Who Will Fight for You?

When it comes to health insurance, everyone wants lower rates. But who will fight for lower rates for your family or your business? If you’re lucky, your state can fight for you.

States have the right to regulate insurance within their borders. Most states have someone – a commissioner or a director – who is able to be your defender.

Now more than ever, health insurance companies need someone to act as a watchdog and keep them accountable. For many goods or services, a competitive marketplace helps keep prices down. But for most of us, two or three insurers dominate the market in our state. If you aren’t happy with your insurer, there may be no better options.

The skyrocketing insurance rates are in part due to a lack of public oversight, a lack of someone with the ability to protect consumers like you. The Affordable Care Act helps a bit. In the law, any rate increase above 10 percent (for the group you are in) can trigger a rate review by an independent third party.

Your state’s insurance commissioner might conduct the review of health insurance rate increases. Or the federal Health and Human Services agency conducts the review for states whose commissioners don’t have the authority to review rates.

Reviewing rates keeps insurers more honest. If the insurer can show the rate increase is justified because of increased costs within a given group, the rate increase moves forward. But they have to show that the increase does more than pad their profits.

However, the real protection for consumers comes with rate rejection. In some states, the commissioner can actually reject a rate increase. This happened in California, where a proposed 39 percent rate increase was found to be due to a “math error.”

Reviewing insurance rates can save you money, and that’s good for all families and businesses.

Do you have questions or concerns? Contact me – Steph Larsen – at 402.687.2100 or StephL@cfra.org.