- Despite questions over the future of the Affordable Care Act (ACA) and its cost-sharing reductions (CSR), many insurers are opting to expand existing offerings or enter new markets in the 2018 ACA health insurance exchanges.
The moves come in contrast to several payers that are reducing participation or withdrawing from health insurance exchanges entirely.
Here is a list, updated frequently, of the major payers that have decided to expand existing offerings or enter new markets in the ACA state health insurance exchanges past 2017.
May 10, 2017 – After pulling out of three of the state’s most populous regions in 2016, including Knoxville, BCBS announced it would be returning to the vacant Knoxville exchange for 2018. The exit earlier this year by Humana had left 16 counties in the greater Knoxville area without a single insurer.
After three difficult years in Tennessee – and losses totaling more than $400 million – the decision by BCBS to expand into the market was based on better-than-expected 2017 results.
“BlueCross’s journey to get and keep people covered under this program has proven challenging, “BCBS Tennessee President & CEO JD Hickey said in a recent letter to Tennessee Insurance Commissioner Julie Mix McPeak.
“I’m pleased to report that, though still very early, our 2017 performance has improved due to a combination of better claims experience and a more sustainable rate structure based on the medical needs of the members we’re serving,” Hickey wrote.
BCBS maintains that the decision was not politically motivated, or a statement of affirmation on the individual marketplace in general.
“In fact, we can’t justify doing so based solely on current political uncertainty,” said Hickey. “Instead we believe it is an extension of our mission to serve our fellow Tennesseans, especially those who do not have other options for coverage.”
In a request to the state insurance commission, BCBS asked for flexibility related to the requirement by Tennessee to serve a majority (51 percent) of the state’s rating areas year over year. There are eight rating areas in the state. By including the Knoxville expansion, BCBS will be offered in six of them.
June 13, 2017 - Centene Corporation will expand its presence in a number of state health insurances exchanges in 2018, building on its successful 2017 marketplace results. The payer is planning to enter the Kansas, Missouri, and Nevada health insurance exchanges. It will also expand its 2018 footprint in six existing markets: Florida, Georgia, Indiana, Ohio, Texas, and Washington.
"Centene recognizes there is uncertainty of new healthcare legislation, but we are well positioned to continue providing accessible, high quality and culturally-sensitive healthcare services to our members," said Centene Chairman, President, and CEO Michael F. Neidorff.
Centene’s success with health insurance exchanges may arise from its record of providing coverage for underinsured and uninsured individuals. The payer has an established history of offering Medicaid, Medicare, Children's Health Insurance Program (CHIP), Aged, Blind or Disabled (ABD), Foster Care and Long Term Care (LTC) plans, in addition to other state-sponsored programs.
Ninety percent of Centene’s 537,200 exchange members are eligible for premium subsidies. The company reported a rise in total membership to 1.32 million as of 2017.
June 21, 2017 - One of the most ambitious 2018 marketplace expansion plans comes from New York-based Oscar Health. The payer intends to expand its current individual and small business offerings in New York and California, while also building on a successful 2017 in Texas. In 2017, Oscar had 40,000 members in San Antonio, with plans in 2018 to expand into the greater San Antonio region and enter Austin.
“We're confident that when the dust settles, the market for health insurance will stabilize in time for 2018,” said Oscar CEO and Co-Founder Mario Schlosser. “For all of the political noise, there are simply too many lives at stake for representatives in Washington, D.C. not to do what's right for the people.”
The insurer will also enter exchanges in three new states. In Ohio, the payer will pair up with the Cleveland Clinic to offer co-branded individual policies. Oscar also plans a return to New Jersey after leaving the state in 2016. The payer has also filed to move into Tennessee, a marketplace that has seen considerable turbulence in the last few years.
Schlosser maintained Oscar is focused on the long-term health insurance marketplace, with a focus on innovation to provide simpler, affordable healthcare.
“We've built an Oscar experience that includes deep integrations with hospitals and doctors; tools for members to find the right care; a data science operation that enables proactive clinical insights; personalized Concierge team service; and free, 24/7 virtual visits,” Schlosser said.