1Q Earnings Chatter Indicates Express, CVS May Benefit From Marketplace Unrest

with Chart: Big Three PBMs’ First-Quarter 2015 Earnings

May 8, 2015

As the big three publicly traded PBMs reported first-quarter 2015 earnings, there was underlying concern about how the pending acquisition of Catamaran Corp. by UnitedHealth Group is likely to shake out during the 2016 selling season and impact the marketplace. Industry observers suggested that Express Scripts and CVS Health may reap the benefits of unrest […]

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HAP plans to revise its 2018 individual plan offerings and withdraw from the ACA marketplace

September 25, 2017

Health Alliance Plan (HAP) said Sept. 15 it plans to revise its 2018 individual plan offerings and withdraw from the Affordable Care Act marketplace. The company will continue to offer insurance off the exchange. Market volatility and uncertainties were the key factors in the decision, HAP said, and will not affect employer-based insurance or Medicare, […]

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Plans Seek New Blood From Data, High-Tech Fields to Meet Shifting Marketplace

April 27, 2015

Health plans are looking for new types of talent to fill their employment needs. In addition to traditional insurance-related jobs, plans want individuals with backgrounds in data analytics, consumer-facing businesses and high technology to meet the industry’s focus on numbers, public engagement via exchanges and vital, fresh websites. It’s not like a flood of Gap […]

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Employers saved up to 15% per worker on their medical benefit costs by using Mercer Marketplace

October 20, 2014

Employers saved up to 15% per worker on their medical benefit costs by using Mercer Marketplace, the company announced Oct. 13. Additionally, Mercer reported an average savings of 10% on life and disability insurance. In 2014, 247 companies representing more than 1 million lives including dependents have joined its exchange platform. This is nearly five […]

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The majority of taxpayers who signed up for health insurance through the federal marketplace are repaying a portion of the Advance Premium Tax Credit

March 2, 2015

So far this tax season, the majority of taxpayers who signed up for health insurance through the federal marketplace are repaying a portion of the Advance Premium Tax Credit because they underestimated their income, a Feb. 24 report from H&R Block said. The mistake resulted from marketplace enrollees using 2012 income data in their insurance […]

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As States Strive to Stabilize Insurance Marketplaces, Insurers Return

August 14, 2019

Felicia Morrison is eager to find a health plan for next year that costs less than the one she has and covers more of the medical services she needs for her chronic autoimmune disease.

Morrison, a solo lawyer in Stockton, Calif., buys coverage for herself and her twin sons through Covered California, the state’s Affordable Care Act insurance marketplace. Morrison, 57, gets a federal subsidy to help pay for her coverage and she said that her monthly premium of $167 is manageable. But she spends thousands of dollars a year on deductibles, copayments and care not covered by her plan.

Felicia Morrison is eager to find a health plan for next year that costs less than the one she has and covers more of the medical services she needs for her chronic autoimmune disease.

Morrison, a solo lawyer in Stockton, Calif., buys coverage for herself and her twin sons through Covered California, the state’s Affordable Care Act insurance marketplace. Morrison, 57, gets a federal subsidy to help pay for her coverage and she said that her monthly premium of $167 is manageable. But she spends thousands of dollars a year on deductibles, copayments and care not covered by her plan.

“I would just like to have health insurance for a change that feels like it’s worth it and covers your costs,” she said….

Read the full Kaiser Health News article

Insurers, Experts Work to Stabilize ACA Individual Marketplaces

April 4, 2018

Despite Congress’ latest failure to pass an Affordable Care Act (ACA) stabilization package, some insurers have publicly stated their commitment to the individual exchanges, and experts say they think carriers are mostly in a good position to weather the challenges they face.

One headwind is the repeal of the tax penalty associated with the individual mandate, which goes into effect in 2019.

S&P analyst Deep Banerjee predicts that while the repeal won’t cause a meaningful decline in ACA exchange enrollment,

Despite Congress’ latest failure to pass an Affordable Care Act (ACA) stabilization package, some insurers have publicly stated their commitment to the individual exchanges, and experts say they think carriers are mostly in a good position to weather the challenges they face.

One headwind is the repeal of the tax penalty associated with the individual mandate, which goes into effect in 2019.

S&P analyst Deep Banerjee predicts that while the repeal won’t cause a meaningful decline in ACA exchange enrollment, insurers are likely to respond by raising their rates. It is “quite possible” that rate hikes for the second-lowest cost silver plan, also called the benchmark plan, could average in the low teens in 2019.

Another challenge is the expansion of short-term and association health plans, which might lead insurers to raise premiums. But in Banerjee’s view, this change likely won’t meaningfully alter the risk profile of the ACA marketplaces, since many exchange enrollees likely need the more comprehensive coverage afforded by ACA-compliant plans.

The impact of the lack of funding for cost-sharing reduction (CSR) payments is also limited. “I don’t think that the CSR issue is going to really be a factor” in whether some insurers decide to exit the exchanges, says Chiquita Brooks-LaSure at Manatt Health, who helped implement the ACA as part of the Obama administration.

