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Arkansas has mostly embraced the ACA, expanding Medicaid via an 1115 waiver that allows the state to purchase private plans for Medicaid expansion enrollees (albeit with a controversial work requirement that took effect in 2018 but was later overturned by a judge).
The state operated a fully state-based small business exchange from 2016 through 2018. (No carriers opted to participate in 2019, so the state is no longer running a small business exchange.) And, as of 2017, the state has operated a state-based exchange for individuals using the HealthCare.gov enrollment platform.
Plans are available from four insurers in the Arkansas exchange. Three of them offer coverage statewide, giving residents in the state more insurer options than people in many other states. Oscar is new to the state’s exchange for 2022, with plans available in the central and northwestern parts of the states.
The following insurers offer plans in the Arkansas exchange for 2022 (note that some of the insurers offer plans through multiple affiliates):
One of those three insurers – QualChoice – offers plans under two separate entities: QC Life and Health (QualChoice Life) and QCA Health Plan (QualChoice). But as of 2020, Centene owns QualChoice. Centene also owns Ambetter, which is one of the other insurers that offers coverage in the Arkansas exchange.
And HMO Partners (Health Advantage), which was new to the marketplace as of 2021, is an affiliate of Arkansas Blue Cross and Blue Shield. So although there are technically plans available from US Able and HMO Partners, they’re both Arkansas Blue Cross and Blue Shield affiliates. And QualChoice plans are now also Ambetter plans. Essentially, there are plans available in the Arkansas exchange from just three entirely separate entities: Centene/Ambetter, Blue Cross Blue Shield of Arkansas, and Oscar.
In 2014 and 2015, plans were available in the Arkansas exchange from Arkansas Blue Cross Blue Shield, Celtic Insurance Company (Ambetter), and QualChoice/QCA Health Plan (both owned by QualChoice Holdings).
UnitedHealthcare of Arkansas joined the exchange for 2016, but their participation only lasted one year. The Arkansas Insurance Department confirmed that United would not participate in the Arkansas exchange in 2017. The carrier pulled out of the state’s individual market at the end of 2016, which was the case in most of the states where United offered exchange plans in 2016.
But United’s market share was small; Arkansas officials reported that only about 550 people in the Arkansas exchange had to switch to another carrier for 2017 due to United’s exit, and that included people with privately purchased exchange plans as well as people covered under the Medicaid expansion “private option” in Arkansas, in which the state uses Medicaid funds to buy private plans in the exchange for Medicaid expansion enrollees. Even prior to the launch of the ACA’s exchanges, UnitedHealthcare only had about 9 percent of the individual market share in Arkansas, trailing Arkansas Blue Cross Blue Shield’s 78 percent market share by a wide margin.
Since 2017, the other insurers have remained in the Arkansas exchange. Plans continue to be available from Arkansas BCBS, Ambetter/Centene, QualChoice Life and Health, and QCA Health Plan.
But as of 2020, both of the QualChoice entities are owned by Centene/Ambetter.
For 2021, Oscar applied to join the state’s individual market, and so did HMO Partners (Health Advantage; an affiliate of Arkansas Blue Cross and Blue Shield, which already offered group plans in the state). HMO Partners was approved to offer individual market plans and sells plans in the exchange as of 2021. Bue Oscar’s filing was not approved, so they did not offer plans for 2021.
However, Oscar’s filing was accepted in 2021, and the insurer is offering health plans for 2022 in Arkansas.
The open enrollment period for 2022 coverage ran from November 1, 2021 to January 15, 2022. Outside of open enrollment, a qualifying event is necessary to enroll or make changes to your coverage. If you have questions about open enrollment, you can read more in our comprehensive guide to open enrollment.
For the first three years of exchange implementation, Arkansas had a partnership exchange for individuals, but since 2017, they have had a state-based exchange using the federal enrollment platform (SBE-FP) at HealthCare.gov. The state ran its own exchange for small businesses from November 2015 until the end of 2018.
For individuals enrolling in coverage through the Arkansas exchange, the interface remained the same after the state transitioned to an SBE-FP, since they continued to use HealthCare.gov’s enrollment platform. But behind the scenes, My Arkansas Insurance (the state-based exchange) is playing a larger role now, and consumers can use that website to obtain information and assistance. The Arkansas exchange call center is operational Monday to Saturday, 8 a.m. to 4:30 p.m, Monday to Friday.
The exchange went through a transition in 2019, however, under the terms of S.B.113, which was enacted as Act 107 in February 2019 and called for the Arkansas Insurance Department to take over the operation of My Arkansas Insurance. Under the terms of the legislation, the board of directors that had been running the Arkansas exchange was abolished and all duties, responsibilities, financial obligations, and assets were taken over by the Arkansas Insurance Department. The exchange as a separate nonprofit entity was officially dissolved in March 2019, and its eight employees were given severance packages.
