Annual Health Plan Rate Review

BCBSMT filed rates to be effective January 1, 2025, for its Individual ACA metallic coverage. As measured in the Unified Rate Review Template (URRT), the range of rate changes for these plans is a decrease of 1.4% to an increase of 13.2%. The following are the average rate increases by product:

• Blue Preferred: 4.8%
  
• Blue Focus: 5.4%

Changes in allowable rating factors, such as age, geographical area, or tobacco use, may also impact the premium amount for the coverage. There are currently 35,036 members on Individual Affordable Care Act (ACA) plans that may be affected by these proposed rates.¹

Consistent with the filed URRT, earned premiums for Individual plans during calendar year 2023 were $185,204,211 and total claims incurred were $166,072,562.

The proposed rates effective January 1, 2025, are expected to achieve the loss ratio assumed in the rate development.

The proposed rates reflect expected change in year over year medical service and prescription drug costs, which includes changes in reimbursement rates to providers, changes in expected utilization of services, the mix and intensity of services, and the introduction of new procedures and technologies.

There are no legally required changes to covered benefits and no significant changes to the benefit structure. Cost-sharing changes were made within these products allowing plans to maintain their metal status, which can contribute to the change in rates.

The proposed rates reflect the impact of the state reinsurance program under SB 125.

The Affordable Care Act expects health plans in the individual market to spend at least 80% of each premium dollar they collect to pay for medical care and activities that improve health care quality for members. If health plans fail to spend at least 80% on medical claims and health care quality initiatives, they are required to give back money to consumers through a premium rebate. These rates assume BCBSMT will once again exceed the 80% threshold.