State releases Oregon's 2015 health insurance rates for individuals, small ...

About 80,000 Moda Health members who buy their own insurance will see their monthly premiums climb an average 10.6 percent next year, while many other insurers are dropping their rates to compete.

Insurance rate decisions were issued by the Oregon Insurance Division Thursday and announced today, showing a tighter range of premiums in the individual market for people not covered by employers or Medicare.

Moda's once market-leading rates have jumped to middle of the pack next year. For a silver plan, a 40-year old Moda customer in Portland will pay $245 a month, up from $221 last year. But they will be able to find four insurers with better premiums, running as low as $222 from Lifewise.

Last year, federal changes to expand coverage of pre-existing conditions caused many rates to go up in the individual market even as insurers cut back on benefits.

In Oregon, one of the most competitive insurance markets in the nation, 2014 rate hikes did not hit consumers as badly as expected. In part that's because Moda came in with low rates - so low that some accused the insurer of underpricing to more than double its market share. Moda officials denied it.

For 2015, other insurers have made aggressive moves to cut rates, which were largely approved by state regulators. Providence Health Plan rates, for example, will drop 14 percent in the individual market.

Insurance Commissioner Laura Cali credited new rules that require plans to adopt standard plan designs and propose rates at the same time, with the final rates posted on the coveroregon.com website and elsewhere online.

'Consumers can now compare plans side by side,' she said. 'I think that's overall a good thing.'

Open enrollment begins again Nov. 15.

Moda had requested a 12.5 percent hike, but Oregon Insurance Division regulators cut back that request as well as those of other insurers. Kaiser Health Foundation of the Northwest saw its request for a slight rate hike denied, with its premiums cut by 4.1 percent instead.

State regulators were persuaded to make a 2-percent across-the-board premium cut by testimony during rate review hearings. The OSPIRG Foundation said insurers failed to take into accounts the reforms' expansion of Medicaid, which cut hospital costs by reducing the number of uninsured.

The state reined in some efforts to cut rates as well, notably that of Oregon's Health CO-OP, one of two new consumer-operated insurers set up with federal loans last year.

The CO-OP had sought to cut its premiums by 21 percent, but instead the state approved only a 9.9 percent cut after questioning the calculations the insurer used to justify the cut.

The CO-OP's CEO, Ralph Prows, said the firm has already asked for a re-hearing and review to address what he said was information that bolstered the insurer's case.

'We worked with Milliman -- the best outside actuaries in the country -- every week since last October, and we scraped every corner of the cupboard to find every half percent, every quarter percent we could find to pass on to consumers,' Prows said.

Cali, the insurance commissioner, said her division has to ensure rates aren't too low or too high. If rates don't cover costs, 'they may not be able to pay claims, they may not be able to be sustainable.'

She said she hadn't decided whether to give Prows a re-hearing.

Last year the CO-OP had sought to cut its rate request after seeing Moda's rates. The state told the CO-OP it wasn't allowed, although other insurers were allowed to cut their rates.

Moda officials say their plans offer other benefits that make up for their 2015 premium hikes.

'This is not about a price war,' said Robert Gootee, CEO of Moda Health, in a prepared statement. 'What Oregonians need - what Oregonians deserve - is a value comparison, one that balances cost with their need for access to affordable high quality care.'

Small business rates are also tighter. Health Republic, which led the 2014 market with ts 40-year old silver plan employee rate, boosted its rates while other insurers cut theirs in the small group market.

Insurance agents and consumer advocates note that there's more to picking a plan than premiums. Different plans offer different networks, rules and fine print.

The individual market was considered crucial to federal efforts to boost coverage, and in Oregon enrollment jumped from about 150,000 in 2013 to nearly 200,000 as of April.

The rates released are for plans that comply with the Affordable Care Act. But in response to an outcry last fall over premium hikes and plan changes, federal and state officials allowed some non-ACA plans to survive, offering lower rates. Rate changes to those plans in Oregon can be .

To download a PDF of the ACA rate decisions, click here. The most reader-friendly site to follow the rate process is oregonhealthrates.org, though results had not been posted Friday morning. To see the more detailed rate filings, and state comments, go here and click on SERFF.

--Nick Budnick

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