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We’re expanding our Individual/Marketplace offerings with minimal rate increases

When we began offering plans on the ACA Marketplace for 2014, we didn’t fully know what to expect. But as a mission-driven not-for-profit, we were prepared to take a risk by entering a new market so we could help our neighbors get coverage.

We did our best to project how many Tennesseans might buy these new plans and what kinds of health needs they might have. Even so, our rates were far too low to cover the claims costs for those members for the first three years and we lost $400 million.

The unpredictability continued. When we priced our plans for 2018, we factored in a number of potential risks that didn’t end up playing out as they could have. We made higher margins than intended, which then led us to lower rates for 2019 by an average of 14.8%.

Today we’ve found the right balance — we can cover our members’ medical needs and earn a sustainable margin.

So, what’s changing for 2020?

  • We’re proposing nominal rate increases – 1.4% on average compared to 2019.
  • We’re planning to offer coverage in Nashville and Memphis again.
  • We’re adding extra maternity support, enhanced telehealth benefits and a member rewards program.

We will continue watching regulatory developments before finalizing our commitments for next year, but we’ll explain each of these planned changes below.

We know affordability matters to our members, so we’re glad we can propose nominal rate increases for next year.

Our experience with Individual/Marketplace rates is similar to what insurers across the country have faced.

We’ve found the right balance, and on average, our 2020 rates will be around 1.4% higher than our 2019 rates.

That’s good news, especially since what we pay for medical care continues to rise.

Of course, each plan and each region are different, so there will be variation. Some plans may have higher rate increases while others may actually be less expensive next year. We encourage all our members to review their options carefully during the annual open enrollment period in the fall.

Before then, the Tennessee Department of Commerce and Insurance will review our proposed rates – along with detailed data on the medical claims costs we’ve covered for members. We’ll keep an eye on cost trends and potential regulatory changes as well.

Limiting where we offered individual plans was a tough but necessary decision. Next year we intend to offer plans statewide again.

When the ACA Marketplace launched, we were the only insurer to offer plans statewide. Despite the risks, participating in this uncertain new market aligned with our mission and allowed us to serve our neighbors. But after three years of losses totaling $400 million, we had to limit our risk to protect the financial stability all our members rely on.

For 2017, we stopped offering these plans in Knoxville, Nashville and Memphis.

We made that decision carefully because we wanted every Tennessean to have at least one option for Individual/Marketplace coverage. With that goal in mind, we chose to stay in market regions where no other insurers were willing to offer plans.

When another insurer chose to stop offering plans in Knoxville for 2018, those residents faced the possibility of not having any options for coverage. Our mission to serve led us to offer plans there again despite continued uncertainty and risk.

The ACA markets in Nashville and Memphis have reached competitive stability and we have strong provider relationships there. And, for now, the rules governing the ACA Marketplace are keeping important provisions in place that protect stability for everyone – so we look forward to serving individual members in those areas next year.

There are some remaining regulatory and market uncertainties, though, and we’ll continue monitoring these developments before committing to our plans this fall.

We’re doing more to support our members’ health goals.

We know our members value convenience, and more of them are asking us about telehealth options than ever before. For 2020, we’ll make it easier for our Individual/Marketplace members to take advantage of these services.

We’re also adding access to our Healthy Maternity program, which offers more personalized support for expectant mothers.

And we want to help members pursue their own personal health goals, so we’re launching a member rewards program for all our individual plans. Members will be able to earn points, and ultimately gift cards, for completing a variety of activities that promote better health.

We’ll have more details on these enhanced offerings later in the year.

Stay tuned for more information before enrollment begins

Next, the Tennessee Department of Commerce and Insurance will review our proposed rates – along with detailed data on the medical claims costs we’ve covered for members. And we’ll continue monitoring legal and regulatory changes at the federal and state level before we finalize our plans in late August.

If you buy coverage on your own, mark your calendar for open enrollment, which runs from Nov. 1 through Dec. 15.  If you need help selecting a plan, you can contact our sales team at 888-995-7786, a certified application counselor, an enrollment assistor, or a licensed broker or agent.

And if you receive federal premium subsidies to help pay for your plan, make sure you visit healthcare.gov this fall to update your application and see how much financial help you qualify for in 2020.

About Kelly Paulk, Vice President, Product Strategy and Individual Markets

A photo of the authorKelly oversees product strategy for employer group and individual customer markets, provides leadership to operations, sales and strategic marketing areas and serves as the point person for regulatory, compliance and audit processes for the individual product line.

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