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Presbyterian to drop out of Obamacare exchange

ALBUQUERQUE, N.M. — Many insurers are shedding their Obamacare plans lately, and that now includes the largest health plan in New Mexico. Presbyterian Health Plan will no longer offer individual and family policies on the Affordable Care Act marketplace, starting next year, company officials said Monday.

The decision will affect 10,000 exchange members, 80 percent of whom now receive federal subsidies, said Brandon Fryar, president of the health plan, a for-profit subsidiary of Presbyterian Healthcare Services.

Presbyterian, which insures about 18 percent of the Obamacare market in New Mexico, has sent letters to members notifying them of the changes. Existing exchange policies will remain in force until the end of the year.

If members want to continue coverage with Presbyterian, they can still buy policies from the company off the exchange, rather than through HealthCare.gov or the New Mexico Health Insurance Exchange, www.beWellnm.com. But if they do so, they will not be eligible for ACA subsidies.

Presbyterian’s current 16,000 enrollees in its off-exchange insurance plans, those who receive coverage through employers and those in small group plans will not be affected by the change.

Fryar said Presbyterian made the decision to stop offering exchange plans because patients who purchased there used medical services 30 percent more than other patient groups off the exchange. He did not provide a dollar figure.

Presbyterian insures over 466,000 New Mexicans. The largest group is its Medicaid line, with 220,000 enrollees, followed by 170,000 commercially insured individuals and 45,000 Medicare Advantage enrollees.

Also on Monday, Presbyterian said it will be requesting an average increase of 21 percent on its non-exchange, individual plan premiums. The insurer had sought an average 30 percent hike on its exchange plans before deciding to pull out of the exchange.

John Franchini, superintendent of the Office of Insurance, said he has been in discussions with Presbyterian executives for several months to find a way to keep the company in the exchange. Franchini said the discussion included raising rates “to appropriately reflect their claims experience.”

He said he’s concerned when carriers leave the exchange because of the costs of providing insurance to 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.

Presbyterian members receiving subsidies under the Affordable Care Act can seek coverage with insurers that are still offering exchange plans. And, depending on where they live, many of these patients may be able to continue to access the network of Presbyterian providers, according to Jim Hinton, Presbyterian Healthcare Service president and CEO.

The other insurers providing care to the current 55,000 New Mexicans on Obamacare are in the process of filing 2017 rate proposals, and many have suggested they will seek big increases. In preliminary filings this spring, New Mexico Health Connections sought a bump of 20 percent to 30 percent on its individual plans. Christus and Molina asked for increases of between 3 percent and 6 percent. Blue Cross, which is returning to the state’s health insurance exchange after taking a year off, has requested rates that are between 20 percent and 83 percent higher than its 2015 rates.

Thousands of New Mexicans had to shop for new health insurance after Blue Cross stopped offering individual insurance plans through the state health exchange. The company had said it lost $19.2 million in 2015 on the 35,000 individuals covered by plans they purchased on and off the exchange.

Nationwide, a number of large carriers have said they are pulling out of Obamacare in 2017. UnitedHealthcare in April announced it would exit nearly all of the ACA exchanges because of heavier-than-expected losses from covering a population that turned out to be sicker than it expected. And Humana has sent letters to insurance regulators in Alabama, Kansas, Wisconsin and Virginia, saying it would no longer offer individual products there.

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