Wellmark Blue Cross and Blue Shield announced Tuesday that it will narrow its choices for individual Affordable Care Act plans in Iowa and will eliminate ACA individual plans in South Dakota altogether in 2017.
The changes do not affect group health policies offered by Wellmark to employers in Iowa.
In Iowa, Wellmark will no longer offer gold tier plans and will not promote individual under-65 plans that use its Preferred Provider Organization (PPO) network in Iowa. Individual ACA members with a silver or bronze PPO currently may continue on that plan for 2017, however. The changes won't affect people with grandfathered or grandmothered plans (generally those who purchased their individual plans prior to Jan. 1, 2014).
The Des Moines-based health insurer cited double-digit premium increases it has had to make for the past two years, as well as its loss of approximately $99 million over the same period in the individual market, as reasons for the changes.
"Wellmark's mission is to create affordable health insurance for people to access quality health care. And, for the majority of the past 75 years, we've been able to achieve that," Wellmark Chairman and CEO John Forsyth said in a release. "However, it's apparent that continuing to offer plans with broad networks, combined with the rich benefits of the ACA, is not consistent with managing continually rising costs. While we could seek additional premium increases to mitigate rising costs, this is not sustainable for our members' pocketbook."
Wellmark said it will also move forward in 2017 with plans to introduce a new HMO plan for the individual ACA market called Blue Simplicity, which will offer a simplified copay option.
"This plan is like no other on the market today and is designed to help consumers understand the true value of care through simple copay plans -- providing members with transparency and predictability of cost as they seek and use medical services," Wellmark said in a release.
And as announced in May, Wellmark will also roll out two new individual market health plans in 2017 that partner with health systems in Iowa to provide coverage through those specific networks. Its new Wellmark Value Health Plan is a partnership with Mercy Health Network, while the Wellmark Synergy Health plan will partner with the University of Iowa Health System.
Both Wellmark Value Health Plan and Wellmark Synergy Health will offer individual ACA plans both on and off the public exchange in a total of 40 Iowa counties.