From a consumer perspective, however, nothing has changed. The exchange website is still active (it now says “My Arkansas Insurance, A Division of the Arkansas Insurance Department), as is the call center. But the behind-the-scenes work is now being done by the Arkansas Insurance Department instead of a separate entity called the Arkansas Health Insurance Marketplace.
The Arkansas Insurance Department published the proposed rate changes for 2022, in August 2021, and they amounted to a proposed an average rate increase of 6.5%. The approved rates ended up being a bit lower than proposed for some of the insurers, resulting in an overall average rate increase of about 4.4% for 2022. And Oscar is new to the marketplace for 2022.
The following average rate changes were approved for 2022:
QualChoice and QCA are now owned by Centene and marketed under the Ambetter brand. And Health Advantage, which joined the Arkansas marketplace as of 2021, is an affiliate of Arkansas Blue Cross and Blue Shield. So although there are six different insurers listed on the state’s individual market rate change overview, three of them are under the Ambetter umbrella, and two are under the Arkansas Blue Cross Blue Shield umbrella.
Whenever we talk about weighted average rate increases (about 4.4% in Arkansas for 2022), it’s important to keep several points in mind:
One additional point: The number of people with true private individual market health plans through the Arkansas exchange stood at 60,258 as of early 2021. Although the individual market filings for 2022 showed a market size of nearly 329,000 people (including on-exchange and off-exchange), the majority of those people are enrolled in expanded Medicaid in Arkansas, which uses Medicaid funds to purchase private health plans for enrollees.
As has been the case in many of the states that use HealthCare.gov, enrollment in the Arkansas exchange initially peaked in 2016 and declined each year through 2020. But it grew for 2021 and appears to have hit a record high for 2022. As of December 15, 2021, with another month remaining in open enrollment for 2022 coverage, 81,947 people had enrolled in plans through the Arkansas exchange.
Here’s a look at how enrollment in private plans in the Arkansas exchange has varied over the years:
Although Arkansas uses Medicaid funds to purchase private plans in the exchange for Medicaid expansion enrollees, those enrollments are not reflected in the numbers above. For perspective, more than 277,000 low-income Arkansas residents had coverage under Medicaid expansion as of June 2020, with Medicaid funds being used to purchase their plans in the exchange.
Through 2016, SBE-FPs used Healthcare.gov for free. But the fee increased 1.5 percent of premiums for 2017, to 2 percent of premiums in 2018, and to 3 percent in 2019. The fee in states that rely fully on the federally-run exchange is 3.5 percent, so states like Arkansas that otherwise run their own exchanges are only getting a small discount. As a result, Nevada and New Mexico (both of which have SBE-FPs) are planning to transition to their own enrollment platforms, and Oregon is also considering it.
Starting in December 2016, the Arkansas Health Insurance Marketplace began collecting 3 percent of premiums as its exchange fee, replacing the previous 3.5 percent fee that Healthcare.gov charged before the state-run exchange was up and running. In 2017, half of the new fee was remitted to Healthcare.gov for use of its enrollment platform, and the other half was used by the Arkansas exchange to cover their operations costs. The fee was essential to the exchange, as they could no longer use federal grant money to cover operational expenses after the end of 2016.
But there was significant controversy over the legality of the fee, and whether it could be implemented without the consent of the full legislature. Arkansas Online’s Andy Davis has a thorough account of the issues surrounding the exchange fee in articles dated September 7, September 8, and September 9, 2016.
Soon thereafter, the Arkansas Health Insurance Marketplace board of directors voted unanimously to increase the fee to 3.5 percent starting in 2018, but this was before HHS announced that the exchange user fee for SBM-FPs would be just 2 percent in 2018 (instead of the 3 percent that had been proposed). So the Arkansas exchange ended up keeping the 3 percent fee in place for 2018 as well.
But for 2019, the exchange has to pay 3 percent for the use of HealthCare.gov, making the previous fee insufficient, as it would have to be fully remitted to the federal government, leaving nothing left for the state to run its exchange operation. So the fee was increased to 4.25 percent of premiums for 2019. This allowed the exchange to keep 1.25 percent and remit the other 3 percent to HealthCare.gov. This is higher than the fee charged in states that simply rely fully on the federally-run exchange (3.5 percent), but Arkansas retains some flexibility and control by having a state-run exchange, and that would be lost if the state simply defaulted to the federally-run exchange.
