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A TRUSTED INDEPENDENT HEALTH INSURANCE GUIDE SINCE 1994.
Louise Norris | March 24, 2023
Wyoming uses the federally run health insurance exchange/marketplace (HealthCare.gov) and two insurers offer plans in the marketplace for 2023, both statewide.
Average premiums in Wyoming are significantly higher than the national average, but that means subsidies are also significantly larger in order to make the after-subsidy premiums affordable.
During open enrollment for 2023 coverage, 38,565 residents enrolled in private individual-market plans through the Wyoming exchange — by far a record high.
Wyoming still has not expanded Medicaid under the ACA, and Medicaid expansion legislation failed for the ninth time during the 2023 session.
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:
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:
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:
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:
Following in the footsteps of several other states — including Alaska, which shares many insurance dynamics with Wyoming — the Wyoming Department of Insurance worked in 2018 on a 1332 waiver proposal to seek federal funding for a reinsurance program. The proposal needed state legislative support before it could be submitted to the federal government, and although the Wyoming House passed a reinsurance bill (HB 85) with nearly unanimous support in early 2019, the measure died in the Senate.
Lawmakers in the Senate were concerned about the 1% assessment that the measure would have imposed on health and disability insurers in the state. That assessment was expected to raise about $9 million per year in state funding, but that would have been dwarfed by the federal “pass-through” funding that the state would have received under the terms of the 1332 waiver they would have proposed if the legislation had been enacted.
Reinsurance works by covering a portion of high-cost claims (the details vary across the states that have set up reinsurance programs, but they generally either reimburse insurers if they have patients with certain high-cost conditions, or reimburse a portion of claims that exceed a certain dollar amount; Wyoming’s legislation would have left the details up to the state insurance commissioner).
That results in lower premiums, because the insurers know that some of their risk is being absorbed by the reinsurance program. When premiums are lower, premium subsidies (funded by the federal government) are also lower, since they don’t have to offset such high premiums (for example, if the after-subsidy price needs to be $100, the subsidy amount will be lower if the pre-subsidy amount is $500, versus if it’s $350).
By using a 1332 waiver, the state gets to keep the federal savings, rather than having the federal government keep the money. The state would then use the money to fund the reinsurance program, in addition to the $9 million that the state would have raised via the assessment on insurers. In Wyoming, the estimate was that the federal pass-through funding would have amounted to $60 million per year, so federal funds would have covered nearly 87% of the cost of the reinsurance program.
If the state had enacted HB 85 and moved forward with a 1332 waiver for reinsurance, it would have benefitted roughly 3,500 people who were paying full price for individual/family ACA-compliant plans in Wyoming (both on-exchange and off-exchange). These individuals didn’t qualify for premium subsidies at that point.
In most cases, that was because their incomes exceed 400% of the poverty level (note that this is no longer an obstacle to receiving subsidies, thanks to the American Rescue Plan and Inflation Reduction Act). They could also have been affected by the family glitch (which has also been fixed, as of 2023), or purchasing coverage outside the exchange for some reason, where subsidies weren’t available.
But the vast majority of Wyoming exchange enrollees do qualify for subsidies, and that’s especially true under the American Rescue Plan’s provisions. As of early 2022, 96% of Wyoming exchange enrollees qualified for premium subsidies. These enrollees would not be helped by a reinsurance program, and could end up actually paying more for their coverage if subsidy amounts declined by more than the decline in their own plan’s rates.
For those who didn’t qualify for any subsidies and were thus responsible for paying 100% of their premiums, the projection was that a reinsurance program would have lowered their premiums by about 17%. But until if and when the “subsidy cliff” returns (2026 at the earliest), a reinsurance program would likely do more harm than good, as it would reduce the subsidy amounts that virtually all Wyoming exchange enrollees receive.
In early 2016, then-Governor Matt Mead signed SF49 into law, exempting direct primary care programs from Wyoming Department of Insurance regulations and oversight. That makes it easier for doctors to establish direct primary care practices, charging members a set monthly fee in return for whatever primary care the patient might need.
Particularly in states like Wyoming, where unsubsidized health insurance is much more expensive than average, and where the “subsidy cliff” is much more of an issue than it would be in places with lower premiums, direct primary care models can be an attractive alternative to higher-priced major medical health insurance. And like healthcare sharing ministries, direct primary care practices pose a potential threat to the stability and health of the regular insurance risk pool, since sicker applicants are more likely to gravitate to higher-priced – but much more comprehensive – ACA-compliant health insurance.
With that said, it’s important to note that direct primary care memberships only cover primary care. If a member needs care that involves hospitalization or treatment that cannot be provided in a primary care setting, the primary care membership will not provide any value.
HealthCare.gov
800-318-2596
Wyoming Insurance Department
Provides consumer protection and support to Wyoming residents by investigating consumer complaints and resolving issues on insurance matters.
(307) 777-7401 / Toll Free: 1-800-438-5768 / [email protected]
State Exchange Profile: Wyoming
The Henry J. Kaiser Family Foundation overview of Wyoming’s progress toward creating a state health insurance exchange.
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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