Os­car, Cen­tene bet on Oba­macare as other insurers pull back on ex­changes

Modern Healthcare - - NEWS - By Shelby Liv­ingston

Eye­ing po­ten­tial growth op­por­tu­ni­ties, Cen­tene Corp. and startup Os­car Health plan to ex­pand their foot­prints on the ACA mar­ket­places.

While Repub­li­can lead­ers in the Se­nate were craft­ing their plan to re­place the Af­ford­able Care Act, the na­tion’s insurers were cal­cu­lat­ing how much risk they are will­ing to take in the in­di­vid­ual mar­ket. In the end, some insurers made their es­capes. Oth­ers in­di­cated they would stay for 2018. And a cou­ple are swoop­ing in to pick up the busi­ness that’s left be­hind.

Insurers had un­til last Wed­nes­day— one day be­fore the draft Se­nate bill was re­leased—to an­nounce whether they would sell plans on the ACA ex­changes in 2018. Insurers could still pull out by fall, but the ini­tial dead­line pro­vides a first look at the shape of the in­di­vid­ual mar­ket. Sev­eral, in­clud­ing Aetna and Hu­mana, pre­vi­ously said they would stop of­fer­ing in­di­vid­ual plans in cer­tain mar­kets, cit­ing fi­nan­cial losses and un­cer­tainty over whether key pro­vi­sions of the health­care law would re­main in play.

An­them, which cov­ers 1.1 mil­lion ex­change mem­bers and had wa­vered over whether to sell ex­change plans next year, pulled out of mar­ket­places in In­di­ana and Wis­con­sin, fol­low­ing a pre­vi­ous an­nounce­ment to drop out of Ohio. But the in­surer filed pre­lim­i­nary rates in 11 other states. MDWise, an In­di­anapo­lis-based in­surer, also will leave In­di­ana’s mar­ket­place, say­ing it lost $21 mil­lion on ex­change plans in 2016. Its exit will af­fect 30,800 mem­bers. Eye­ing op­por­tu­ni­ties for growth, Cen­tene Corp. and New York­based startup Os­car Health plan to ex­pand their foot­prints on the ACA mar­ket­places. Cen­tene, which has ex­pe­ri­ence man­ag­ing the care of low-in- come Med­i­caid mem­bers, will start of­fer­ing cov­er­age on ex­changes in Kansas, Mis­souri and Ne­vada, while ex­pand­ing its pres­ence in the six states where it cur­rently sells plans. Cen­tene cov­ers 1.2 mil­lion ex­change mem­bers.

De­spite los­ing mil­lions on the ex­changes in 2016 and 2015, Os­car Health filed to ex­pand into cer­tain coun­ties in Ohio, New Jersey and Ten­nessee. The startup, founded by Joshua Kush­ner, pre­vi­ously sold plans in New Jersey but ex­ited the mar­ket this year. Os­car will also ex­pand its pres­ence in Cal­i­for­nia and Texas and will keep sell­ing plans in New York. In 2017, Os­car cov­ered about 105,000 mem­bers.

Oth­ers, in­clud­ing Molina Health­care and High­mark Health, in­di­cated that they will con­tinue to sell cov­er­age in each of the states where they cur­rently op­er­ate. Chicago-based Health Care Ser­vice Corp. also filed rates in the five states where it sells ex­change cov­er­age, but a spokes­woman for the in­surer said no fi­nal de­ci­sions have been made re­gard­ing par­tic­i­pa­tion or prod­ucts.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.