Insurers must submit Affordable Care Act filings to state or federal regulators for the upcoming year. The rates were finalized on October 15, 2020, and open enrollment time was started from November 1, 2020. Insurers set costs for 2021 amid the coronavirus pandemic, so there is significant uncertainty in plan costs.
The 2021 rates are finalized, and this table summarizes the premium rates for 50 states and the District of Columbia.
The Rate Change and COVID-19 Load on ACA Marketplace Plans
| Overall | Rate Change | Impact of COVID-19 on Rates* |
|---|---|---|
| 25th Percentile | -3.5% | 0.0% |
| Median | 1.1% | 0.0% |
| 75th Percentile | 4.6% | 2.0% |
Loads of COVID-19 added in the 2021 rate filing reflect the difference between the assumptions and individual behavior. Here is the explanation justifying the effect of COVID-19 on the 2021 rate filing.
Pent-up demand and morbidity adjustments
Most insurers expect that because of pent-up demand, health costs will rise in 2021. Assuming that vaccine will be ready and available to the general public next year, the costs may increase for COVID-19 testing, treatment, and vaccination. Some insurers also think that morbidity may increase because of deferred care and its impact on chronic conditions. Any economic downturn on individuals’ health and insurance status can also cause significant rate increases.
Fidelis (New York) – 8.4% COVID-load
The premium rates of 8.4 percent have been updated for 2021 healthcare coverage to reflect the COVID-19 pandemic effects. The morbidity adjustment reflects the estimated impact of COVID-19 on healthcare utilization and intensity in 2021, including:
- The direct cost of treatment, testing, and vaccination of COVID-19.
- Pent-up demand following social distancing “lockdown.”
- Morbidity impact of economic disruption
- Morbidity impact of lasting population health changes caused by COVID-19
Vaccination costs
Some insurers anticipate the loads for a likely vaccine.
MVP (Vermont) – 1.3% COVID-load
“MVP assumes the COVID-19 vaccine to be tested and widely available in 2021. An immunization would add to the claim cost and will account for the costs. MVP is assuming that the immunization would be covered in full at the cost of $75/dose. MVP also expects that the vaccine will be provided to 80% of the population, so the claim cost is increasing by 1.0%.”
No adjustments to premiums from COVID-19
Many insurers didn’t specify any COVID-19 rate impact. Most of them refused to adjust their rates based on expectations of how the pandemic will affect costs next year. Others expect the upward and downward effects will sum up to net-zero impact.
CareSource Indiana, Inc (Indiana) – 0% COVID-load
According to CareSource, “There are equal chances of increasing or decreasing the premium costs in 2021 due to COVID-19. Because of the uncertainty, we are not going to make an adjustment to the 2021 premium rates.”
Anticipated decreases in premium costs
Maine Community Health Options (Maine) (-1.2% COVID-load)
A few insurers are assuming that circumstances may have a net negative effect of COVID-19 on the costs.
“After estimating the impact of the COVID-19 pandemic, Maine decreased the costs by 1.2%.
