Most D.C. residents who buy health insurance through an online marketplace under the federal Affordable Care Act will see a modest increase in prices next year.
Insurance plans for individuals will cost, on average, 4 percent more — a gentler increase than in Maryland, where the most popular plan will cost on average 26 percent more starting in January.
The D.C. Department of Insurance, Securities and Banking (DISB) said Tuesday that it reviewed proposed rate increases from all of the insurers that offer plans through D.C. Health Link, the local marketplace created under the health-care law.
The insurers who offer individual plans on the marketplace initially asked for rate increases ranging from 6.5 percent to 14.5 percent, DISB said. But after the rate review process, they agreed to smaller increases — an average of 2 percent for CareFirst HMO plans, 4.6 percent for CareFirst PPO plans and 6.6 percent for Kaiser Permanente HMO plans.
DISB also approved rate increases ranging from 0.2 percent to 11.2 percent for the eight categories of small-business insurance plans on the marketplace.
Philip Barlow, DISB associate commissioner for insurance, said after the insurers submit proposed rates, the city examines the information used to reach those prices and challenges any assumptions it believes are incorrect.
“We work very hard to make sure that we don’t have the kind of increases like they’re having to do in Maryland, because we find those particularly difficult for consumers,” Barlow said.
Residents can enroll in the plans from Nov. 1 to Jan. 31.
The upcoming year will be the third year of operation for the state health exchanges created under the law. Health policy experts are paying close attention to rates in 2016, because it is the first year that insurers are setting their rates based on a full year of data from real patients’ use of the coverage they obtain via the exchanges.
In Maryland, insurers found that those patients cost more than they budgeted for when they set their earlier prices.
“People who are in that pool in Maryland are, in fact, older and sicker than we expected them to be,” said a spokesman for CareFirst, which covers the largest number of Marylanders who obtain insurance through the exchange rather than a job.
With next year’s rate increases in the District, a CareFirst PPO plan for a typical 40-year-old will cost on average $253 a month for a “bronze” level plan, according to the DISB announcement Tuesday.
That 40-year-old’s insurance would cost $420 monthly for a “gold” plan or $512 for a “platinum” plan.
Rates are lower — an average of $168 for “bronze” to $449 for “platinum” — for a CareFirst HMO plan. For a Kaiser HMO, the average 40-year-old’s plan will cost $207 to $371.
Many low-income customers who purchase insurance through the marketplace receive subsidies to cover some of the cost.
Amy Goldstein contributed to this report.