However, unsubsidized enrollees would be hurt disproportionately. For instance, in Washington, only 60% enrollees are subsidy-eligible, while the remaining 40% would have to bear the full brunt of premium hikes.

To ensure that the ACA exchanges continues to be viable markets for both insurers and consumers, allocating funding for reinsurance is “one of the key things that Congress could do,” Brooks-LaSure says. It is also important to retain robust outreach to consumers.

Insurers, Experts See Stabilizing ACA Individual Marketplaces

April 2, 2018

Congress’ latest failure to pass an Affordable Care Act (ACA) stabilization package, taken together with policy changes that have chipped away at the law, have renewed concerns about spiking premiums and insurer exits in the marketplaces next year. However, some insurers have already publicly stated their commitment to the individual exchanges, and experts say they […]

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Plan participation in state-based marketplaces is relatively stable

February 1, 2016

Plan participation in state-based marketplaces is relatively stable, according to a Jan. 21 blog post on The Commonwealth Fund website written by three Georgetown University researchers. The authors reported that nine of the 17 state-based exchanges have the same number of participants from the year prior, three have seen an increased number of participants and […]

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Blues Plans Dominate Marketplaces; Medicaid Plans Increase Presence

July 6, 2020

by Jinghong Chen Between 2016 and 2018, Medicaid-focused insurers expanded their footprint into the Affordable Care Act (ACA) marketplaces by offering lower premiums for silver plans, according to a recent analysis by the Robert Wood Johnson Foundation. Blue Cross Blue Shield plans remained the dominant players, accounting for almost half of marketplace enrollment nationally in […]

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State-Based Marketplaces Enroll Thousands During Special Enrollment Periods

June 8, 2020

by Jinghong Chen In light of the coronavirus pandemic, 12 out of 13 state-based marketplaces — all but Idaho’s marketplace — offered a new special enrollment period (SEP) for residents to sign up for coverage. According to the most recent data, more than 290,000 people across 11 states have enrolled in marketplace plans during pandemic-related […]

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NM Medicaid Buy-In Could Leverage Managed Care Structure

December 26, 2018

With the aim of expanding health care coverage and affordability for residents who would not otherwise qualify for Medicaid or federal subsidies to purchase Affordable Care Act marketplace coverage, several states are exploring the concept of allowing people to buy into their Medicaid programs. New Mexico may be the furthest along in that process, having commissioned a two-part study to seriously consider the financial implications of four different Medicaid buy-in scenarios.

By Lauren Flynn Kelly

With the aim of expanding health care coverage and affordability for residents who would not otherwise qualify for Medicaid or federal subsidies to purchase Affordable Care Act marketplace coverage, several states are exploring the concept of allowing people to buy into their Medicaid programs. New Mexico may be the furthest along in that process, having commissioned a two-part study to seriously consider the financial implications of four different Medicaid buy-in scenarios.

According to the report produced by Manatt Health, “Evaluating Medicaid Buy-In Options for New Mexico,” Medicaid is the largest payer in the state, covering more than 40% of the state population. By contrast, the BeWellNM marketplace covers about 50,000 individuals, or 2% of the population. While marketplace coverage may be affordable for some, there are various reasons why eligible individuals are opting out, such as rising premiums and cost-sharing affordability, especially if they do not qualify for federal subsidies, observed the report.

The report also suggests that individuals would pay premiums and cost-sharing, but by leveraging Medicaid’s purchasing power, provider networks and reimbursement rates, the cost of buy-in coverage would be less than the cost of private coverage. That report made a qualitative assessment of four options:

(1) Targeted Medicaid Buy-In Program, where the state offers Medicaid-like coverage off the BeWellNM marketplace to those not eligible for Medicaid, Medicare or subsidized marketplace coverage.

(2) Qualified Health Plan Public Option, where the state offers a lower cost public option product on the marketplace to individuals and small employers, although it could be expanded outside of BeWellNM for people who are not eligible to purchase individual coverage.

(3) Basic Health Program, a state-offered option for individuals with incomes up to 200% of the FPL who are not Medicaid-eligible and are otherwise eligible to purchase coverage through the marketplace.

(4) Medicaid Buy-In for All, where the state offers Medicaid coverage to everyone (except those covered by Medicare) as a lower-cost option off the marketplace.

According to Patricia Boozang at Manatt, the consulting firm and its actuarial partner Wakely Consulting Group are now in the second phase of the study, working “to develop an actuarial analysis that projects the number of people likely to be covered through one or two variations on the Option 1 Targeted Buy-in model” outlined in the paper.

