Annual Health Plan Rate Review

BCBSNM filed rates to be effective January 1, 2025, for its Individual ACA metallic coverage. As measured in the Unified Rate Review Template (URRT), the range of rate changes for these plans is an increase of 5.8% to an increase of 9.8%. The following are the average rate increases by product:

• Blue Community: 9.0%

Changes in allowable rating factors, such as age, geographical area, or tobacco use, may also impact the premium amount for the coverage. There are currently 30,363 members on Individual Affordable Care Act (ACA) plans that may be affected by these proposed rates.¹

Consistent with the filed URRT, earned premiums for Individual plans during calendar year 2023 were $155,189,734 and total claims incurred were $146,419,819.

The proposed rates effective January 1, 2025, are expected to achieve the loss ratio assumed in the rate development.

The proposed rates reflect expected change in year over year medical service and prescription drug costs, which includes changes in reimbursement rates to providers, changes in expected utilization of services, the mix and intensity of services, and the introduction of new procedures and technologies.

There are no legally required changes to covered benefits and no significant changes to the benefit structure. Cost-sharing changes were made within these products allowing plans to maintain their metal status, which can contribute to the change in rates.

The proposed rates reflect the impact of New Mexico legislation items and/or regulatory changes effective on January 1, 2025, as well as the New Mexico Office of the Superintendent of Insurance (OSI)’s requirement for issuers to use a 44% CSR adjustment factor for Silver plans sold on the Exchange.

Plan offerings comply with 2025 Plan Year Individual QHP and Small Group Market Rate Filing Guidance to set the tobacco rating multiplier at 1.0 for all individual on-and-off-exchange plans, offer only two on-exchange non-standardized Silver and Gold plans in any rating area, and keep the minimum premium differential for a 21-year-old between any two non-standardized silver plans in a single area above $10 PMPM.

In addition, Turquoise variants are made available for each Silver and Gold plan with the expansion of Turquoise 3 eligibility to 200-400% FPL and the introduction of -13 variant for Native Americans between 300-400% FPL and participate in Gold plans, as mandated by the Health Insurance Marketplace Affordability Program Policy and Procedures Manual.

The Affordable Care Act expects health plans in the individual market to spend at least 80% of each premium dollar they collect to pay for medical care and activities that improve health care quality for members. If health plans fail to spend at least 80% on medical claims and health care quality initiatives, they are required to give back money to consumers through a premium rebate. These rates assume BCBSNM will once again exceed the 80% threshold.