2016 plan type trends infographic v29 - mckinsey.com/media/mckinsey/industries/healthcare … ·...
TRANSCRIPT
Findings across 50 states and DC
2016 exchange market remains in flux: Plan type trends
PLAN OFFERINGS1
McKinsey Center for U.S. Health System Reform
MARKET VIEWCounting plans at county level
METHODOLOGYThe above findings are based on publicly available, approved 2016 individual market exchange rates as displayed on exchanges for all states and DC, compiled within the McKinsey Exchange Offering Database. Plan types reported here were taken directly from exchange websites and Summary of Benefits and Coverage (SBC) documents. Independent assessment of plan types was not part of the analysis presented in this document.
HMO: a health maintenance organization is a plan typically centered around a primary care physician who acts as gatekeeper to other services and referrals; it usually provides no coverage for out-of-network services, except in emergency or urgent care situations.
EPO: an exclusive provider organization is a plan similar to an HMO. It usually provides no coverage for any services delivered by out-of-network providers or facilities except in emergency or urgent-care situations; however, it generallydoes not require members to use a primary care physician for in-network referrals.
PPO: a preferred provider organization is a plan that typically allows members to see physicians and get services that are not part of a network, but out-of-network services often require a higher copayment.
POS: a point-of-service plan is hybrid of an HMO and a PPO; it is an open-access model that may assign members to a primary care physician and usually provides partial coverage for out-of-network services.
MARKET VIEWPrices at county level
MARKET VIEWCounting plans at a county level
1. Plan is defined as a health insurance offering in which an individual can enroll, offered by a carrier2. Competitively priced defined as being priced within 10% of the gross premium lowest-price plan in the same county and metal tier3. Gross premium meaning premiums calculated before tax credits4. FL, IN, NJ, NY, and SC have no carriers offering a PPO but at least one carrier offering a POS plan; VT and NM have no carriers offering PPO and POS plans.
Note: These analyses are across all plan offerings and do not reflect enrollment
healthcare.mckinsey.com/reform
McKinsey Center for U.S. Health System Reform
HMO and EPO plans that were competitively priced in 2015 are increasing premiums more modestly than competitively priced PPO and POS plans.
PPOs are becoming less common across silver exchange plans.
MARKET VIEWCounting plans at county level
Most carrier types are shifting towards HMOs and EPOs, most notably the national carriers. Medicaid carriers continue to offer predominantly HMO plans.
% SEEING INCREASE IN PLANS BY METAL TIER
Median 2015 to 2016 percent change in gross3 premium across all competitively priced2 plans
Percentage of silver plan offerings by plan type across years
BRONZE SILVER GOLD PLATINUM
KEY: HMO & EPOPPO & POS
CATASTROPHIC
Percent change in number of PPO offerings by county from 2015 to 2016
9
2014
26
59
6
35
750
8
47
10
35
8
51
14
27
8
17
2015
14
63
6
12
2016
2014 2015 2016
31
952
8
34
851
7
43
13
35
9
2014 2015 2016
877
3
12
2014
858
22
28
2015
14
44
14
50
2016
25
7
18
23
2014
1064
3
22
2015
966
3
29
2016
12
55
4
45
2014
542
8
56
2015
36
6
42
2016
46
8
4
2
55
2014
25
18
51
2015
34
11
63
2016
23
10
44
2
86
2014
14
82
2015
18
70
20168
22
CO-OP NATIONAL BLUE REGIONAL/LOCAL PROVIDER MEDICAID
Percentage of silver plan offerings by plan type across carrier types and years
KEY: HMO EPO PPO POS
KEY: HMO EPO PPO POS
KEY:-100%
-99% to -75%-75% to -50%-50% to -25%-25% to 0%0% to 25%25% to 50%50% to 75%
75%+No PPOs in 2015 and 2016
Competitively priced silver plans2
31% of the PPOs that withdrew in 2016 were priced >35% above the lowest gross silver premium in the same county; 21% of the refiled PPO plans were in that same price category.
As of 1.04.2016
All silver plans
21 8 13
1714
13 12
19 10
40
As HMO and EPO plans are becoming increasingly prevalent, the number of PPO offerings is decreasing; this varies by state. Seven states4 will not have any carriers offering PPO plans on-exchange.