Anthem’s Withdraw from the Individual Market

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Anthem’s Withdraw from the Individual Market

At Stolly Insurance we have the privilege of providing health insurance from some of the best companies in the state, this includes Anthem Blue Cross / Blue Shield. Anthem has recently announced that they will be withdrawing from the Individual Insurance Market which includes some of our customers here at Stolly Insurance Group. We have gathered the information given to us by both Anthem and the Ohio Department of Insurance to make sure that we are keeping you all informed of these changes as well as helping you get the right coverage next year when individual policies are no longer effective. You can contact our Life and Health Department here at Stolly Insurance for any further questions you may have.

Below is Anthem’s Statement about the withdraw as well as some FAQ’s.

 

Anthem's Withdraw from the Individual Market

Anthem Statement

For more than seven decades, Anthem Blue Cross and Blue Shield has served consumers in the Ohio Individual market and throughout that time our commitment remained the same: to provide access to affordable, quality healthcare. And, since the inception of the exchanges, Anthem continued its commitment to serve consumers in all of the states where we provide fully insured individual health plans.

A stable insurance market is dependent on products that create value for consumers through the broad spreading of risk and a known set of conditions upon which rates can be developed.  Today, planning and pricing for ACA-compliant health plans has become increasingly difficult due to the shrinking individual market as well as continual changes in federal operations, rules and guidance.

We are pleased that some steps have been taken to address the long term challenges all health plans serving the individual market are facing, such as improving the eligibility requirements that allow consumers to purchase a plan outside of open enrollment and improved risk adjustment.  However, the Individual market remains volatile and the lack of certainty of funding for cost sharing reduction subsidies, the restoration of taxes on fully insured coverage and, an increasing lack of overall predictability simply does not provide a sustainable path forward to provide affordable plan choices for consumers.

As a result, Anthem has made the difficult decision to reduce its 2018 Individual plan offering in Ohio to one off-exchange medical plan in Pike County only. This decision does not impact individuals or families with grandfathered  or grandmothered plans. As the Individual marketplace continues to evolve, Anthem will continue to advocate solutions that will stabilize the market to allow us to return to a more robust presence in the future.

Why is Anthem withdrawing from the exchanges?

A stable insurance market is dependent on products that create value for consumers through the broad spreading of risk and a known set of conditions upon which rates can be developed. Planning and pricing for ACA-compliant health plans has become increasingly difficult due to the shrinking Individual market as well as continual changes in federal operations, rules and guidance. We are pleased that some steps have been taken to address the long term challenges all health plans serving the Individual market are facing. However, the Individual market remains volatile and the lack of certainty of funding for cost sharing reduction subsidies, the restoration of taxes on fully insured coverage and, an increasing lack of overall predictability simply does not provide a sustainable path forward to provide affordable plan choices for consumers.

If cost-share reduction (CSR) funding is restored, will Anthem considering refiling to participate?

Our commitment is to ensure we are able to provide consumers with access to affordable health plan choices. When any legislative or regulatory changes are made that impact our business, we carefully review them to determine how they will impact our members and operations. As the marketplace continues to evolve and adjust to changing regulatory requirements and marketplace conditions, we will reevaluate whether a more robust presence in the exchange is appropriate in the future.

In some states Anthem is the only health plan. What’s your message to your members who are left with no choices in their market?

Our commitment to members has always been to provider greater access to affordable, quality healthcare. And, since the inception of the exchanges Anthem maintained its commitment to serve consumers in all of the states where we provide fully insured Individual health plans. Even as other plans elected to withdraw from the exchanges, we remained in our markets and continued to work with local state and regulatory leaders to advocate solutions for long-term sustainability of the marketplace.

This was a difficult decision that was only made after thoughtful consideration and ongoing discussions with state and regulatory leaders. Unfortunately, the Individual market remains volatile and these conditions do not provide us with a sustainable path to provide affordable plan choices for consumers across the country.

We understand that as changes in our healthcare system are being discussed, many people are unsure about what this might mean for them and their families. Changes are necessary to accelerate the stabilization of Exchanges and provide consumers with coverage they want at a price they can afford. To that end, Anthem will continue to advocate solutions that will stabilize the market to allow us to expand coverage options in the future.

What Individual products will Anthem offer?

In Ohio, Anthem will offer a Catastrophic HMO plan, off-exchange in Pike County only.

Why only offer in Pike County? Why not just exit the market completely?

This allows us to maintain state eligibility requirements to renter the Individual market should it stabilize in the coming year. We hope to do so.

What about people on your so-called Grandmothered and Grandfathered plans?

Our members on these plans will not be impacted by this decision. These plans will continue to be available next year to members currently enrolled in those plans. As a reminder, Grandfathered plans must have been purchased prior to March 23, 2010. Grandmothered plans must have been purchased by December 2013.

Do members enrolled in your Individual health plans need to pick another plan right now?

It’s important to note this does not impact the benefits of members currently enrolled in our Individual health plans. They can use their health benefits without interruption until the end of the year. Members will receive a letter in the mail that will include a “formal notification” that that their current plans will end at the end of 2017. We will also provide some guidance on what to do during open enrollment.

How and when will members who are currently enrolled in an on-exchange plan be notified?

Members who currently have an on-exchange plan with Anthem will need to make a change if they want to have coverage beginning in January 2018. They will receive notice informing them of the changes and options that will be available to them in 2018. Members can use their health plan benefits without interruption until December 31, 2017.

What is Anthem doing to improve affordability of healthcare for its consumers?

Anthem is working to hold down the cost of insurance through innovative, value-based, partnerships with physicians, hospitals and other providers, and by providing members with tools that allow them to make informed decisions about their health and health care. Despite these concerted efforts, and helpful regulatory improvements in areas such as risk adjustment and special enrollment periods, the Individual market remains volatile, uncertain and simply does not provide a sustainable path forward to provide affordable plan choices for consumers. Anthem will continue to advocate solutions that will stabilize the market to allow us to expand coverage options in the future.

How will this change impact members who are enrolled in Anthem’s dental, vision or life benefits?

There is no change to these products. Anthem will continue to offer dental, vision and life products to Individual consumers. Members who have dental and/or vision benefits with us will get renewal details in the fall.

Will Anthem return to the exchange market?

As the marketplace continues to evolve and adjust to changing regulatory requirements and marketplace conditions, we will reevaluate whether a more robust presence in the exchange is appropriate in the future. Anthem will continue to advocate solutions that will stabilize the market to allow us to expand coverage options in the future.

If an Anthem member receives their benefits from their employer, do they need to do anything?

The changes to our Individual products only impact those individuals who purchase our health plans on their own. If a member receives their health insurance benefits from their employer, this does not impact their health benefits. Also, members on Anthem’s so-called Grandfathered and Grandmothered Individual plans are not impacted by this decision.

Will Anthem continue to offer dental, vision and life benefits to Individual consumers?

Yes, at this time Anthem intends to continue to offer dental, vision and life benefits to Individual consumers.

 

For more information on this you can visit the Ohio Department of Insurance’s fact sheet on their website.