Wellmark joining exchange in 2017
Wellmark Blue Cross and Blue Shield, the largest carrier in Iowa’s individual market, did not participate in the exchange in Iowa in 2014 or 2015, and will not offer exchange plans for 2016 either. But the carrier has committed to joining the Iowa exchange when the 2017 open enrollment begins next fall, which should give a tremendous boost to exchange enrollment in the state.
Iowa is one of the states that is allowing grandmothered (transitional) health plans to remain in force until October 2016, and a significant number of Wellmark’s pre-2014 enrollees have opted to keep their non-ACA-compliant plans. Those plans are coming to an end next fall, but Wellmark’s expansion onto the exchange means that enrollees who qualify for premium subsidies and cost-sharing subsidies will be able to get them and also keep the name-brand carrier they already know (Wellmark has been selling ACA-compliant health plans outside the exchange for the last two years, but subsidies are only available on plans obtained through the exchange).
Wellmark has 137,000 individual market members in Iowa, but the majority of them have non-ACA-compliant health plans. Healthcare.gov’s rate review tool indicates that about 33,000 members (3,046 plus 29,975) have ACA-compliant plans, although the Iowa Insurance Division’s August notice regarding Wellmark’s rate increase states that there are roughly 23,000 members on ACA-compliant plans.
Looking ahead to 2016
The Iowa Insurance Division announced in May that five carriers had submitted proposals to sell individual coverage in the exchange for 2016 – up from one that currently offers plans.
Early in the 2015 open enrollment period, Coventry and CoOpportunity Health both offered plans in the Iowa exchange. But CoOportunity stopped offering policies in late December 2014. CoOportunity was a CO-OP health insurer formed with funding through the Affordable Care Act. CoOpportunity got into financial difficulty after higher than expected enrollment and claim costs in 2014, and was subsequently liquidated, leaving Coventry as the only marketplace insurer available in Iowa.
But that’s about to change.
In 2016, Coventry and Medica will offer plans state-wide, while the rest of the carriers will have plans in select areas. United Healthcare of the Midlands, Avera, and Gunderson will all offer plans in various areas of the state, and two additional carriers will offer small group plans through the exchange.
For the three carriers that offered individual health insurance in 2015, the approved average rate changes for 2016 are:
- Wellmark = 17.6 to 28.7 percent increases, across ACA-compliant, transitional, and grandfathered plans. (137,000 members, OFF-EXCHANGE ONLY; rate hike for ACA-compliant off-exchange plans is 24.5 percent)
- Coventry = 19.8 percent increase (47,000 members)
- Gunderson = 9.4 percent (60 members, all off-exchange in 2015, but on-exchange plans will be available in 2016)
At ACAsignups, Charles Gaba put the weighted average rate increase market-wide at a little over 22 percent. But for people who currently have a plan through the exchange, it’s 19.8 percent, since those plans are all through Coventry.
With the addition of new carriers and plans in the Iowa exchange, it will be extremely important for current enrollees to shop around during open enrollment (November 1 to January 31) for 2016 plans. If a new carrier takes over the benchmark plan spot (second lowest-cost silver plan), subsidies won’t necessarily keep pace with the rate increases on the Coventry plans.
More than 45,000 Iowans singed up for qualified health plans during the second open enrollment period. While an improvement over 2014, the 2015 total is just 20 percent of the estimated 225,000 Iowans who are eligible to sign up on HealthCare.gov. Nationally, about 40 percent of those eligible actually enrolled during the 2015 open enrollment period.
And as expected, not everyone who enrolled has kept their coverage. Some people never paid their initial premium, and others cancelled their coverage early in the year for one reason or another. By the end of June+, there were 39,347 people with in-force coverage through the Iowa exchange.
Iowa expanded Medicaid under the ACA, but with a waiver that called for using Medicaid funds to purchase private health plans for eligible residents. But in June 2015, the state announced that they were abandoning their alternative “private option” for Medicaid expansion, and switching Medicaid enrollees to regular Medicaid managed care plans instead.
Iowa’s uninsured rate decreased 1.4 points, from 9.7 percent in 2013 to 8.3 percent in 2014 according to the Gallup-Healthways Well-being Index. By the first half of 2015, the same survey put the uninsured rate in Iowa at just 5 percent. Iowa’s Medicaid/CHIP enrollment grew by 21 percent – about 104,000 people – from 2013 to June 2015, which is no doubt a significant factor in the reduction in the uninsured rate.
2015 premiums up 11 percent on average
A study by The Commonwealth Fund found that 2015 marketplace premiums in Iowa increased by 11 percent on average compared to 2014. The Commonwealth Fund’s study was weighted for differences in premiums between urban/suburban/ rural areas and insurer participation.
2014 enrollment metrics
In total, 29,163 people enrolled in qualified health plans (QHPs) during the 2014 open enrollment, and an additional 36,891 people qualified for Medicaid or the Children’s Health Insurance Program (CHIP).
Just 11.1 percent of Iowa residents eligible to enroll through the marketplace did so in 2014. Iowa tied with neighboring South Dakota for the lowest percentage of eligible enrollees signing up. A Kaiser Health News article attributed the low enrollment in both states to Wellmark Blue Cross & Blue Shield’s decision against participating in the states’ marketplaces rather than a boycott of the Affordable Care Act. In addition, the fact that transitional (pre-2014) plans were allowed to renew meant that overall enrollment in ACA-compliant plans was lower than expected.
A U.S. Department of Health and Human Services report showed the 2014 average, post-subsidy premium for Iowa consumers was $108 per month. The national average in states using HealthCare.gov $82 per month after subsidies. In 2015, the average after-subsidy premium in Iowa increased to $117 per month, and the national average increased to $105 per month (in the 37 states that used Healthcare.gov in 2015).
Twenty-six percent of Iowa residents selected a bronze plan (20 percent nationally), 57 percent selected a silver plan (65 percent nationally), 12 percent selected a gold plan (9 percent nationally), 4 percent selected a platinum plan (5 percent nationally) and 2 percent selected a catastrophic plan (2 percent nationally). Twenty-six percent of Iowa enrollees were between the ages of 18 and 34.
Iowa’s approach to the marketplace
Iowa operates a partnership exchange with the federal government. Iowa residents use the federal marketplace, HealthCare.gov, to compare and purchase coverage. The state is responsible for plan management, consumer assistance, and Medicaid eligibility determination. Iowa’s plan management functions include selecting and monitoring the qualified health plans (QHP) that offer policies on the exchange. Iowa’s role in consumer assistance is education and outreach, coordinating the in-person consumer assisters, and overseeing the Navigator program. The federal government manages the exchange website and call center, and funds the Navigator program.
Iowa is occasionally mentioned as a state that may transition to a different model for its exchange. In February 2014, Gov. Branstad floated the idea of a regional exchange in conjunction with South Dakota, Nebraska and Kansas. Bills to convert to a state-run exchange were introduced in Senate committees in both 2013 and 2014, but neither advanced.
Iowa health insurance exchange links
State Exchange Profile: Iowa
The Henry J. Kaiser Family Foundation overview of Iowa’s progress toward creating a state health insurance exchange.
Consumer Advocate Bureau
Provides consumers with assistance in navigating the health care system, assistance programs, and other issues related to health insurance benefits.
1-877-955-1212 / email@example.com