Health Care

Insurer drops out of Kansas market as open enrollment begins on health exchange

Photo illustration
Photo illustration Courtesy of MetroCreative

Black Friday shopping is around the corner, but health care shopping already has arrived. Open enrollment season for individual plans starts Sunday and runs through Jan. 31. But people who want coverage by Jan. 1 need to sign up by Dec. 15.

People who don’t get health insurance through an employer can buy insurance using HealthCare.gov, the federal marketplace, called an exchange. HealthCare.gov was set up through the Affordable Care Act.

Previously, Kansans who bought individual insurance plans from the exchange primarily chose from two providers: BlueCross BlueShield and Coventry – or Aetna, its parent company.

A third company, UnitedHealthcare, will join the Kansas market for 2016. But Coventry decided at the last minute it would discontinue its individual insurance plans in Kansas.

That means 44,000 Kansans who use individual exchange plans from Coventry will need to shop around again during enrollment season to have coverage next year.

“Clearly, we wish this was not happening,” said Clark Shultz, director of government and public affairs for the Kansas Insurance Department. “But we are very grateful that UnitedHealthcare is coming in and that will help pick up some of the people that need to go elsewhere from Coventry.”

The Affordable Care Act requires most Americans to have insurance or pay a fine. But tax credits are available for many people to lower the price of insurance.

Kansas does not have its own health insurance marketplace, so Kansans must use the federal site or buy directly from an insurance company.

But people who buy insurance from HealthCare.gov can receive tax credits and subsidies to help pay premiums and out-of-pocket costs.

In Kansas, 83,000 uninsured residents are eligible for tax credits, according to data from the U.S. Department of Health and Human Services.

How to pick a plan

Kansans can shop and compare insurance plans on HealthCare.gov.

The site also allows people to compare out-of-pocket costs, which include deductibles, co-payments and co-insurance. It’s important to compare out-of-pocket costs along with premiums because plans can set out-of-pocket costs as high as $6,600 for individuals and $13,200 for families.

What’s different

Rohan Hutchings, communications director for Aetna, said Coventry sent out a letter Friday to the roughly 44,000 Kansans who need to find new plans next year. That’s nearly half of the 96,197 Kansans who received health insurance through HealthCare.gov, according to data from the U.S. Department of Health and Human Services.

He stressed that Coventry would still offer its insurance plans for employers, Medicare and individual plans not on the exchange.

But tax credits don’t apply to people who buy individual plans outside the exchange, such as the ones still offered by Coventry.

Hutchings said Coventry decided to leave Kansas after a companywide review of market conditions and competition.

He said the most recent review led to Coventry’s decision to discontinue its individual exchange plans in three markets: Kansas, Utah and Washington, D.C. Coventry joined the Kentucky market for 2016.

Sheldon Weisgrau, director of the Health Reform Resource Project for the Kansas Association for the Medically Underserved, said he fears Coventry’s dropped plans could lead to insured Kansans becoming uninsured.

That’s because those buyers would have been automatically re-enrolled for 2016 but will now have to find a new provider.

“I’m concerned that some of those people are going to drop through the cracks” he said.

Rates

As with any industry, more competition generally means lower prices for the consumer.

Ken Selzer, the Kansas insurance commissioner, previously had said the addition of UnitedHealthCare could help drive down premium rates for Kansans.

But Coventry’s last-minute decision to pull its individual marketplace plans means competition will probably remain the same for years.

Companies can’t change rates for 2016 individual plans because they’re already set by the insurance department. But it’s unclear what would happen with those rates going forward.

Insurance companies proposed steep insurance hikes nationwide for 2016 individual plans.

In Kansas, companies proposed increases as high as 39 percent. But the insurance department ultimately approved increases up to 25.4 percent. The average increase in Kansas was 16 percent.

But Weisgrau, of the Health Reform Resource Project, said the tax credits could absorb some of those increases, so the consumer wouldn’t have to pay the total difference

Reach Gabriella Dunn at 316-268-6400 or gdunn@wichitaeagle.com. Follow her on Twitter: @gabriella_dunn.

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