2025 Rate Change Justification

The Centers for Medicare & Medicaid Services require Qualified Health Plans, such as Aspirus Health Plan, to post a notification online explaining the necessity of rate changes.

At Aspirus Health Plan, we do our best to control costs and provide our members with the best value for their money. To continue providing top-quality health plans, rate adjustments are needed from time to time. The Centers for Medicare & Medicaid Services require Qualified Health Plans, such as Aspirus Health Plan, to post a notification online explaining the necessity of rate changes.

The primary factors impacting Aspirus Health Plan’s premium rate changes are:

• The continued increases in the cost of medical care and prescription drugs.
• An increase in health care service use by consumers.
• Aspirus Health Plan is establishing premiums for 2025 assuming the Cost Sharing Reduction benefit subsidies are not funded and therefore need to be included in the premium development. A rate decrease has also been applied assuming the Wisconsin Health Care Stability Plan will be fully funded in 2025.

Rate adjustments were made to the renewing health plans and the individual HMO and POS products as a whole. Primary changes in cost sharing were made to satisfy the 2025 plan standardization rule issued by CMS as well as to maintain benefit offerings within the prescribed metal tiers.