Affordable Care Act Premiums See Slight Decline as Marketplaces Stabilize

February 10, 2020

by Jinghong Chen The cost of the lowest-priced silver plan in the Affordable Care Act exchanges fell by an average of 3.5% from 2019 to 2020, according to a new analysis from the Robert Wood Johnson Foundation. The report also examined premiums in major urban and rural areas in select states, finding that rural premiums […]

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HHS asks for public feedback on how to improve the ACA’s marketplaces

June 19, 2017

HHS issued a request for information on June 12, asking for public feedback on how to improve the Affordable Care Act (ACA)’s marketplaces. HHS is seeking public input about any changes to existing guidance or regulations that could help empower patients and promote consumer choice, stabilize the individual and small-group exchanges and make coverage more […]

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With One Hand, Administration Boosts ACA Marketplaces, Weakens Them With Another

October 30, 2018

In the span of less than 12 hours last week, the Trump administration took two seemingly contradictory actions that could have profound effects on the insurance marketplaces set up by the Affordable Care Act.

In the span of less than 12 hours last week, the Trump administration took two seemingly contradictory actions that could have profound effects on the insurance marketplaces set up by the Affordable Care Act.

First, officials issued guidance Monday morning that could weaken the exchanges set up for people who buy their own insurance. The new approach makes it easier for states to get around some ACA requirements, including allowing the use of federal subsidies for skimpier plans that can reject people with preexisting conditions.

Yet, the other move — a proposed rule unveiled Monday evening — could bolster ACA marketplaces by sending millions of people with job-based coverage there, armed with tax-free money from their employers to buy individual plans…

Read the full Kaiser Health News article

NM Medicaid Buy-In Could Leverage Managed Care Structure

December 20, 2018

With the aim of expanding health care coverage and affordability for residents who would not otherwise qualify for Medicaid or federal subsidies to purchase Affordable Care Act marketplace coverage, several states are exploring the concept of allowing people to buy into their Medicaid programs. New Mexico may be the furthest along in that process, having […]

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A new BCBSA study said ACA marketplaces feature solid competition in most regions of the country

January 18, 2016

A new Blue Cross Blue Shield Association study, “The Evolving Affordable Care Act Marketplaces: The 2015 to 2016 Transition,” released on Jan. 13, said ACA marketplaces feature solid competition in most regions of the country, but the types of plans being offered are changing to meet consumer demand and alleviate some risk for carriers. “For […]

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Rates for the Most Common ACA Health Plans Drop for a Second Year

October 22, 2019

The average price for the most common type of health insurance sold through the Affordable Care Act’s federal marketplace will drop by about 4 percent for next year, extending a reversal of steep rate increases that daunted HealthCare.gov in its early years.

The second consecutive year of lower monthly premiums coincides with a significant improvement in the number of insurance companies selling ACA health plans. Just 12 percent of ACA customers live in counties that will have only one insurer in the marketplace for the coming year, compared with almost 30 percent for 2018, and more than two-thirds will have a choice of at least three companies.

The average price for the most common type of health insurance sold through the Affordable Care Act’s federal marketplace will drop by about 4 percent for next year, extending a reversal of steep rate increases that daunted HealthCare.gov in its early years.

The second consecutive year of lower monthly premiums coincides with a significant improvement in the number of insurance companies selling ACA health plans. Just 12 percent of ACA customers live in counties that will have only one insurer in the marketplace for the coming year, compared with almost 30 percent for 2018, and more than two-thirds will have a choice of at least three companies.

This brightening scenario for Americans buying such health insurance creates awkward conflicting messages for senior Trump administration officials who on Tuesday presented the statistical picture of the ACA marketplaces before the seventh annual enrollment season opens late next week….

Read the full The Washington Post article

CBO says gross premiums for silver plans would increase by 20% if CSR payments were terminated

August 21, 2017

The Congressional Budget Office (CBO) said Aug. 15 that gross premiums for silver plans in the Affordable Care Act (ACA) individual marketplace would increase by 20% in 2018 if cost-sharing reduction (CSR) payments were terminated. By 2020, these premiums would be 25% higher than if CSR reimbursement continues. If CSR payments are halted after rates […]

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Centene Expands Affordable Care Act Exchange Offerings for 2019

November 2, 2018

by Carina Belles
Centene Corp. earlier this month said it will offer Affordable Care Act exchange plans in four new states in 2019, as well as expand existing coverage options to new counties in six of its other markets. Centene is already the exchange market leader, with 1.76 million enrollees nationwide (see chart below). The news may be another sign things are turning around for the marketplaces, as individual premium rates have also declined nationwide,

by Carina Belles
Centene Corp. earlier this month said it will offer Affordable Care Act exchange plans in four new states in 2019, as well as expand existing coverage options to new counties in six of its other markets. Centene is already the exchange market leader, with 1.76 million enrollees nationwide (see chart below). The news may be another sign things are turning around for the marketplaces, as individual premium rates have also declined nationwide, and fewer counties have just one participating marketplace insurer compared to 2018.

NOTE: Exchange figure includes about 270,000 members enrolled in Fidelis Care, Inc.’s New York marketplace offerings. Centene completed its acquisition of Fidelis in July 2018.
SOURCE: AIS’s Directory of Health Plans (DHP). Visit aishealthdata.com/dhp for more information.