8 key points on payer participation in the 2016 marketplace

Practice Management

Although some payers have exited the marketplace due to heavy financial losses, the Department of Health and Human Services reported the average number of payers per state have slightly increased in 2016, according to Kaiser Family Foundation.

Here are eight key points:

 

1. HHS reported nine out of ten returning HealthCare.gov customers will have access to three or more payers to choose from in 2016.

 

2. Forty percent of counties in states using HealthCare.gov will have merely one to two insurers, up from 35 percent of counties last year.

 

3. Seventeen percent of counties using HealthCare.gov will see a net increase in the number of payers offering coverage, while 36 percent of counties will experience a decrease.

 

5. With the withdrawal of three major insurers in Arizona's marketplace, ten out of the 15 counties in the state will have a net loss of five or more payers.

 

4. Of the 2,603 counties using HealthCare.gov this year, 60 percent of these counties' residents can choose from a plan offered by three or more payers.

 

5. In 2016, 13 percent of counties using HealthCare.gov will go from having three or more insurers to just one or two insurers. Those states offering just one or two insurers include South Dakota, Utah, South Carolina, Tennessee and Arizona.

 

6. On the other hand, Iowa and Missouri will now have three or more payers in most counties, compared to last year when the states only had one or two payers.

 

7. Rural counties will have an average number of 2.9 insurers in 2016, down from 3.1 insurers in 2015.

 

8. Urban counties will have an average of 3.5 insurers this year, also down from 3.9 insures in 2015.

 

More articles on practice management:
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5 key thoughts on how HIPAA impacts patient care

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