ACA Rate Increase Justification

According to the Center for Medicare and Medicaid Services (CMS), qualified health plan insurers, such as CareFirst BlueCross BlueShield and CareFirst BlueChoice (collectively, CareFirst), must post a notification on its website explaining the necessity of rate increases.

The primary factors driving CareFirst’s proposed premium rate changes are:

  • An increase in the cost of medical care. This includes cost increases for specific medical services and goods, as well as increases related to rising utilization of those services and goods.

  • The impact of expected changes to fees imposed on health insurers, such as CareFirst, under the requirements of the Affordable Care Act (ACA).

  • Changes in the level of sickness of the members insured by CareFirst BlueCross BlueShield.

  • The projected impact of changes in the ACA Risk Adjustment program.

CareFirst submits proposed rates to the Maryland Insurance Administration (MIA), Virginia Bureau of Insurance (VBOI) and the Washington D.C. Department of Insurance, Securities and Banking (DISB) for approval. Once these agencies complete their review process and make a final decision on any rate filings, a summary of the results are posted on their websites.