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June 26, 2017

Health insurers file 2018 coverage plans for ACA exchanges, but outlook remains unclear

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Health insurance companies had until Wednesday to file plans to sell exchange coverage on for the 2018 coverage year, but they do not have to sign final contracts to sell plans via the exchanges until Sept. 27—meaning they have another three months to change their minds.

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Insurer exits put counties at risk of exchange plan 'dead zones'

Leading up to the deadline, some experts and CMS raised concerns that U.S. residents could have limited or even no exchange plan options for 2018. CMS in an analysis ahead of the filing deadline said an estimated 47 counties in Ohio, Missouri, and Washington were at risk of these so-called coverage "dead zones." CMS' analysis was based on public insurer announcements made as of June 9, and the agency said it expected "the number of consumers with no coverage choices [to] rise" in future months. 

Similarly, according to the Kaiser Family Foundation, 48 counties—one in Washington, four in Indiana, 18 in Ohio, and 25 in Missouri—as of June 26 were at risk of having no exchange insurer for the 2018 coverage year, which would affect about 34,962 current exchange plan enrollees. According to Washington Insurance Commissioner Mike Kreidler, two insurers have since decided to offer 2018 exchange coverage for the county in the state at risk of being a dead zone, Klickitat County. 

The dead zones resulted from a swath of insurer exits from the exchanges over the years, but ultimately came down to withdrawals by insurers who were the last company standing in some exchange markets for the 2017 coverage year.

For instance, Blue Cross Blue Shield of Kansas City last month announced plans to pull out of Kansas' exchange for 2018, and Anthem last week said it will withdraw from exchanges in Ohio and Indiana for the 2018 coverage year. Indiana also recently saw insurer MDwise Marketplace leave its exchange.

Others expand their exchange offerings

However, some insurers have filed plans to continue or expand their exchange plan offerings for 2018.

Health Care Service Corp. (HCSC), Highmark Health, and Molina Healthcare all said they will continue selling exchange plans in their current markets for 2018.

Further, Centene, Medica, and Oscar Health all have announced plans to expand their exchange plan offerings into additional markets for 2018, Forbes reports. And in Washington's Klickitat County—a potential dead zone after Premera Blue Cross announced it would not sell 2018 plans on the exchange there—Molina Healthcare and BridgeSpan Health Company on Monday indicated they would provide coverage. 

Situation could change

While Wednesday was the filing deadline to sell exchange plans in 2018, insurers do not have to sign final contracts to sell plans through until Sept. 27, meaning they have another three months to potentially withdraw from the markets.

Further, regulators could choose to accept late filings, and some state regulators are working with insurers to try to bring exchange plan options to counties facing dead zones. States also could consider other initiatives to entice insurers to the market. Iowa, for instance, has submitted to CMS a so-called "state innovation waiver" request under the ACA that would implement reforms intended to offset insurers' risks in the market (Small, FierceHealthcare, 6/20; Marso/Lowry, Kansas City Star, 5/24; Fox59, 6/21; Livingston, Modern Healthcare, 6/22; Japsen, Forbes, 6/21; Kaiser Family Foundation chart, 6/20 [accessed 6/26]; Mercado, CNBC, 6/23; Wilde Mathews, Wall Street Journal, 6/21; Office of the Insurance Commissioner for Washington State release, 6/26).

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