The news that some exchange carriers will offer lower premiums in 2015 was a surprise in many markets. But the biggest surprise could await exchange customers who stick with their existing exchange plan without shopping around.

An unintended consequence of lower premiums is lower subsidies, which raises the percentage of premium that enrollees pay for their plan.

Every rating region in a state has its own benchmark plan that is used to determine subsidies. The benchmark is based on the premium of the second-lowest priced silver plan available in each rating region. The subsidies available to qualified enrollees has an equalizing effect on premiums across the nation, to a degree. For instance, premiums are higher in rural states such as Alaska and Wyoming, but because premiums start at a higher level, so do the subsidies.

The second-lowest silver tier plan is used to offer ensure some market protection for participating carriers. If the lowest-priced silver plan were used to determine subsidies, an insurer could severely undercut its competitors. Using the second-lowest offers some protection against that.

Heading into the 2015 open enrollment period, carriers throughout the nation have readjusted premiums to match enrollment trends. Many plans that were priced low in 2014 have increased premiums. Those that overshot their markets on price were often new to commercial insurance, such consumer operated and oriented plans (CO-OPs) and managed Medicaid insurers, and some have scaled premiums back for 2015.

In Arizona, Meritus (a CO-OP formed by physicians and Phoenix-area business leaders) has the three lowest-priced plans in Maricopa County in 2015, followed by Health Choice Arizona and University of Arizona Health Plans, all of which saw relatively low enrollment in 2014. Health Net of Arizona dominated the low-premium silver plans, and for 2015, it will have one plan among the 10 cheapest.

In Colorado, the Connect for Health exchange's lowest-priced plans are from Colorado HealthOp. The CO-OP replaces Kaiser Permanente and Humana as market's low-cost plans. In Idaho, a new entrant, the Mountain Health Cooperative, has the lowest-priced silver plan, although the price difference between it and Blue Cross of Idaho's lowest silver plan is negligible.

Notice that in these states, CO-OPs are driving the lower premium trend, exactly as the Affordable Healthcare Act intended with their creation. None of them are truly undercutting the markets, but forcing other plans to price competitively.

The lower rates are not confined to states with CO-OPs. Rate review in Washington produced premiums considerably lower than the rates requested by market-leading Premera Blue Cross and its LifeWise subsidiary (the state must approve plan rates).

The onus falls on exchange consumers to shop around. Simply renewing a 2015 plan offers no guarantee of the same premium, benefits or subsidy.

Individual health policies have never been more than a one-year contract, and the ACA has not changed that. A plan benefit or premium available one year can be the gone next year. Ultimately, the change in premiums and their effects on subsidies prove that exchange shoppers will need to stay nimble and do their homework. Premiums will change and decline in subsidies could become a financial burden.

If consumers don't shop and get stuck with lower subsidies and a higher out-of-pocket costs, they won't be shy about shopping in 2016.

Follow Bill Melville on Twitter @BillMelvilleDRG

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