Texas BCBSTX individual risk pool 2023 performance – $4.8 billion in revenue, 95% loss ratio, $290.70 pmpm cost……………..
Blue Cross and Blue Shield of Texas (BCBSTX) filed rates to be effective January 1, 2025, for its Individual ACA metallic coverage. BCBSTX rates are going up.
According to the BCBSTX rate filing application “The proposed rates reflect expected change in reimbursement rates to providers” along with other factors such as “increased utilization” and new and more expensive drugs.
“Blue Cross and Blue Shield of Texas (BCBSTX) filed rates to be effective January 1, 2025, for its Individual ACA metallic coverage…..the range of rate changes for these plans is a decrease of 3.4% to an increase of 15.1%.”
The following are the average rate increases by product:
- Blue Advantage 6.7%
- Blue Advantage Plus
- 5.9%
- MyBlue Health 6.7%
“There are currently 1,316,049 BCBSTX members on Individual Affordable Care Act (ACA) plans that may be affected by these proposed rates.”
Of interest, BCBSTX noted in their filing “Earned premiums for Individual plans during calendar year 2023 were $4,814,938,937 and total claims incurred were $4,590,926,548.” This produces a 95% loss ratio or $3,488 per member per year ($290.70 pmpm).
SOURCE: Texas Department of Insurance
ADDITIONAL RESOURCES:
INSURANCE CODE CHAPTER 1698. RATES FOR CERTAIN COVERAGE
Health care coverage guide (texas.gov)
