Pittsburgh-based health insurer pulled out of Crawford County for 2017 due to marketplace losses.
Highmark Inc. is returning to Crawford County, maybe.
The Pittsburgh-based health insurer said it plans to offer individual health insurance plans to Crawford County residents this fall through the Affordable Care Act’s Health Insurance Marketplace. Highmark pulled individual marketplace plans from 27 Pennsylvania counties, including Crawford County, for 2017 after suffering more than $800 million in losses on marketplace plans since 2014.
But Highmark’s decision is contingent on the federal government continuing to provide tax subsides to people who qualify and continuing to require everyone to have health insurance. Insurers have until late September to finish their plans.
“We will make our full participation decisions then — understanding that stability of the market will be critical, including the government’s commitment to (cost share reduction) and the individual mandate, actions by other insurers and transition to new health-care laws and regulations,” Highmark spokesman Aaron Billger said in an email.
If Highmark and UPMC Health Plan stand by their initial decisions filed with the Pennsylvania Insurance Department, they will offer a total of 28 individual health plans in Erie County and 16 in Crawford County in 2018, compared to 27 and nine respectively, in 2017.
Many of those plans will cost more in 2018, however.
Highmark is asking for an average rate increase of almost 20 percent, while UPMC Health plan is requesting an average hike of nearly 8 percent.
Highmark’s proposed monthly premiums for a 40-year-old nonsmoker from Erie County range from $250.74 to $711.32, while UPMC Health Plan’s range from $201.62 to $709.07, with the more expensive plans offering increased coverage, and lower annual deductibles and co-payments.
Statewide, insurers are seeking an average increase of 8.8 percent.
The insurers’ requests must be approved by the insurance department before they take effect. The department usually announces its decision in mid-October and plans are made available on the marketplace’s website, www.healthcare.gov., by Nov. 1.
“We are starting to see some stability in rates,” said Jim Stults, UPMC Health Plan’s senior director of small market sales and account management. “It’s much more stable than last year and we are committed to working with the Pennsylvania Insurance Department.”
UPMC will also unveil a new network in its marketplace plans. Its Partner Network will offer lower premiums but only include UPMC-owned hospitals and providers, such as UPMC Hamot and UPMC Northwest. Its Premium Network will include all hospitals and providers who contract with UPMC Health Plan.
Enrollment in marketplace plans has remained fairly stable in both counties over the past three years.
Erie County’s enrollment has gone from 7,098 in 2015, to 6,377 in 2016, to 6,536 this year. Crawford County’s enrollment had followed a similar trend during that span, from 2,104 to 1,888 to 2,143.
But future enrollment depends on the federal government stabilizing the marketplace, said Teresa Miller, Pennsylvania’s insurance commissioner.
“For months, I have asked Congress and the Trump Administration to help stabilize the individual market rather than trying to undermine the entire law, which will only hurt the real Pennsylvanians who benefit from the law,” Miller said in a prepared statement.
Date:Aug 13, 2017