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ACA exchanges: Who's in, who's out?


What MCOs should know about insurers’ plans for the marketplace exchanges in 2018.

As the future of the Affordable Care Act (ACA) remains unclear, payers have to decide whether or not to stay in the marketplace exchanges or leave them in 2018. Some have already made this decision, while others are still grappling with it. Here’s a look at the status of a few insurers’ decisions as of press time.

Looking ahead to 2018, Jon Allison, executive vice president, business development and integration, CareSource, Dayton, Ohio, says the insurer is preparing to offer coverage in the states in which it has plans-Ohio, Indiana, Kentucky, and West Virginia.

“We have offered plans on the marketplace since it opened in 2013,” Allison says. “Our goal was to align our business growth with our mission to improve the health and well-being of those we serve. We also saw the marketplace as an opportunity to serve a larger population, while ultimately helping consumers take responsibility for their healthcare. In addition, we see the marketplace as an affordable option for our members who transition off of Medicaid.”

Adds Allison, “When we entered the marketplace, we knew it would be a long-term investment. As Congress continues to reshape the ACA, we remain committed to providing coverage for the population we have served for our 28-year history.”

San Francisco-based Blue Shield of California is another insurer that is planning to stay in the marketplace exchanges. Rob Spector, area vice president, Covered California, health insurance exchanges, says the company has submitted its 2018 Qualified Health Plan recertification to Covered California and intends to remain in the individual market.

“Because the financial assistance provided by the ACA is available only through the state’s health insurance marketplace, it’s not possible to fulfill our mission of ensuring Californians’ access to high-quality healthcare at an affordable price if we are not in the individual market and on the exchange,” Spector says. “Covered California continues to strengthen and stabilize the marketplace, with multiple carriers and significant investments in marketing and outreach to attract a healthy mix of consumers.”  


Humana made the decision to exit the exchanges earlier this year. “Our reason was based on Humana’s analysis of data associated with the company's healthcare exchange membership following the 2017 open enrollment period, as we saw further signs of an unbalanced risk pool and decided that we could not continue to offer this coverage for 2018,” says Mark Mathis, director, corporate communications, Humana, Louisville, Kentucky.

Still undecided

At press time, Kurt Kossen, divisional senior vice president, Retail Markets,

Health Care Service Corporation, Chicago, Illinois, said that the company is currently developing 2018 products and pricing, however, it has not made any decisions regarding its 2018 product offerings or whether or not it will participate in the exchanges. The company currently operates plans in Illinois, Montana, New Mexico, Oklahoma, and Texas.

“As we look forward, it's imperative that we have market stability and regulatory certainty to allow us to continue to serve our members,” Kossen says. “For this reason, we are actively working with policy makers at the state and federal levels to offer our experience and resources so that needed changes can be achieved to foster competition, choice, and innovation.

Kossen says the insurer’s pricing is largely driven by anticipated costs for healthcare its members will receive next year. “We have to make assumptions about what the market will look like and price accordingly,” he says. “There is currently some uncertainty concerning the 2018 market, and we’re hoping clarity is provided soon.”


Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.


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