Health insurance premium increases in Massachusetts: More ways it can happen

Last week (ACA rollout hits some Massachusetts businesses harder than expected) I described how the implementation of Obamacare caused one small businesses's Blue Cross Blue Shield of Massachusetts premium to jump by 29 percent for the upcoming renewal. The main issue was family size --previously only the first two kids were counted when calculating premiums, now it's the first three kids. This group, with lots of kids, is paying the price.After that I heard from two other BCBS MA customers who were experiencing big premium hikes. One is a two-family partnership where one family has two kids and the other has none. Their premium is up 17%. The second is a non-profit organization where the number of kids also shouldn't be a deciding factor. Their premium increase is 26%.Here's what BCBS MA told me about these two:The first group was a new customer entering its first renewal year. Initially, BCBS rated the company based on the expected --rather than actual-- number of dependents. The rate was based on ~1.5 kids for one family and 0 for the other. (Something tells me they probably knew 1.5 was either too high or too low and not right on!) In any case, in a small group that is enough to make a significant difference in rates. With the ACA, health plans have to gather the dependent info even for new customers.For the non-profit organization, the number of members covered declined from 12 to 7, which pushed them into a more expensive rate per member. (Even though rating based on group size is being phased out, it's still a significant factor.) In addition, the group's prior year increase had been tempered under a state law that limited the rates of increase for renewals. The ACA overrides the state's rule and BCBS tells me they are unable to cap this year's rate increase.For what it's worth, BCBS tells me that the median rate increase in the merged (individual + small group market) this year is 5-6%, which means these three examples are outliers. They also tell me that rate increases a year from now should be in the low single digits for all three of these customers and others like them.I'd be interested in hearing from other Massachusetts customers of Blue Cross and other plans. Have your rates jumped? Are they steady? Did they fall? Do the explanations above seem to account for what's happened to you?Leave a note in the comments or mention on Twitter @HealthBizBlog.—By healthcare business consultant David E. Williams of the Health Business Group