Blue Cross of TN coming back to ACA

[littleb]

Just read that BCBS of Tennessee will be returning to the Knoxville market under the ACA next year.

All insurance carriers left the area and it looked like Knoxville would have no health coverage for 2018. This is great news and it looks like BCBS might remain in Tennessee under the ACA where it is currently the only carrier. Rates might be high but at least between Cigna and Blue Cross there will be plans in place.

With BCBS returning to the marketplace it gives me hope that other insurance carriers may return to the States they left.

Good times.

https://www.healthinsurance.org/tennessee-state-health-insurance-exchange/

 

[simple girl]

Great news!!!

 

[2017ish]

...
All insurance carriers left the area and it looked like Knoxville would have no [individual, ACA-compliant] health [insurance] coverage for 2018. This is great news and it looks like BCBS might remain in Tennessee under the ACA where it is currently the only carrier. Rates might be high but at least between Cigna and Blue Cross there will be plans in place.

With BCBS returning to the marketplace it gives me hope that other insurance carriers may return to the States they left.

Good times.

https://www.healthinsurance.org/tennessee-state-health-insurance-exchange/

Apologies for raining on the parade, but have you read the letter from BCBS to Commissioner McPeak? https://mgtvwate.files.wordpress.com/2017/05/blue-cross-letter.pdf (A scribd version is linked from within the article you cited) I don't see this as great news unless one is in a position to have health insurance heavily subsidized or is mainly concerned about having "ACA-compliant" insurance next year... Basically, as part of its view of its mission and in response to no one else being willing to shoulder the task in that geographic area, one nonprofit insurer has committed to continuing to attempt to square the circle for one more year--as long as premiums are boosted substantially to allow it to not lose too much money on this costly submarket.

 

[Sarah S]

I have seen this before listed as a reason for higher premiums and I don't understand. Could someone explain ?

Why would the elimination of cost sharing reductions cost the insurers more? If someone does not pay their copay or deductible is the insurance company liable for it? I would have thought if I failed to pay something that the insurance company told a provider I owed it would be between me and the provider. Is this untrue?

 

[littleb]

Apologies for raining on the parade, but have you read the letter from BCBS to Commissioner McPeak? https://mgtvwate.files.wordpress.com/2017/05/blue-cross-letter.pdf (A scribd version is linked from within the article you cited) I don't see this as great news unless one is in a position to have health insurance heavily subsidized or is mainly concerned about having "ACA-compliant" insurance next year... Basically, as part of its view of its mission and in response to no one else being willing to shoulder the task in that geographic area, one nonprofit insurer has committed to continuing to attempt to square the circle for one more year--as long as premiums are boosted substantially to allow it to not lose too much money on this costly submarket.

Per a paragraph in the letter:

"Given the potential negative effects of federal legislative and/or regulatory changes, we believe it
will be necessary to price-in those downside risks, even at the prospect of a higher-than-average
margin for the short term, or until stability can be achieved. These risks include but are not limited
to the elimination of Cost Sharing Reduction subsidies (CSRs), the removal of the individual mandate
and the collection of the health insurer tax."


Yes, it is not an ideal situation but the fact that BCBS will be back in the Knoxville area is good news. There were rumors that BC might leave the entire state so most likely, they will continue to offer insurance in the areas where they offer it today. I do not live in Knoxville but in a county where BCBS is the only health insurance carrier.

 

[simple girl]

I have seen this before listed as a reason for higher premiums and I don't understand. Could someone explain ?

Why would the elimination of cost sharing reductions cost the insurers more? If someone does not pay their copay or deductible is the insurance company liable for it? I would have thought if I failed to pay something that the insurance company told a provider I owed it would be between me and the provider. Is this untrue?

I don't understand it in depth myself, but this article may help:

The Effects of Ending the Affordable Care Act’s Cost-Sharing Reduction Payments | The Henry J. Kaiser Family Foundation

 

[Sarah S]

Thanks. That helps. They get an amount up front it looks like. It should be revenue neutral but probably is not. One would expect the loss of cost sharing subsidies would somewhat reduce utilization though as it would increase the cost of using services to those no longer subsidized but I suppose they can not count on it.

When I was working I saw patients' behavior in asking ( demanding) expensive tests and meds change when copayments and deductibles increased and tiers and formularies for medications were instituted

 

[MBSC]

One would expect the loss of cost sharing subsidies would somewhat reduce utilization though as it would increase the cost of using services to those no longer subsidized but I suppose they can not count on it.

The enrollee's portion of cost sharing would not increase. Federal regulations would still require the insurer to reduce the enrollee's portion of cost sharing but the remaining portion would no longer be gov't funded. Let's say the Silver Plan has a $50 office copay but the enrollee qualifies for CSR reducing their portion to $20. If the $30 in gov't funding goes away, the insurer can 1) stop offering the $50 copay plan to all or 2) increase revenue (raise premiums) at the next AEP to cover the $30 owed to the provider.

The removal of cost sharing funding does not remove the federal regulations requiring reduced cost share on Silver Plans for eligible enrollees.

 

[Sarah S]

Thank you for clarifying

 

[GTFan]

Article in the Atlanta Journal-Constitution today said that BCBS filed to stay in GA next year too. New rates are due by end of June. I would expect to see substantial increases again given the experience of other state filings so far, but folks using the exchange with subsidies will be largely protected from those. It will be interesting to see what happens with the cost sharing going forward.

BCBS was the only ACA choice for 96 out of 159 counties this year.

 

[ShokWaveRider]

I have a sneaky feeling that after seeing the proposed AHCA plan(s). The Insurance Companies would prefer keeping the current ACA subsidies than losing customers who cannot afford the Silver plans (That are / were most popular). Losing customers that currently get ACA subsidies is guaranteed premium income for them.