END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

Time: D H M S

Drop-out Roundup: Idaho, Missouri, Nebraska, Kansas

Everyone's being dumped onto Medica...assuming they stick around themselves.

Between updating the "Who could lose coverage" graphics, prepping for my town hall thing last night and updating the 2018 Rate Hike project, I've gotten way behind on my "Who's saying 'screw rate hikes, I'm just gonna bail completely next year' updates. Let's take care of that now, OK? The first three updates are courtesy of Louise Norris writing for healthinsurance.org; the fourth is vai Kimberly Leonard for the Washington Examiner:

IDAHO: BridgeSpan is out, 4 carriers staying put:

Insurers in Idaho had to submit forms for 2018 plans by May 15, but they have until June 2 to file rates. Mountain Health CO-OP, SelectHealth, PacificSource and Blue Cross of Idaho all filed forms to continue to offer Your Health Idaho plans in 2018.

There are currently five insurers that offer plans in Your Health Idaho, but BridgeSpan’s form filing only shows off-exchange plans for 2018. BridgeSpan confirmed by phone that their plans will not be available on-exchange in Idaho in 2018; current Your Health Idaho enrollees who have BridgeSpan coverage will need to switch to a different plan during open enrollment (November 1, 2017, through December 15, 2017), as on-exchange BridgeSpan plans will be terminated at the end of 2017. BridgeSpan noted that the switch to only offering off-exchange plans is a cost-control measure, but is also a result of uncertainty and instability for the exchanges.

Regence Blue Shield of Idaho (BridgeSpan’s sister company) will also only offer off-exchange plans in 2018, but their plans are already only available off-exchange.

MISSOURI: Blue Cross Blue Shield of Kansas City is out; 25 counties slated to go bare?

The Missouri exchange currently has four participating insurers. But two of them — Humana and Blue KC — have announced that they will exit the exchange at the end of 2018. The other two — Anthem and Cigna — have not indicated anything specific for Missouri. But Anthem clarified in late April that they would continue to participate in the exchanges where they currently participate, as long as the federal government commits to funding cost-sharing reductions going forward (the Trump Administration’s failure to commit to funding CSRs has caused considerable uncertainty in the insurance markets nationwide).

Anthem offers plans throughout most of Missouri — everywhere except 30 western counties that are currently served by Blue KC. But Cigna’s participation is limited to 10 counties in the St. Louis area and five counties in the Kansas City Area. In 25 counties in the western part of Missouri, no insurers are currently slated to offer exchange coverage in 2018.

...Blue KC currently offers individual market coverage — on and off-exchange — in 30 western Missouri counties. But they announced in May 2017 that they would exit the ACA-compliant individual market at the end of 2017, in both Missouri and Kansas, and that 67,000 enrollees would need to secure new 2018 coverage during open enrollment. Blue KC noted in their announcement that they have lost more than $100 million on their ACA-compliant individual market plans through 2016, calling the losses unsustainable. People who have grandmothered and grandfathered individual market plans (ie, purchased prior to October 2013) are not impacted by the exit.

Blue KC’s exit leaves 25 counties in western Missouri with no insurers slated to offer coverage in the exchange in 2018. The same thing nearly happened in Pinal County, Arizona in 2017, and in 16 counties in the Knoxville, Tennessee area for 2018, but in both cases an insurer stepped in to pick up the slack. It’s not known yet whether another insurer will start to offer coverage in those 25 counties in Missouri in 2018.

KANSAS: BCBS Kansas City out; Medica & BCBS Kansas Solutions still in:

There are three insurers offering plans in the Kansas exchange in 2017: Blue Cross Blue Shield of Kansas Solutions (in all but two counties), Blue Cross Blue Shield of Kansas City (Blue KC, in Johnson and Wyandotte counties), and Medica.

...Blue KC did not file plans by May 15, but didn’t indicate at that point that they would exit the exchange, instead requesting “flexibility” from the state insurance department, amid concerns about market stability. But on May 24, Blue KC announced that they will exit the ACA-compliant individual market at the end of 2017, and will no longer offer ACA-compliant plans on or off the exchange in Kansas or Missouri.

...But it will have a significant impact in Johnson and Wyandotte counties in Kansas, where Blue KC currently offers coverage. Between the two states, roughly 67,000 people will have to secure new coverage during open enrollment (November 1, 2017, through December 15, 2017). The only other option for 2018 coverage in the Kansas side of the Kansas City metro area will be Medica.

Medica filed plans for statewide availability in the Kansas exchange in 2018. Medica first joined the Kansas exchange in 2017, and has a 10,000 member enrollment cap. They have not said whether that enrollment cap will continue in 2018; that decision will be part of their rate filing process, which will happen in July. If the enrollment cap does remain in place in 2018, it will create a substantial enrollment block in the Kansas City area, as there are 32,000 ACA enrollees just in Johnson and Wyandotte counties alone in 2017.

Blue Cross Blue Shield of Kansas Solutions also filed plans to remain in all of their current counties (everywhere except Johnson and Wyandotte counties).

NEBRASKA: BCBSNE is out; Medica hasn't decided yet:

Health insurer Blue Cross Blue Shield announced Thursday that it would not be participating in the invidual market in Nebraska next year, and the remaining insurer hasn't decided if it will leave also.

...Insurers have blamed a variety of factors for their decisions, including uncertainty injected into the market by the Trump administration, as well as the failure to sign up enough young, healthy people in these plans to balance out risk pools.

...Medica is the other insurer offering plans on the exchange in Nebraska.

"Things are still changing daily," Geoff Bartsh, vice president for Medica's individual and family business, told the Omaha World-Herald. "We're still looking at changes and will continue to evaluate things. We are still planning to participate in the Nebraska market for 2018. We haven't made any final decisions on that yet."

Between Iowa (see early April), Nebraska and part of Kansas, Medica seems to be turning into the last man standing in several states...assuming they choose to keep standing.