Health Plan Weekly

The long-term care needs of the nation’s “silver tsunami” of 65-and-older population — a wave that began as the first of the baby boomer generation turned retirement age in 2011 — continue to elicit challenges in the broad health care buckets of spending, coverage, access to services and disparities in care. But during a recent webinar, experts discussed some promising solutions, including one health insurer’s initiative that takes a caregiver-centric approach to post-acute care.

Such pervasive problems in long-term care, an industry with a $415 billion tab in annual spending, were the primary theme of an Aug. 7 National Institute for Health Care Management (NIHCM) webinar, an event that framed the contributory elements of the country’s “long-term care crisis” — namely, underinvestment, a lagging workforce, fragmented care and an industry that often fails to take a person-centered approach.

Affordable Care Act exchange insurers proposed a median premium increase of 7% in 2025, with most falling between a 0% and 10% increase, according to an analysis by Peterson-KFF Health System Tracker.

Among the 324 ACA exchange insurers across 50 states and Washington, D.C., that were included in KFF’s analysis, proposed premium changes ranged from a drop of -14% to a jump of 51%. And while 50 of the health plans proposed decreasing premiums, 85 requested rate increases greater than 10%.

For the 2025 plan year, Centene Corp. will not offer Medicare Advantage plans in Alabama, Massachusetts, New Hampshire, New Mexico, Rhode Island and Vermont, Modern Healthcare reported, citing an Aug. 5 note from investment bank Stephens. However, Centene will continue offering Medicare Part D Prescription Drug Plans in those states. Pinnacle Financial Services, a health insurance brokerage, also posted to its website a notice from Centene about exiting those markets, which account for about 3% of the insurer’s MA membership.  

BlueCross BlueShield of Vermont, the state’s largest insurer, is on the verge of insolvency, according to a July 29 article in the Burlington Free Press. However, Kevin Gaffney, commissioner of the state’s Department of Financial Regulation, told the newspaper, “BlueCross BlueShield of Vermont is a big tanker. We have to start to turn it. We can do that and there are steps to do it.” Gaffney said he is requiring the insurer to file a plan of solvency by early September. In October 2023, BCBS of Vermont finalized an “affiliation” with Blue Cross Blue Shield of Michigan in which the Vermont plan became a subsidiary of BCBS of Michigan.  

With Affordable Care Act premium rate requests now filed for 2025, industry observers are eagerly awaiting data from the federal government detailing how exchange insurers are pricing their health plans. In the meantime, a new analysis that combs through some of the earliest rate filings offers insights into the various factors insurers and their actuaries are considering.  

“One piece of good news is that there’s just not the turbulence that we’ve seen in past years,” Sabrina Corlette, co-founder of the Georgetown University Center on Health Insurance Reforms (CHIR), tells AIS Health, a division of MMIT. In a July 29 CHIR blog post, Corlette detailed what she learned from a deep dive into insurers’ rate requests in Maine, Maryland, Oregon, Vermont and Washington, D.C. — states where regulators require health plans to submit their rate filings one to two months before the July 17 federal deadline that applies to most states.