Out since 2017, Blue Cross to reenter ACA marketplace in Nebraska in 2023

After exiting the health care exchange in 2017, Blue Cross Blue Shield of Nebraska will reenter the marketplace next year with a new plan called Nebraska HeartlandBlue, which will be available for Nebraskans not covered by an employer’s health plan.

“We’re excited that we can get back in,” said Ron Rowe, Blue Cross’ executive vice president. “Ever since we’ve gotten out, we’ve been analyzing, trying to figure out when is the right time to get back in. Now is the right time.”

For 2022, Nebraskans could select from marketplace plans offered by four insurers: Medica Health and Bright Health, both based in Minnesota, and 2022 newcomers Oscar, headquartered in New York City, and Ambetter, from Nebraska Total Care.

That’s a change from 2018 and 2019, when Medica was the only insurer offering plans on the exchange. The state started with four insurers offering plans when the exchange launched in 2014.

The full slate of individual and small group plans that will be available on the exchange in 2023 isn’t yet available. The Nebraska Department of Insurance will make the individual and small group market plans and rates available Oct. 31, a day before open enrollment begins Nov. 1, according to a department spokeswoman. Open enrollment will continue until Dec. 15.

Medica will participate in the exchange in Nebraska in 2023, according to a spokesman. The insurer also will expand its network and plan offerings for next year. In 2022, about half of Nebraskans with ACA coverage had plans through Medica.

Rowe said Blue Cross got out of the market because of instability that led to losses of $140 million over three years.

Aetna Health, which also dropped out of the Nebraska marketplace in 2017, said at the time that it expected to lose more than $200 million in health plans in Nebraska, Iowa and two other states that year.

During the first three years, insurers were to be paid based on three factors, Rowe said. During the second year, the federal government decided not to pay on the second factor, which caused difficulty for all insurers and a lawsuit that eventually was settled by the Supreme Court.

In addition, penalties for not having insurance initially were supposed to be substantial enough to encourage young, healthy people to participate in the marketplace. But the penalties weren’t as substantial as anticipated and at one point were not enforced, Rowe said. Fewer young, healthy people participated than insurers had hoped, leaving older, sicker people who require more health care to make up the pools.

Political and regulatory uncertainty, with changing rules, also made it difficult to plan or manage the business, he said. The company decided to exit the marketplace to make sure losses didn’t spill over and require employers or Medicare members to subsidize the marketplace pool.

Most of those concerns now have been resolved, he said, and the government has standardized the plans.

“Now the market is stable, so it’s time for us to get back in,” Rowe said.

Consumers, health care providers and insurance brokers also have urged the company to reenter the market, he said. About 60% of Nebraskans who have ACA plans enroll through an insurance broker or independent agent. Nearly 1,000 brokers will be licensed to offer the gold, silver and bronze plans, and Blue Cross will begin broker training Aug. 17.

Nebraska HeartlandBlue will be available in all 93 of Nebraska’s counties. During open enrollment or any special enrollment period for which they’re eligible, Nebraskans can visit HealthCare.gov or NebraskaBlue.com to purchase individual coverage.

Rowe said he can’t discuss rates because proposed figures have yet to be approved by the State Insurance Department and CMS.

“We think we’re going to be very competitive,” he said.

According to an analysis by the nonpartisan Kaiser Family Foundation, Nebraska’s market average individual benchmark premium in 2022 was $595. The U.S. average was $438. Only five states had higher ones. However, Nebraska’s 2022 benchmark premium was down from a peak of $838 in 2019.

Rowe said enrollment in the marketplace in Nebraska is projected to increase to about 100,000 next year. If enrollment continues to grow, he said, rates on the exchange should continue to come down.

How much individual consumers pay, however, also depends on the subsidies and tax credits for which they qualify. With the economy as it is, he said, some people may qualify for larger subsidies.

The American Rescue Plan, a pandemic aid package, expanded the tax credits available to people who purchase plans on the exchange. The additional subsidies are set to expire at the end of 2022, but Congress is considering extending them. Rowe said it appears that may happen.

Medicaid eligibility also expanded during the pandemic. That will end when the federal government ends the public health emergency. Rowe said Blue Cross anticipates some of those who lose Medicaid coverage will enter the marketplace.

“It’s been a long time coming,” he said of the insurer’s return to the marketplace, “and we’re excited about it.”