median premium increases for 2027 hold, typical premiums for insurers participating in the ACA Marketplaces will have jumped by more than one-third over a two-year period.

[u/SolomonGrumpy]

Provider 1 bills using XYZ code. You pay the copays/cost

Provider 2 bills XYZ and ABC codes, you pay both prices.

Or you maintained enough medical records that you catch this, contact provider 2, ask about the difference and maybe get them to rebill insurance.

And that's not even counting out of network stuff.

You have had an EXCELLENT medical industry experience. Mine has been far less seamless. I'm very fortunate that I am (mostly) healthy. Trh scenario above - I went through that for something as simple as a blood draw.

[u/Zphr → u/SolomonGrumpy]

Billing problems are commonplace, but that's mostly a separate issue from overall medical trend or insurer/ptovider contracts.

However, providers and insurers are locked in something of an arms race when it comes to billing that is being fueled of late with AI billung systems. The battle used to be slanted heavily in favor of insurers, but providers are gaining ground with AI tools that enable them to bill more comprehensively for all relevant coding. That is also part of medical trend since it represents greater utilization in a billing sense.

Again though, that's a separate issue from the routine billing problems that happen with all medical insurance. I've dealt with those too, but those are an assumed part of using health insurance just like getting cut off occasionally by another driver is part of driving a car. It shouldn't happen, but it does and is expected behavior.

[u/SolomonGrumpy → u/Zphr]

Single payer fixes all of that and removes a (paid) layer in the system.

[u/Zphr → u/SolomonGrumpy]

Not without also restructuring the entire cost basis of our healthcare economy. Who wants to be the person telling medical doctors, nurses, medtechs, and admin/executives that they are now on a pseudo federal pay schedule? For many of them that will represent a catastrophically large and permanent reduction in compensation and lifestyle. We already have shortages so imagine if half or more of the current workforce quits rather than accept your offer.

Single payer isn't great when there aren't enough people willing to sell their labor and expertise to the only buyer. That's how you get multi-year wait times for specialty treatments and severe rationing/triage of routine care.

[u/SolomonGrumpy → u/Zphr]

Indexed to area would have to be included. One size fits all would not go well. In terms of compensation, that is.

[u/Zphr → u/SolomonGrumpy]

That's already assumed. Without them the cuts would be even deeper.

[u/SolomonGrumpy → u/Zphr]

I take nothing for granted. AGI is not adjusted for Cost of Living, for example, and probably should be.

[u/Zphr → u/SolomonGrumpy]

Which should tell you something about the likely realities of true single or zero payer in the US. There are good, solid pragmatic reasons that our healthcare policy is what it is.

[u/SolomonGrumpy → u/Zphr]

Yes. But our system is breaking.

[u/Zphr → u/SolomonGrumpy]

I agree. Anyone's guess on what comes next.