Wyoming health insurance marketplace guide 2023

Wyoming uses the federally run exchange, so residents enroll through Healthcare.gov.

Then-Gov. Matt Mead announced in late 2012 that Wyoming would default to the federal health insurance exchange for 2014, with the possibility of moving to a state-run exchange at some unspecified future date.

In 2012, the Wyoming legislature passed a bill requiring a small committee to study the federal government’s implementation and operation of the exchange. The committee was to monitor how many state residents use the federal exchange, what problems they encounter, operating costs, and other factors in deciding whether to recommend the state eventually take over operations of the exchange. The committee held its first meeting in April 2013, but Wyoming has never seriously considered the possibility of running its own exchange.

Gov. Mead initially refused to expand Medicaid, but began supporting expansion as time went on. In November 2014, Gov. Mead and the Health Department presented lawmakers with a modified Medicaid expansion proposal, and the governor asked them to approve it. Although a Senate committee approved a modified version of Mead’s proposal, the full Senate rejected it. Medicaid still has not been expanded in Wyoming as of 2023, despite the availability of additional federal funding under the American Rescue Plan.

In Wyoming, the open enrollment period for individual/family health coverage runs from November 1 through January 15.

Outside of the annual open enrollment window, you can only enroll or make changes to your coverage if you qualify for a special enrollment period. Most special enrollment periods require a qualifying life event, although some do not (such as the enrollment opportunity for Native Americans, or for people earning under 150% of the poverty level).

If you have questions about enrollment opportunities, you can read more in our guide to open enrollment and our guide to special enrollment periods.

Two insurance companies offer individual/family plans in Wyoming’s marketplace, and both have statewide coverage areas:

• Blue Cross Blue Shield of Wyoming
• Mountain Health CO-OP (Montana Health CO-OP)

BCBSWY had been the only carrier offering coverage in Wyoming’s exchange (and the entire individual market, including off-exchange) since 2016, after WINhealth stopped offering coverage at the end of 2015. But starting with the 2021 plan year, Mountain Health CO-OP joined Wyoming’s market, offering coverage statewide. The CO-OP already offered plans in neighboring Montana and Idaho, and expanded its coverage area to include Wyoming.

WINhealth announced in late 2015 that they would exit the individual market at the end of that year (at that point, they were still planning to continue to offer group plans. The decision to exit the individual market was triggered by the shortfall in risk corridors payments. WINhealth found out on October 1, 2015 that they would not receive $4.4 million they were due under the risk corridors program (nationwide, insurers were shorted about $2.5 billion in risk corridors payments that year, and a total of about $12.5 billion over the three years the program was operational; the Supreme Court ruled in 2020 that the federal government must pay the money to insurers).

But Wyoming’s then-Insurance Commissioner Tom Glause noted that WINhealth’s decision “did not come as a surprise to the Department [of Insurance],” as they were already aware of the financial challenges WINhealth had been facing prior to the risk corridors shortfall.

And on October 21, 2015 the other shoe dropped when WINhealth was placed in receivership by the Wyoming Department of Insurance. They ceased sales of new plans at that point, and in January 2016, a Laramie County District judge signed an order to liquidate the company.

In the ensuing years, the Wyoming Department of Insurance had discussions with several out-of-state carriers about the possibility of them entering the Wyoming market at some point. In the spring of 2016, Melody Health Insurance Canopy Health Insurance had announced its plan to offer health insurance in the Wyoming and Nevada exchanges – limited to the Cheyenne and Las Vegas metro areas – for 2017. But the Wyoming Insurance Department confirmed in August 2016 that Canopy had been unable to get licensed in Nevada, which was the first step towards getting their Wyoming license.

As a result, they were not able to get licensed in Wyoming, and have never offered coverage in the Wyoming exchange. Blue Cross Blue Shield of Wyoming continued to be the only insurer offering plans in the Wyoming exchange from 2016 through 2020, although Mountain Health CO-OP has brought competition to the state’s market once again.

As described below, full-price premiums in Wyoming decreased fairly significantly for 2021 and decreased again for 2022. But they were still among the highest in the nation in 2022, and the average percentage rate increase in Wyoming for 2023 was significantly larger than the national average, putting Wyoming’s full-price premiums lower than only West Virginia’s.

But very few people pay full price for their coverage: 96% of Wyoming exchange enrollees were receiving premium subsidies as of 2022. And because full-price premiums are high in Wyoming, premium subsidies are also very large.

That’s especially true now that the American Rescue Plan has enhanced premium subsidies (and the Inflation Reduction Act extended that through 2025).

