2016 Rate Filings
Blue Cross and Blue Shield of Texas (BCBSTX) recently filed its 2016 rates with Texas. Below are FAQs that may help you understand what this means.
Who does this affect?
The 2016 rates will affect individuals and families who bought health insurance either directly from us or the Health Insurance Marketplace.
Will my premium increase?
It depends. It's important to understand that rates are not the same as premiums. Rates, which affect premiums, are based on several things, like region, pharmaceutical costs, and use of insurance benefits. However, your 2016 premiums will depend on the general rates, plus the number of people on your plan, their ages, and where you live.
Are increased rates about BCBSTX making more profits?
Rates are based on our members' health care claims in previous years. When the Marketplace opened in 2014, we began offering new plans and set rates based on new requirements and what we thought member claims would be. Now that we have a full year of member claims with the new plans, we have a better idea of our costs. These costs are also affected by region, pharmaceutical costs, and use of insurance benefits, among other things. We are adjusting our rates so that we can keep providing coverage options across the state for people who don't have insurance through an employer.
There are consumer protections in place to limit our ability to raise premiums just to increase profits. For example, medical loss ratio (MLR) requirements require at least 80% of premiums to go to medical costs each year. If that requirement isn't met, BCBSTX may need to give certain customers premium rebates.
When will I find out if my premium is going up? How will I be notified?
If your 2016 premium does go up, we will send you a letter in the fall to notify you.