Centene to sell marketplace plans in Missouri's 'bare' counties in 2018

Centene Corp. will sell individual health insurance exchange plans in 40 Missouri counties next year, including dozens of counties that were at risk of having no marketplace options in 2018.

The St. Louis-based insurer is one of a few health plans moving into markets that other insurers ditched because of financial losses and ongoing regulatory uncertainty over healthcare reform.

The CMS under the Trump administration has held up recent marketplace retreats by insurers Anthem and Aetna as a sign that Affordable Care Act marketplaces have failed. The agency earlier this week projected 49 counties will have no exchange options next year. If no marketplace health plan is available, consumers wouldn't have access to the federal financial subsidies that reduce premiums and lower out-of-pocket costs.

But those gaps in coverage are starting to be filled. Now 36 U.S. counties in Indiana, Ohio and Nevada are at risk of having no marketplace insurers, according to the Kaiser Family Foundation, which tracks insurer participation. In those "bare" counties, 23,390 people are enrolled in exchange coverage.

Centene, which serves 1.2 million marketplace members, previously announced it would start offering coverage on exchanges in Kansas, Missouri and Nevada, while expanding its footprint in the six states where it currently sells plans. It's still unclear which Nevada and Kansas counties Centene will enter.

Centene is one of a few insurers that have managed to turn a profit on the exchanges, thanks to its experience managing the care of low-income Medicaid members and its narrow-network, low-premium plans.

Meanwhile, Indianapolis-based Anthem on Wednesday announced it would exit all but three counties in Nevada. The move would affect just 8% of its Nevada marketplace membership, a company spokeswoman said.

Anthem, which covers 1.1 million exchange members, previously said it would exit marketplaces in Indiana and Wisconsin, following an earlier announcement to drop out of Ohio. Also on Wednesday, Nevada's Prominence Health Plan said it would exit the state's marketplace completely. All together, 14 rural Nevada counties and 8,000 residents face having no access to subsidized individual coverage.

Like Centene, other insurers are expanding their exchange presence in a time of uncertainty. Oscar Health filed to expand into certain counties in Ohio, New Jersey and Tennessee. The startup, founded by Joshua Kushner, previously sold plans in New Jersey but exited the market this year. Oscar will also expand its footprint in California and Texas and will keep selling plans in New York. In 2017, Oscar covered about 105,000 members.

Earlier this month, small Midwest health insurer Medica said it would sell marketplace plans statewide in Iowa. Iowa was at risk of having no insurers after Aetna and Wellmark Blue Cross and Blue Shield announced they would exit the exchanges in 2018. Medica will also be the single insurer on Nebraska's health exchange after Aetna's exit.