In the early years of ACA implementation, Alaska had the most expensive premiums, at least in terms of the cost of the second-lowest-cost silver plan in each area. But Alaska has since implemented a reinsurance program that has reduced premiums significantly. As a result, the average pre-subsidy premium in Alaska’s exchange was projected to be $888/month in 2023 — still higher than most states, but quite a bit lower than Wyoming’s $1,015/month projected average premium.

As described below, the Wyoming House passed a reinsurance bill in 2019 in an effort to reduce premiums for people who don’t get premium subsidies, but it died in the Senate.

Note that reinsurance is generally not an ideal approach as long as the American Rescue Plan’s subsidy provisions remain in place and the “subsidy cliff” continues to be eliminated. That will be the case through at least 2025.

But since full-price premiums in Wyoming are so much higher than the national average, the “subsidy cliff” was particularly problematic in the state prior to the American Rescue Plan. It left some people with household income a little above 400% of the poverty level with no realistic coverage options. But through at least 2025, people with income above 400% of the poverty level can qualify for premium subsidies if the benchmark plan would otherwise cost more than 8.5% of their household income.

For 2023, according to the federal rate review page (ratereview.healthcare.gov), Wyoming’s marketplace insurers implemented the following average rate changes:

• Blue Cross Blue Shield of Wyoming: 19.35% increase
• Mountain Health CO-OP/Montana Health CO-OP: 4.78% increase

BCBSWY appears to have most of the state’s market share, so the overall average rate increase was likely at least 18%.

When we talk about overall average rate changes, however, we have to keep in mind that they only reflect how full-price premiums change from one year to the next. They don’t account for subsidies or for the fact that a person’s rates will increase each year based on their age, even if their insurer doesn’t change its average premiums at all.

Most enrollees in Wyoming’s exchange receive premium subsidies, which offset the majority of the cost of their coverage. The subsidies increased for 2023, offsetting at least some of the rate increase for most enrollees. 

Here’s a look at how premiums have changed in previous years in Wyoming’s exchange since plans became available in 2014:

• 2015: Average increase of 5%. In 2015, when plans were still available from both BCBSWY and WINhealth, a Commonwealth Fund analysis found that rates in Wyoming’s exchange were an average of 5% higher in 2015 (compared with 2014) for a 40-year-old non-smoker. The NY Times Upshot pegged the increase in benchmark plan premiums in Wyoming at 7% or more, although the Kaiser Family Foundation showed the average benchmark plan rate in Wyoming increasing by just 1.6% for 2015.
• 2016: Average increase of 6%. By 2016, Blue Cross Blue Shield of Wyoming was the only insurer in the state’s individual market. They increased their average rates by about 6% that year. WINhealth had proposed a rate increase of 13.37%, but they shut down at the end of 2015. Time insurance also offered plans outside the exchange in Wyoming in 2015, but they announced in June 2015 that they would exit the individual market nationwide, and would not participate in the 2016 open enrollment period.
• 2017: Average increase of 8%. The average rate increase for Blue Cross Blue Shield of Wyoming’s individual market plans was fairly modest for 2017, especially compared with the national average that year, which was about 25%. BCBSWY’s average rate increase for exchange plans was 8.18% for BlueSelect plans without pediatric dental and 7.85% for BlueSelect plans with pediatric dental.
• 2018: Average increase of 48% for on-exchange plans. 2018 was the first year that insurers had to account for the fact that the federal government was no longer reimbursing them for the cost of cost sharing reductions (CSR, sometimes called cost-sharing subsidies). BCBSWY added the cost of CSR to silver on-exchange plans, and created slightly different off-exchange silver plans that didn’t include the cost of CSR in their premiums. So Blue Cross Blue Shield of Wyoming had separate average rate increases for their off-exchange and on-exchange plans in 2018. Off-exchange, the average rate increase was 39%, with a range of 27.5% to 45.7%. But on-exchange, the average premium increase for 2018 was 48.2%, with a range of 25.9% to 83.6%. BCBSWY’s rate filing noted that “the premium rates for silver plans sold through the FFM would have been significantly lower if CSR funding were appropriated by the Federal government.” Average pre-subsidy premiums in the Wyoming exchange were the second-highest in the country in 2018, at an average of $973/month, according to CMS data. Only Iowa, with an average of $988/month, had higher average pre-subsidy rates. Although the overall rate increase was severe, the addition of CSR costs to silver plan rates and the resulting increase in premium subsidies means that people who get premium subsidies and buy bronze or gold plans gained access to more affordable coverage starting in 2018 (the subsidies are so large that bronze and even gold plans are sometimes free after the subsidy).
• 2019: Average decrease of 0.27% for on-exchange plans. The cost of cost-sharing reductions (CSR) was once again being added to silver on-exchange rates for 2019 in Wyoming, and BCBSWY’s rate filing again indicated that “the premium rates for silver plans sold through the FFM would have been significantly lower if CSR funding were appropriated by the federal government.”For on-exchange plans, the average premiums for BCBSWY plans was 0.27% lower in 2019. And for off-exchange plans, the average decrease was 0.12%. For 2019, Wyoming had the highest average pre-subsidy premiums, at $960/month.
• 2020: Average increase of 1.6%. For 2020 coverage, Blue Cross Blue Shield of Wyoming filed an overall average rate increase of 1.6% for their ACA-compliant individual market plans, which were implemented as-filed. Average pre-subsidy premiums in Wyoming were the second-highest in the country in 2020, at $956/month (West Virginia’s were higher, at $984/month). But subsidies continue to be much larger than they were prior to 2018, with free or very low-cost plans available to enrollees with modest incomes. For people who don’t qualify for subsidies, however, coverage can be unaffordable (for those whose income is just a little above the subsidy-eligibility cutoff, it’s useful to understand how pre-tax contributions to retirement accounts and/or a health savings account might bring total household income into the subsidy-eligible range).
• 2021: Average rate decrease of 10%. For 2021 coverage, Mountain Health CO-OP joined the exchange in Wyoming, offering coverage statewide, bringing added plan choice and competition to the state’s insurance market. And Blue Cross Blue Shield of Wyoming implemented an average rate decrease of about 10% for 2021. This made coverage more affordable for Wyoming residents who don’t receive premium subsidies, although it also reduced the size of the average subsidies that most Wyoming exchange enrollees receive. Subsidies fluctuate based on the cost of the benchmark plan; if it becomes less expensive, the subsidies decrease as well. The average benchmark premium also decreased by 10% in Wyoming for 2021. (Note that the American Rescue Plan subsequently increased the size of premium subsidies; it was enacted in March 2021, but the extra subsidies were retroactive to January 2021 for people who had been enrolled in an exchange plan since the beginning of the year).
• 2022: Small average rate decrease: According to the federal rate review page (ratereview.healthcare.gov), both of Wyoming’s marketplace insurers decreased their average premiums:
  • Blue Cross Blue Shield of Wyoming: Average decrease of 2.22%
  • Mountain Health CO-OP/Montana Health CO-OP: Average decrease of 5.98%

