Moda Dominates Health Insurance Exchange

Once again Moda Health Plan has walked away with the highest number of individual members on the health insurance exchange in Oregon – 101,374 people for a growth of 19 percent over last year. And that number could grow even further once enrollment figures are compiled for the fourth quarter of 2014.

Overall individual enrollment reached 213,526 as of September 30 – a significant 8 percent jump from last year when it stood at 196,477.

Other insurers which saw their numbers escalate included Providence Health Plan, 30,069 members representing a 70 percent increase; Oregon’s Health CO-OP at 9,967, which grew by 96 percent; Health Republic Insurance, which had 5,516 members for a 75 percent jump and LifeWise Health Plan which grew by 51 percent with 36,939 individual members.

Several health plans found themselves on the losing end of the spectrum, and their enrollment numbers declined significantly – Regence BlueCross BlueShield, for example, only ended up with 1,396 members for a 96 percent loss, while its subsidiary, BridgeSpan Health, grew from a base of 11 members in 2013 to reach 182 people, according to preliminary data. Since this story appeared, Regence spokeswoman Regena Frieden contacted The Lund Report, saying the 1,396 membership number only represented new members who joined its plan in 2015, not those who had renewed their health insurance with Regence.  .

PacificSource also found itself in the minus column – dropping down to 9,009 members for a 24 percent loss, while Heath Net Health Plan suffered a similar fate, landing at 2,217 members, a 7 percent decrease.

The Insurance Division is still awaiting final numbers for the small group market, according to Jake Sunderland, public information officer for the Department of Consumer and Business Services.

Health insurers participating on the federal insurance exchange have until 11:59 p.m. on April 30 to submit their proposed rate increases for 2016 in the individual and group market.

Health Net Increase

Initially, it looked as if HealthNet was gaining a foothold by becoming the first insurer to actually request new rates for the small business market. But, in fact, Health Net’s initial request of a 7.8 percent increase was actually for small group transitional plans not subject to the ACA regulations. After the Insurance Division determined, based on its financials, that Health Net should have requested a 13.35 percent increase, the company agreed, saying it had done a miscalculation and later lowered that request to 8.2 percent to reflect the overall change for its 11,680 members.

Following a public hearing held yesterday, the Insurance Division will announce its decision May 4, while Health Net has 21 days to file an appeal.

For this particular market, Health Net says its claims’ costs represented 77.7 percent of premiums, while administrative expenses were 20.2 percent, leaving 2.1 percent for profit margin. Although HealhNet saw its overall membership grow last year to reach 73,002, it still landed in the red to the tune of $44 million – the highest amount of any Oregon insurer -- after bringing in $327,884,445 in premiums and spending $293,709,002 on medical expenses. Actually, on its 2014 annual statement, Health Net told the Insurance Division that it incurred an underwriting loss of $52.76 million last year. It’s also unknown whether Health Net intends to participate in next year’s exchange. Calls to Health Net were not returned by press time. “We have no indication one way or another whether or not they will submit filings for the exchange for plan year 2016,” Sunderland told The Lund Report. “The rate filings due April 30 will be the first indication of any intention to do business on the exchange.”

Calls to Health Net were not returned by press time.

Diane can be reached at [email protected].

This story has been corrected to accurately reflect the new individual enrollment figures for Regence Blue Cross BlueShield.