Business

Blue Cross plans to continue offering ACA plans in NC

Posted May 31, 2016 10:51 a.m. EDT
Updated May 31, 2016 6:07 p.m. EDT

— 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.