   

A record-high 38,565 people enrolled in coverage through Wyoming’s exchange during the open enrollment period for 2023 coverage. That was the third year in a row with a new record-high enrollment level. 

Here’s a look at how many people enrolled in private plans through Wyoming’s exchange during open enrollment for each year since coverage became available in 2014:

• 2014: 11,970 people enrolled. This was the fourth lowest in the country, but Wyoming has the smallest population in the US.
• 2015: 21,092 people enrolled.
• 2016: 23,770 people enrolled. All former WINhealth enrollees had to switch to Blue Cross Blue Shield of Wyoming for 2016, as Winhealth stopped offering coverage at the end of 2015. Enrollment grew from 2015 to 2016 in all but one county in Wyoming. Only Fremont county experienced an enrollment decline, with a 267-person drop in enrollment. Wyoming consumer advocates believed that was likely due to the federal government ruling that the Northern Arapahoe Tribe is a large employer and is thus required to offer health insurance to its full-time employees. As a result, some of the tribe’s employees may have switched from exchange plans to group coverage offered by the tribe.
• 2017: 24,826 people enrolled. In the majority of the states that use HealthCare.gov, enrollment peaked in 2016 and declined a little more each year. But in Wyoming, enrollment grew again for 2017, just as it had in each of the previous years.
• 2018: 24,529 people enrolled — the first time that Wyoming’s exchange experienced a decline in enrollment. Across all states that use HealthCare.gov, average enrollment was about 5% lower in 2018, so Wyoming’s 1% enrollment decline was much less significant than other states experienced. 
• 2019: 24,852 people enrolled. This was a new record high for Wyoming. That came despite the elimination of the ACA’s mandate penalty at the end of 2018 and the Trump administration’s decision to reduce funding for HealthCare.gov’s marketing and enrollment assistance, and to expand access to non-ACA-compliant plans.
• 2020: 24,574 people enrolled.
• 2021: 26,728 people enrolled. This was a new record high.
• 2022: 34,762 people enrolled. Another new record high.
• 2023: 38,565 people enrolled. Yet another new record high.