Not surprisingly, however, the higher fee was controversial. Arkansas Insurance Commissioner, Allen Kerr, noted in 2018 that the Arkansas Insurance Department could take over the duties the exchange currently performs (while continuing to use HealthCare.gov as the enrollment platform) for under $600,000/year, as opposed to the $3.8 million that the exchange spent in the previous fiscal year. Kerr said that if the Insurance Department were to take over the duties of the exchange, the fee would drop back down to 3 percent as of 2020, which would be entirely remitted to HealthCare.gov by the insurers, and the cost to manage the exchange’s duties would come from the insurance department’s budget, which was currently not fully utilized.
But opponents of this proposed change note that consumers would have less assistance if the exchange board was to be dissolved and its employees let go. The exchange said that it was already reducing the amount that it spends, and had agreed to reduce the exchange user fee starting in 2020, although it still would have been above the level that’s collected in states that rely entirely on HealthCare.gov.
All of that ended up being a moot point, however, when the state enacted S.B.113 in February 2019 and moved the exchange under the umbrella of the Arkansas Insurance Department. Commissioner Kerr has noted that the exchange user fee will drop to 3 percent in 2020, as the Insurance Department will not need to collect a fee above and beyond the amount that must be remitted to HealthCare.gov.
For perspective, all of the state-run exchanges have carriers fees/assessments in order to generate funding needed to operate the exchange, but the fees vary considerably from one state to another (in all of the states that rely solely on HealthCare.gov, the fee is 3.5 percent), and the significant variations in enrollment volume make it hard to compare states on an apples-to-apples basis. Nevada also has a state-run exchange that uses HealthCare.gov, but their carrier assessment is only 3.15 percent for 2019 (and they have to pay the same 3 percent to HealthCare.gov that Arkansas has to pay). Average premiums in Nevada’s exchange are virtually identical to the average premiums in the Arkansas exchange ($507/month versus $509/month), but Nevada’s exchange has more enrollees — almost 78,000 versus 62,000 — which means they can generate more total revenue with the same percentage carrier fee.
The Arkansas legislature considered a bill to establish a state-run exchange during the 2011 session, but it did not pass. The Arkansas Insurance Department then shifted gears and received grant money in February 2012 to develop a partnership exchange.
The Arkansas Health Insurance Marketplace was established in 2013 by the Arkansas legislature, under Act 1500, to create a state-based exchange. But the process was then put on hold for a while.
In March 2015, lawmakers had passed Senate Bill 343, which required the state to wait to proceed with establishing a state-run exchange until after the King v. Burwell ruling was announced. That put the Arkansas Health Connector’s transition to a fully state-run model on hold, although lawmakers and the exchange board continued to work on the details of how the state-run exchange would work.
In June 2015, Arkansas was one of three states that got conditional approval from the Obama Administration to operate a state-run exchange (at that point the state had a partnership exchange, which is considered federally-run).
That same month, the Supreme Court issued a ruling in the King v. Burwell case, clarifying that subsidies are legal in the federally-run marketplace. That meant there was no longer a concern that subsidies could evaporate and insurance markets would destabilize in states that use Healthcare.gov. Although Arkansas had been working towards a state-based exchange for some time, and had obtained almost $100 million in federal funding to make the switch, the Court’s ruling removed some of the incentive to proceed with the transition, since subsidies were safe regardless of how the exchange is structured.
Following the Supreme Court’s decision, Arkansas Governor Asa Hutchinson asked the state to reconsider whether the move to a state-run exchange is still the best course of action: “I am convinced now more than ever that we need to proceed with caution to measure the costs to the taxpayers and the reliability of the outcome as we consider the potential of a state exchange.” In August 2015, he reiterated his concerns, saying: “Right now, we’re building a state-run exchange with a $99 million grant from the federal government, and I’m asking the question, why are we building the state exchange rather than relying on a continued partnership with the federal exchange?“
In September 2015, Hutchinson said that the state’s progress towards creating a state-run health insurance exchange for individual plans was “on pause at this point” and that he had communicated that information to HHS. Hutchinson went on to say that Healthcare.gov was working well, and that he wasn’t sure the state needed to push forward with plans for a state-run exchange, which involved additional risks and costs.
By June 2016, Hutchinson’s focus has turned to operating a state-based exchange but using the federal enrollment platform at Healthcare.gov, and that took effect in November 2016. Individuals can get assistance and information at My Arkansas Insurance, and are then directed to HealthCare.gov to enroll.
Arkansas Health Connector
My Arkansas Insurance
Website for Arkansas’ state-based health insurance exchange (run by the AR Insurance Department; enrollments are conducted via HealthCare.gov)
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
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