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Little to no options for ACA coverage

A shrinking number of insurances companies cover Mercy, CoxHealth patients

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Local hospitals and patients have a dwindling number of insurance coverage options under the Affordable Care Act – with Ambetter of St. Louis the only provider currently in the market, and only through Mercy Hospital Springfield.

The federal clock is ticking. HealthCare.gov’s open enrollment period for next year began Nov. 1 and ends Dec. 15.

While Mercy patients have the single option, CoxHealth still does not have an insurer to cover its marketplace clients.

“There continues to be a great deal of uncertainty and instability in the health care marketplace,” said CoxHealth Corporate Communications System Director Yvette Williams, noting the hospital’s sole ACA insurer Anthem Blue Cross and Blue Shield decided Sept. 1 to discontinue local marketplace coverage for next year. “However, we are striving to offer more options through the marketplace for those patients who want to access CoxHealth.”

The health system is negotiating with Centene Corp., she said, to provide marketplace coverage through St. Louis-based insurance company Ambetter. Mercy officials say they’ve already struck a deal with Ambetter to cover their patients in 2018.

Since 2014, the number of insurance companies nationwide participating in HealthCare.gov’s marketplace has fluctuated – and current participation is lower than ever. The number of insurance companies in the marketplace peeked in 2015 with an average of six per state, according to research by the Kaiser Family Foundation, and it has dropped since then to average 3.5 for 2018.

Next year, Missouri will have three marketplace options spread across counties.

Humana Inc., a current provider in Missouri, announced in February it would end its marketplace coverage, stating, “Based on its initial analysis of data associated with the company’s health care exchange membership following the 2017 open enrollment period, Humana is seeing further signs of an unbalanced risk pool. Therefore, the company has decided that it cannot continue to offer this coverage for 2018.”

Anthem announced in September it would pull its 2018 marketplace coverage from several Missouri counties, including Greene.

“The market for these plans has become unstable. And with federal rules and guidance changing, it’s no longer possible for us to offer all of these plans,” Anthem President Amadou Yattassaye said in a news release.

“This is not an easy decision for us. We know that changes like these can have a real impact on the people we serve.”

Officials at Anthem and Ambetter could not be reached for additional comment.

Greene County residents would have been left without any federally subsidized health coverage for next year, if Ambetter had not thrown its hat into the marketplace, said Michele Hare, a certified application counselor at Mercy in Springfield.

Her office with three other marketplace counselors, funded initially by a $573,000 grant from the Missouri Foundation for Health, offers free assistance to those signing up for health insurance coverage and federal premium subsidies.

Hare and her team have worked with about 50 clients on Ambetter insurance plans during the current enrolment period.

“The highest package so far that I’ve come across has been around $300 a month, based on their income. I’ve had numerous that were zero premiums, and it varies in between there,” she said. “And their deductibles are anywhere from nothing to $1,800 per person.”

Hare said she’s seen a handful of CoxHealth patients move to Mercy providers.

Both health systems declined to disclose the number of patients and associated revenues through the marketplace coverage. 

The Kansas City metropolitan area has four insurance carrier options, said Rebecca Brannon from Mercy’s St. Louis counseling office, and the St. Louis area has five.

“Most of the state is offered only one insurance provider per county,” Brannon added, noting with Ambetter’s first entry in the Springfield market, it’s the only ACA insurer for Greene, Christian, Lawrence, Barry, Jasper and Newton counties.

“People are pretty receptive this year, jumping on it early versus waiting until the 15th,” Brannon said.

“People are being more proactive than last year.”

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