Ritter Insurance Marketing, Craig Ritter

Highmark Will Stay in ACA Marketplace

Highmark recently announced it has no plans to leave the ACA Marketplace.

Unlike other carriers who have dropped out or scaled back coverage for 2017, Highmark plans on sticking with the exchange in Pennsylvania, Delaware, and West Virginia.

The announcement came alongside the company’s financial results for the first half of 2016. During the telephone media briefing, the Pittsburgh company reported suffering just $68 million in losses for the first six months of this year compared to $257 million in the first half of 2015.

But it’s not all roses. Executive Vice President and CFO Karen Hanlon said, “Despite this improvement, and consistent with what has been reported by our healthcare industry peers, these continued annual losses are not sustainable for any company that has an obligation to serve all of its members, patients, and customers.”

Highmark gained traction by intentionally reducing ACA enrollments. They reformulated products, increased cost-sharing, shifted to narrow provider networks, reduced physician payouts by four and a half percent, and reduced or eliminated commissions for ACA brokers.

Highmark CEO David Holmberg suggested limitations and stricter enforcements on Special Enrollment Periods to rein in costs and remain sustainable.

Highmark’s decision to stick with the exchange hasn’t swayed them from their lawsuit against the government. In addition to several other carriers, Highmark filed a lawsuit with the U.S. Court of Federal Claims to recoup their 2014 ACA losses. To date, CMS’ risk corridors provision has paid only 12.6 percent of what ACA-participating insurers lost that year.

“From my perspective, we fulfilled our obligation. We did exactly what we were asked to do. All we ask is for the federal government to live up to their obligation to us,” Holmberg said.


Posted by filed under Affordable Care Act, CMS, Delaware, Highmark, News, Pennsylvania, Under 65, West Virginia .

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