Americans are slowly adjusting to the changes brought about by the Affordable Care Act (ACA), also known as ObamaCare. However, there are concerns that there are still more changes ahead – and that some of these changes to come may not be easy to live with. In particular, there are a lot of questions surrounding what 2015 ObamaCare premiums will look like. Inflationary pressure will generally cause premiums to increase each year, but the goal of the ACA is to slow the rate at which premiums grow.

It’s important to understand that health insurance rates are not yet set in stone. The way insurance premiums are adjusted each year at the state level is a negotiation. The insurance companies will submit their filing to the state, indicating the rate changes they would like. The state will then respond with either an approval or a counter-offer. The negotiations over premiums can go on for quite some time.

One way that Americans are protected from excessive rate increases is the process of a rate review. The rate review calls for insurance companies to publicly give reason for any rate hike of 10% or higher. Rate reviews vary by state.

Because rates are not yet set, predicting the changes in the insurance industry for 2015 has become a favorite discussion topic — much like predicting next year’s Super Bowl winner. There are two prediction scenarios to consider: Premiums will increase greatly, or they will increase only moderately.

Prediction One: Premiums Will Increase Significantly in 2015 

For those who opposed the ACA for financial reasons, the fear is that the worst is still to come. Because the ACA will take years to roll out, and won’t be fully implemented until 2020, there are concerns that costs and premiums will rise over time as the insurance industry adjusts.

One of the arguments for premiums going up is that healthier, younger Americans are not going to be willing to pay several hundred dollars a month for insurance. Although the tax penalty for not being insured goes up in 2015, some Americans will still opt to pay the penalty rather than be insured. This will keep insurance costs high in the Marketplace, which will lead to high premiums.

A leading healthcare analysis group points to a different concern that may cause higher premiums in 2015 – increased use of healthcare services, along with higher technology and care costs, will keep premiums higher in 2015. They also pointed out that the increases will vary greatly by state – states with lower rates of young adults enrolling, for instance, will see bigger hikes while other states may have a better risk mix.

Prediction Two: Premium Increases in 2015 will be Modest 

The other prediction for 2015 is a moderate increase in premiums. Many costs may increase every year due to inflation – the cost of bread, milk, car repairs, and so on – and insurance is no different. However, another predictive scenario, expects that the increases will be far less than many expect.

The Congressional Budget Office (CBO) released a report predicting only a nationwide average 3% increase in premiums for health insurance in 2015, which is much smaller than many others are forecasting. The CBO credits the lower premiums to stricter payout policies for Marketplace plans compared to employer-based insurance. Also, many Marketplace policies cover fewer providers than employer-based coverage. However, the CBO expects those differences to lessen over time, and the report forecasts higher premium growth after 2015 and 2016.

Another argument against higher 2015 premiums is that young, healthy adults enrolled in larger numbers than expected during 2014 and with increased education about the importance of health insurance, that trend could continue. Having healthier people purchase an insurance plan helps balance out the needs of the sicker participants and keeps costs down, which keep premiums lower. As the tax penalty increases, the incentive to get insurance gets stronger.

The truth is that no one yet knows what insurance premiums will be in 2015 — not even insurance companies themselves. The initial rate filings are being sent to the states, but that is only the start of the negotiations. In addition, the rate changes in each state will be very different, and will depend on the amount of healthy young adults who enroll to offset the sicker participants. Finally, health insurance costs are the main driver of insurance rates, and it’s anyone’s guess how much technology, medicine, and procedures will cost in coming years.