Health exchange fees to more than double
May 9, 2014
The fees charged by the Silver State Health Insurance Exchange will more than double next year.
The exchange board voted unanimously on Wednesday to set the fee for 2015 at a flat $13 per member per month.
The current fee is just $4.95 per member per month.
A key reason for the increase is that the exchange is currently operating on federal funds but, as of next year, will have to support itself. The PMPM fees are the source of the revenue that will pay for operation of the exchange.
Insurance Commissioner Scott Kipper told the board that works out fo about 3.4 percent of the average $377 monthly fee enrollees are paying for health insurance. He pointed out that is less than the 3.5 percent those on the federal health exchange are paying.
Kipper recommended the board go with a flat $13 PMPM fee insread of a percentage because it will take until mid-October before insurance carriers will know their rates for the coming year, which means the state exchange wouldn’t actually know what percentage it will need to fund operations until then.
“So if we do a percentage, we’re not going to have that amount until it’s too late,” said board member Lynne Etkins.
With open enrollment for the exchange health plans set for November, Kipper said that was exactly what would happen. He said by setting a flat PMPM, the board would know what funding to expect now rather than later.
Kipper said that rate was based on a conservative projection that enrollment would rise to 60,000 next year. It is currently just over 34,000.
At that number of enrollees, the fees would generate about $9.36 million, about $3 million more than the projected overhead to operate the exchange.
He said given the problems the exchange has had, it’s prudent to be conservative but that, if more people than that enroll, their fees would be added to the projected budget.
The $13 PMPM fee is for a Qualified Health Plan without dental coverage. Adding dental or buying a dental plan without a health plan would cost 83-cents a month.