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Blue Cross plans to continue offering ACA plans in NC

Posted May 31

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— Blue Cross Blue Shield of North Carolina plans to continue offering coverage through the federal HealthCare.gov marketplace across the state in 2017, officials said Tuesday.

The state's largest health insurer – and the only company to offer Affordable Care Act plans in all 100 counties – had considered pulling out of the federal marketplace because of heavy losses the past two years.

"Since the ACA’s first enrollment period, we’ve continued to see a large number of older and less healthy customers enroll in our individual ACA plans as compared to our other customer groups," Brian Tajlili, Blue Cross' director of actuarial and pricing services, said in a statement.

The company lost $282 million last year on plans purchased through HealthCare.gov, more than double the $123 million it lost in 2014.

Tajlili said Blue Cross paid out $1.29 billion in claims for the sickest 5 percent of ACA customers’ medical care in 2015, which was more than 70 percent of the company's total ACA revenue for 2015. He said ACA customers use the emergency room more frequently than others, undergo more orthopedic procedures and take costlier prescription drugs – Blue Cross spent more than $139 million for seven brand-name drugs for ACA customers last year.

To help offset those costs, Blue Cross has requested an average 18.8 percent rate increase on ACA plans for 2017. The state Department of Insurance will review those requests and set final rates this summer. Company officials said they will make a final decision then on whether to continue offering ACA coverage in some counties.

The DOI approved an average 32.5 percent rate increase for Blue Cross last year for 2016 plans.

The company already is scaling back its planned offerings statewide to cut costs, dropping the top-of-the-line "platinum" health plans in 2017. Those plans accounted for only 3 percent of its ACA customers. The lower-level "silver" plans account for 76 percent of its ACA coverage.

Blue Cross has filed with DOI to have 24 plans on HealthCare.gov in 2017.

More than 610,000 North Carolinians have health coverage through the HealthCare.gov exchange, making the state the fourth-largest nationally in ACA enrollment. More than half of them have plans through Blue Cross.

Aetna, the parent of Coventry Health Care of the Carolinas, which provides ACA plans in a couple dozen North Carolina counties, has requested an average rate increase of 24.5 percent for its plans in 2017.

9 Comments

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  • Richard Bunce Jun 1, 9:57 a.m.
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    "Blue Cross has requested an average 18.8 percent rate increase on ACA plans for 2017. The state Department of Insurance will review those requests and set final rates this summer. Company officials said they will make a final decision then on whether to continue offering ACA coverage in some counties."

    Bury the lead... looks like a warning shot to the DoI... don't reduce the rate request or we bail on some Counties where we lose money and where we may be the only insurer.

  • Fanny Chmelar May 31, 5:27 p.m.
    user avatar

    Snapple Fact #734

    "Potatoes have more chromosomes than humans."

  • Roger Way May 31, 2:43 p.m.
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    Promise #1: “If you like your health care plan, you’ll be able to keep your health care plan, period.” Remarks by the President at the Annual Conference of the American Medical Association,” June 15, 2009

    Promise #2: “[T]hat means that no matter how we reform health care, we will keep this promise to the American people: If you like your doctor, you will be able to keep your doctor, period.” Remarks by the President at the Annual Conference of the American Medical Association.

    Promise #3: “In an Obama administration, we’ll lower premiums by up to $2,500 for a typical family per year.” Remarks of Senator Barack Obama: Health Care Town Hall,” June 5, 2008

  • Roger Way May 31, 2:42 p.m.
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    Promise #4: “[F]or the 85 and 90 percent of Americans who already have health insurance, this thing’s already happened. And their only impact is that their insurance is stronger, better and more secure than it was before. Full stop. That’s it. They don’t have to worry about anything else.” News Conference by the President, April 30, 2013

    Promise #5: “Under my plan, no family making less than $250,000 a year will see any form of tax increase.” Remarks in Dover, New Hampshire,” September 12, 2008

    Promise #6: “I will not sign a plan that adds one dime to our deficits—either now or in the future.” Remarks by the President to a joint session of Congress on health care.

  • Roger Way May 31, 2:42 p.m.
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    Promise #7: “[W]hatever ideas exist in terms of bending the cost curve and starting to reduce costs for families, businesses, and government, those elements are in this bill.” Remarks by the President After Meeting with Senate Democrats,” December 15, 2009

    Promise #8: “I will protect Medicare.” Remarks by the President to a Joint Session of Congress on Health Care.

    Promise #9: “I will sign a universal health care bill into law by the end of my first term as president that will cover every American.” Barack Obama Campaign Promise No. 521: Cut the Cost of a Typical Family’s Health Insurance Premium by up to $2,500 a Year,” updated December 1, 2009

    Promise #10: “So this law means more choice, more competition, lower costs for millions of Americans.” Remarks by the President on the Affordable Care Act and the Government Shutdown,” October 1, 2013

  • Michael Bawden May 31, 2:26 p.m.
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    Bought a BCBSNC plan for member of family two years ago for 260.00 a month.
    After two years, no changes to coverage, it is now 430.00.
    This is not an ACA policy. 70% increase and BCBSNC is STILL losing money.
    These are FACTS not FEELINGS.

    The other option is to have that person pay the fine and not be covered. They could not pay the large deductible, so why even have a policy.

  • Norman Lewis May 31, 2:23 p.m.
    user avatar

    They were told to continue ACA plans by the Federal government. The end game for Obamacare is mandatory Nationwide enrollment in one of their plans. No other way the Affordable Care Act can remain solvent. Interesting that Congress and the President are immune from ACA requirements and have their own plan (paid completely for by taxpayers) that has coverage levels unimagined by the people paying the bills.

  • Roger Chance May 31, 1:50 p.m.
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    Who is surprised by the increase in the cost of "Affordable care". Gonna' provide coverage for everyone, then fine you if you can't afford it. Why has the executive branch been so quiet about this? (just kidding-what do you expect more untruths?)

  • Victoria Clark May 31, 1:04 p.m.
    user avatar

    I'm sure they will as long as they continue getting our tax dollars.