All of the numbers should be taken with a caveat: Some of those consumers have not made their first premium payment and therefore aren't officially enrolled. But it provides a snapshot of what share of the emerging individual market is being captured by the major publicly traded firms. The CMS officials announced Jan. 24 that 3 million individuals had selected coverage through the state and federal exchanges.
Aetna was the latest to provide some insight into enrollments during a call with investors Thursday. Roughly two thirds of the 200,000 enrollees have made their initial payments, according to company officials. But for individuals who signed up before Jan. 1, that figure is closer to 90%.
Aetna CEO Mark Bertolini indicated that it's too early to determine how the company will proceed in offering products on the exchanges for 2015 coverage. The deadline for submitting plans to be sold during the 2015 open enrollment period is expected to be June 27, according to a recent letter from the CMS.
“We know the information and the questions we need to answer before we can be comfortable with the rates that we will submit,” Bertolini said. “It's way too early to tell because we have very little information. The demographics are about where we thought they would be, a little skewed to higher cost individuals.”
But Bertolini downplayed the importance of the exchanges to Aetna's overall book of business. He pointed out that the individual market currently accounts for only 3% of the company's revenues and 1% of profits. “We expect the business to lose money in the first year,” he said.
Bertolini also indicated that back-end accounting functions for the federal exchange remain inoperable and that that's a major concern moving forward. But with the overall functionality of the federal exchange improving dramatically since December, considerable attention has turned to the adequacy of provider networks.
Legislation pending in several states would push insurers to include more providers in their networks, and hospitals in Washington and Kentucky have complained about being shut out of important plans. The CMS issued guidance this week indicating that it will have tougher network adequacy rules in place for plans offered through the exchanges during the 2015 open enrollment period.
Bertolini suggested that “doc shock” will be a major issue moving forward. “I think we're going to hear a lot about this over the next six months,” he said. “We do pay a lot of attention to it because it does impact pricing.”