Dive Brief:
- Presbyterian Health Plan, the largest health insurer in New Mexico, announced it will stop selling individual and family policies through the Affordable Care Act marketplaces.
- The insurer currently covers about 18% of the state's ACA market and its departure will impact about 10,000 exchange members, of whom 80% receive federal subsidies, the Albuquerque Journal reported.
- Presbyterian will still offer its policies off the exchange, though that leaves consumers unable to apply federal subsidies just as the insurer seeks an average 21% increase on its non-exchange individual premiums.
Dive Insight:
Presbyterian's move follows other high profile departures announced in recent months for various 2017 ACA regional markets including those of UnitedHealthcare and Humana.
The company said it opted to end its exchange plans because its exchange enrollees made 30% higher usage of medical services than their other patient groups, though no dollar figure was specified.
The state's superintendent of the office of insurance, John Franchini, told the Journal he had tried to work with Presbyterian to keep them in the exchange, including by raising its premium rates to better synch with its claims experience. The company had requested a 30% average increase on its exchange plan premiums before it decided to end them.
He praised the state's remaining exchange carriers for working to adapt to serving a sicker population.
“Fortunately, the remaining carriers – New Mexico Health Connections, Molina, Christus, and again this year Blue Cross Blue Shield of New Mexico – are ready to handle the transition,” Franchini said.