Iowa: Wellmark to Join Marketplace for 2017 Open Enrollment

Citing system improvements at and the Supreme Court’s ruling in King v. Burwell to uphold the legality of subsidies, Wellmark Blue Cross Blue Shield will offer plans on Iowa's Federally-facilitated Marketplace for the first time for coverage year 2017, the company announced last week. The Des Moines Register notes that Wellmark, one of the most well-known insurers in the State, sells more than three-quarters of all individual market policies in Iowa, the majority of which are grandfathered ACA non-compliant plans that can no longer be offered after September 2016Kaiser Health News speculated that Wellmark’s exclusion from the Marketplace thus far may have contributed to the State’s low overall enrollment rate, among the lowest in the nation. For coverage year 2016, five carriers will offer products on the Marketplace, four of which will be new to the Marketplace.

Kentucky: State’s Co-Op Announces Closure

Kentucky Health Cooperative announced that it will not offer health plans for coverage year 2016. Currently 51,000 Kentuckians across all 120 counties have coverage through the Kentucky Health Cooperative purchased on Kynect, the State's Marketplace. According to the Louisville Courier Journal, the State’s Department of Insurance will help these individuals purchase new plans from one of the other seven insurers on the Marketplace. Kentucky Health Cooperative interim CEO Glenn Jennings said that the decision to shut down was due to the significantly lower-than-expected risk corridors reimbursement that CMS recently announced.

Oklahoma: Reduced Choice for Marketplace Participants

Three insurers covering less than 3% of the State’s Federally-facilitated Marketplace enrollees are leaving the Marketplace for coverage year 2016, leaving only two plan options for consumers: Blue Cross Blue Shield of Oklahoma, the current market leader, and UnitedHealthcare, a new entrant to the market. Blue Cross Blue Shield is also moving 40,000 subscribers from its “Blue Choice” plan, which it is discontinuing in 2016 for the individual market for cost reasons, to two new plans with fewer participating providers. Affected members will have the option to switch plans or carriers during open enrollment. The three companies leaving the Marketplace are CommunityCare of Oklahoma and GlobalHealth, both Tulsa-based HMOs, and Assurant Health, a Wisconsin-based company that is leaving the individual health insurance market nationwide. The Deputy Commissioner of the Oklahoma Insurance Department said that most insurers on the State’s Marketplace lost money in 2014 and would probably do so again in 2015.

Wyoming: One of Two Insurers Pulls Out of Federal Marketplace

WINhealth announced that it will no longer offer Qualified Health Plans through the Federally-facilitated Marketplace for 2016, leaving Blue Cross Blue Shield of Wyoming as the lone insurer for the upcoming open enrollment period. The 8,200 individuals currently enrolled in WINhealth plans (approximately 38% of Wyoming’s Marketplace enrollees) will retain coverage through the end of 2015, but must reapply and select a new plan on for 2016. WINhealth’s decision came shortly after CMS’s October 1 announcement that insurers will receive only 12.6% of their risk corridors payment requests, which will reduce WINhealth’s payments by $4.4 million, making it financially unsustainable to participate. The risk corridors program was designed to provide protection against claims uncertainty for the first three years of the Marketplace program.

Virginia: HIV Patients Enrolled in Qualified Health Plans See Improved Health

study presented at an Infectious Diseases Society of America conference indicated that low-income HIV patients who enrolled in a Qualified Health Plan (QHP) with financial assistance from the State’s AIDS Drug Assistance Program (ADAP) were 45% more likely to reduce their HIV viral load to “very low or undetectable levels,” compared to those who continued to receive their medication through ADAP alone. The study’s lead researcher explained the improved outcomes were “likely a result of more comprehensive care” and access to a wider set of HIV medications. Researchers also noted that enrolling ADAP members in QHPs provides coverage to a greater number of HIV patients than traditional ADAPs due to cost efficiencies, though only 47% of eligible Virginians in ADAP enrolled in a QHP. ADAPs, which all states have, pay for medications and medical care at federally funded clinics for uninsured and underinsured low-income HIV patients, and are permitted to pay QHP premiums and cost sharing for qualified HIV patients. The conference spokesman noted it is not yet clear if other states are seeing similar outcomes to Virginia or what the overall financial impact is of enrolling ADAP patients in QHPs.