Iowa/South Dakota: Wellmark drops off-exchange plans in SD, swaps PPOs for HMOs in IA
2019 OPEN ENROLLMENT ENDS (most states)
Time: D H M S
Wellmark Blue Cross and Blue Shield announced Tuesday that it will narrow its choices for individual Affordable Care Act plans in Iowa and will eliminate ACA individual plans in South Dakota altogether in 2017.
First, some clarification: Wellmark isn't on the exchange to begin with, and wasn't planning on joining it in SD next year, so this is a rare case of a carrier dropping their off-exchange individual market offerings. Since all of Wellmark's indy enrollees in South Dakota are paying full price, this one can't be blamed on APTC enrollees being sicker than average, etc.
Having said that, this does impact around 8,000 off-exchange enrollees in SD.
As for Iowa, it's more of a mixed bag...Wellmark is basically swapping out higher end PPO plans for lower end HMO, which is pretty much the trend everywhere:
In Iowa, Wellmark will no longer offer gold tier plans and will not promote individual under-65 plans that use its Preferred Provider Organization (PPO) network in Iowa. Individual ACA members with a silver or bronze PPO currently may continue on that plan for 2017, however. The changes won't affect people with grandfathered or grandmothered plans (generally those who purchased their individual plans prior to Jan. 1, 2014).
...Wellmark said it will also move forward in 2017 with plans to introduce a new HMO plan for the individual ACA market called Blue Simplicity, which will offer a simplified copay option.
...And as announced in May, Wellmark will also roll out two new individual market health plans in 2017 that partner with health systems in Iowa to provide coverage through those specific networks. Its new Wellmark Value Health Plan is a partnership with Mercy Health Network, while the Wellmark Synergy Health plan will partner with the University of Iowa Health System.
Also remember that this will be the first year that Wellmark has participated in the ACA exchange in Iowa:
Both Wellmark Value Health Plan and Wellmark Synergy Health will offer individual ACA plans both on and off the public exchange in a total of 40 Iowa counties.
Many Wellmark customers who already are covered by individual broad-network plans will be allowed to keep them. However, about 7,000 who purchased “gold-tier” plans in recent years will soon receive notices that those relatively expensive, rich-benefit plans are being curtailed.
OK, so that's 8,000 off-exchange enrollees in South Dakota and 7,000 Gold (mostly PPO?) enrollees in Iowa, or 15,000 more who'll have to shop around.