2018 MIDTERM ELECTION

Time: D H M S

West Virginia: Requested 2016 avg. rate hike: 19.7%, but new carrier joining the exchange

West Virginia is pretty easy to calculate. Their total 2014 individual market was only 42,225 people (including "grandfathered" plans...WV did not allow "transitional" policies to be extended beyond 2013), and they had 33,421 people select exchange-based QHPs during the 2015 open enrollment period, of whom 31,106 were still effectuated as of 6/30/15.

Assuming about 5% are "grandfathered" (and not part of this risk pool), and assuming their total individual market grew by about 20% this year (this has been typical of many other states), that means they should have around 48,000 ACA-compliant enrollees at the moment (31K exchange-based plus another 17K or so off-exchange).

All 31,106 of the exchange enrollees are signed up with Highmark Blue Cross Blue Shield...because it's the only insurance carrier operating on the WV exchange...which means their 19.7% requested average rate hike pretty much says it all.

What about the off-exchange enrollees? Well, Aetna does offer an ACA-compliant HMO off of the exchange in WV...but only 135 people are enrolled in those plans, which isn't even a rounding error (FWIW, Aetna is requesting a 15.3% hike for those 135 people).

It's possible that there's some other company operating in the state which offers individual policies...but I doubt it; according to eHealthInsurance, Highmark is the only show in town this year, on or off the exchange.

The good news is that according to Louise Norris, a second player is jumping into WV which will hopefully provide some pricing competition next year...if only in part of the state:

But for 2016, CareSource will also be offering plans in 15 of West Virginia’s 55 counties (Boone, Brooke, Cabell, Clay, Hancock, Kanawha, Lincoln, Marshall, Mason, Ohio, Pleasants, Putnam, Wayne, Wirt, and Wood).

Kentucky Health Cooperative (a CO-OP created under the ACA) had planned to expand into the West Virginia exchange in 2015, but in early November 2014, the CO-OP announced that they were postponing their expansion into West Virginia by a year, saying that they needed additional time to make sure that the new West Virginia Health Cooperative would be fully functional before being offered for sale in WV.