WINhealth chooses not to participate in 2016 individual market
Wyoming provider cites too much uncertainty and risk in the individual health care insurance market
by WINhealth media release
October 8, 2015
CHEYENNE, WYO – As of October 8, 2015, WINhealth has chosen not to participate in the individual market, to include the federal exchange, for the 2016 plan year. The decision not to participate stems from a recent announcement from the federal government regarding the risk corridor program.
According to the Centers for Medicare and Medicaid Services (CMS), "The goal of the risk corridor program is to support the Marketplaces by providing insurers with additional protection against uncertainty in claims costs during the first three years of the Marketplace. The temporary risk corridor program provides payments to insurance companies depending on how closely the premiums they charge cover their consumers’ medical costs. Issuers whose premiums exceed claims and other costs by more than a certain amount pay into the program, and insurers whose claims exceed premiums by a certain amount receive payments for their shortfall."
This recent development from CMS came as a surprise to WINhealth. The financial impact of the federal government’s decision on WINhealth amounts to approximately $4.4M. The ambiguity of federal government repayments, both in timeline and amount, have created an environment of uncertainty and increased risk in the individual environment. For this reason, WINhealth has chosen not to participate in the individual market for 2016.
WINhealth’s President & Chief Executive Officer, Stephen Goldstone, stated "The federal government’s decision to significantly reduce the reimbursement we would receive under the risk corridor program came as a complete surprise to WINhealth. This combined with the continuous delays in repayment has caught WINhealth flat-footed with no choice but to turn down participating in the exchange for 2016."
Current WINhealth individual members will continue to have coverage through December 31, 2015, so long as they continue to pay their monthly premiums. Open Enrollment begins November 1, 2015. All individual members will need to choose a plan through a new insurance carrier between November 1, 2015 and December 15, 2015 for a plan that starts on January 1, 2016. Current WINhealth individual members can look at their options through the federal exchange by visiting healthcare.gov. Should WINhealth members have any questions about their current plan, they should contact WINhealth directly or their broker/agent. Should members have any questions regarding Open Enrollment, they should contact healthcare.gov or Enroll Wyoming.
Editor’s note: WINhealth is a not-for-profit managed-care company founded by Cheyenne Regional Medical Center (CRMC) and Southeast Wyoming Preferred Physicians in 1996 to provide healthcare plan options for Wyoming individuals and groups. They are based in Cheyenne, Wyoming. In June, 2015, CRMC announced they were interested in selling their interest in WINhealth to get out of the insurance business (Cheyenne Regional Medical Center seeks to sell interest in WINhealth). At the end of 2014, according to a news article in Wyoming Tribune Eagle, the federal government owed WINhealth over $14 million dollars. CRMC loaned WINhealth $6 million to help cover its expenses. WINhealth is one of two insurance companies in Wyoming that sell insurance on the federally-created marketplace exchange.