Aetna had filed with the Indiana department of Insurance to offer individual plans for 2017. Aetna was to be a welcomed option for individual policies, especially because it looked like they were going to the Franciscan Alliance as their network.
Recently, Aetna announced that they were withdrawing their filling, from Indiana and 4 other states. This came on the news that company had lost up to $300 million operating on the federal exchange.
This is a huge blow to Indiana, there will be no individual policy that will have access to the Franciscan network (that could change). This will lead many Hoosier in a serious dilemma, they will no longer have access to their doctors. For people current insured through United Healthcare, on or off the exchange, those networks have access to Franciscan. As it stands, these people will lose access in 2017.
For Hoosiers that live South of Indianapolis, this is going to be a problem. If your health insurance is an individual plan, in 2017 Community Hospital South will be your only option for care outside of emergency. If you are located inside 465, then IU Methodist may be your only option.
This going to cause a huge disruption if things stand. This is not to say that Franciscan could join another network before Jan. 1st.
How can a national company like Aetna, spend all the time and resources to offer coverage, and then just pull out?
It’s called the Risk Adjustment and it was one of the key factors in the Affordable Care Act. If a company does a better job handling risk, then they have to pay. That money is then given to the company that did not handle risk well. With Aetna announcing the $300 million loss in the federal exchange market, lead most health insurance insiders to believe they had to pay a large sum to the Risk Adjustment program.
This may appear to be a knee jerk decision, but it is more calculated than it looks.
The ACA is penalizing companies who are better at controlling risk, their intentions were to create a more level playing field but it’s the exact opposite. It’s driving companies out of the market.