As summer begins to wind down, it is a good time for health insurance agents to start seriously looking at the upcoming ACA Open Enrollment Period and all the new things that will be happening for the next OEP.
Actually for 2027, there are a lot of moving pieces. Some are calling 2027 one of the most significant shifts in the ACA market in decade. We have premium increases, changes in rules and regulations, and carrier changes.
For this article, let’s start with premium increases. This is never an easy situation for agents to deal with, and significant price increases put stress into the system as more and more people shop health plans instead of simply renewing a plan. As an agent, you need to know why prices are going up as you will need to explain that during your meeting with clients.
Why Premiums Are Increasing
The median premium increase is around 14 percent this year. That is not a small increase, and it comes after increases last year. Carriers say premiums are increasing because of:
- Medical inflation
- Prescription drug costs
- Hospital reimbursement increases
- Smaller, higher-risk enrollment pools
- Regulatory changes.
Where Are Increases the Largest?
At this point, rates are not final and will continue to be announced into early fall. But there are some trends emerging that reveal where some of the increases are the highest.
Silver premiums are very popular with consumers, and they are seeing increases. Since benchmark Silver premiums determine subsidy calculations, many carriers have raised Silver premiums substantially over the past two years.
Other factors are:
- PPO products continue to experience larger increases than many HMO or EPO products because of higher provider reimbursement and greater utilization.
- Several carriers have narrowed networks or shifted members toward EPO products to help control costs.
– Consumers ages 55–64 are among those seeing the largest dollar increases because ACA age-rating rules allow premiums up to three times higher for older adults than younger adults.
It is difficult at this point to pinpoint increases by regions of the U.S. as not all states have reported carrier filings. Patterns will become clearer as we near OEP.
Pandemic Subsidies Are Still Out
During the Covid-19 pandemic, the federal government increased subsidies so more people would be enticed to buy an ACA plan. With the pandemic being over, those subsidies expired and have not been renewed by Congress.
This is still affecting consumers. Many have been surprised at how much their premiums increased with without the federal government’s enhanced subsidies. This has led to some consumers exiting the market, which can mean less healthy people remain in the market and drive up insurance payouts.
What to Expect
Current clients are going to be asking agents why their premiums have gone up. They are likely going to want alternatives that will remain affordable for them and will want to shop plans.
There may be opportunities to help clients by switching metal plans or looking at different carriers and even supplemental insurance.
A focus on retention could be vital this year. While agents always need to be pursuing new clients, making sure your existing people are taken care of during this next OEP will be key to a successful OEP. They are going to be shopping, and they should do that shopping through you.
Get on top of your carrier portfolio changes as they happen and then calculate how each change may impact each of your clients. Those being proactive have the best chance of helping their existing clients stay insured and also onboarding new people who are seeking coverage.
How Pandora Insurance Can Help Agents Like You:
Pandora Insurance partners with National Life Insurance and major insurers in the Medicare market and the ACA market. We have the training, commissions, and marketing support to help you.
Enjoy these benefits when contracted with us!
- Freepre-license courses for our contracted agents 2-15, 2-40, 2-14
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- Knowledge-based and practical training
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- Carriers include: ACA (Obamacare), Medicare, life, and supplemental
- Commission and bonus reporting
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