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Congress Battles Over the Fate of ACA Marketplace via Tax Bill

Earlier this year, the Trump administration and Congress agreed that the Affordable Care Act (ACA) health insurance exchanges should be stabilized, but now it appears the effort remains in the hands of only a few senators. As the GOP forges ahead...

December 15, 2017
CVS’s $69B Deal to Buy Aetna May Set Up ‘Channel Conflict’

CVS Health Corp. put an end to rumors and unveiled its $69 billion megadeal to acquire health insurance giant Aetna Inc. on Dec. 3. By and large, industry experts say the retail pharmacy services behemoth’s self-description — as “a company at the...

December 14, 2017
CMS Makes Big Changes for MA VBID Test, but Are They Enough?

In keeping with the new administration’s theme of providing Medicare Advantage organizations more flexibility, CMS on Nov. 22 unveiled a set of revisions to the MA Value-Based Insurance Design (VBID) model that grants MA organizations in certain...

December 7, 2017
Proposed Aetna-CVS Deal Has MA, Part D Growth Potential

After more than a month of speculation, CVS Health Corp. on Dec. 3 confirmed its agreement to acquire Aetna Inc. for about $69 billion, or $207 per share. Although both companies operate multiple lines of business, executives during their first...

December 7, 2017
As Federal CHIP Funds Dwindle, States Scramble on Coverage

In late November, states began to feel the impact of federal dollars lost when Congress failed to reauthorize the Children’s Health Insurance Program (CHIP) by the Sept. 30 deadline. Some states are scrambling now, trying to maneuver through...

December 1, 2017
3Q Earnings Roundup: MCOs Anticipate MA Growth From AEP

As publicly traded managed care organizations reported earnings for the quarter ending Sept. 30, some carriers highlighted opportunities for growth in Medicare Advantage through new service area expansions, stars improvements that will help them...

November 17, 2017
Early ACA Signup Surge May Not Translate to Fruitful Season

The early November deluge of individuals enrolling in Affordable Care Act (ACA) exchange plans far exceeds expectations in a season marked by ongoing political brinkmanship and ensuing public confusion over marketplace stability. Even CMS — which...

November 17, 2017
As CMS Considers Demos, Plans Must Prep for Work Provisions

In her first major speech on the Medicaid program, CMS Administrator Seema Verma on Nov. 7 informed attendees of the National Association of Medicaid Directors fall conference that the agency is streamlining its approach to reviewing and approving...

November 16, 2017
Humana Sees MA Strain in 2018 After Falling Profits, Job Cuts

November began as a busy month for Humana Inc. On Nov. 2, the Louisville-based insurer filed a lawsuit against the federal government in the U.S. Court of Federal Claims, seeking just over $611 million in unpaid funds from the Affordable Care Act...

November 10, 2017
Possible CVS/Aetna Buy, Other Moves May Be ‘Game Changers’

If Aetna, Inc. is negotiating its potential $66 billion-plus sale to CVS Health Corp. and hoping to finalize the deal as soon as December — as sources have confirmed to multiple media outlets since The Wall Street Journal broke the story...

November 10, 2017
McLaren Health Care Set to Expand to Indiana With MDwise Purchase

Michigan-based McLaren Health Care announced Nov. 2 it has finalized a deal to acquire MDwise, an Indiana insurer that primarily serves the state’s Medicaid population. The acquisition is expected to close by the end of the year, pending...

November 6, 2017
AmeriHealth Caritas to Exit Iowa Medicaid

After months of rate renewal negotiations with the state of Iowa “yielded no agreement on contract rates and terms,” AmeriHealth Caritas Iowa informed state officials it would exit the managed Medicaid program at the end of November. ...

November 3, 2017
BMCHP, Tufts Will Play Key Roles in MassHealth Transformation

As part of a major overhaul of the MassHealth program, the Executive Office of Health and Human Services (EOHHS) in Massachusetts recently reached agreements with Boston Medical Center HealthNet Plan (BMCHP) and Tufts Health Public Plans. The two...

November 3, 2017
Post Mega-Mergers, Anthem Rolls Up MA in Fla., CVS Pursues Aetna

Since Aetna Inc. in February called off plans to acquire Humana Inc., and Anthem, Inc. and Cigna Corp. in May terminated their own deal, analysts have been speculating on future mergers and acquisitions among the mega-insurers. Aetna’s proposed...

November 3, 2017
CVS’s Rumored Bid to Buy Aetna Is Seen as ‘Potentially Risky’

If Aetna Inc. is negotiating its potential $66 billion sale to CVS Health Corp. — as sources have confirmed to multiple media outlets since *The Wall Street Journal* broke the story Oct. 26 — the insurer kept mum during its Oct. 31 earnings call. ...

November 3, 2017
CVS Health Corp. in Talks to Buy Aetna

CVS Health Corp. is in talks to buy Aetna Inc. for $66 billion, or more than $200 per share, sources told The Wall Street Journal on Oct. 26. ...

October 27, 2017
Maryland Approves Amended ’18 Premium Rates

The Maryland Insurance Administration (MIA) on Oct. 25 unveiled approved amended premium rates for individual-market, on-exchange Silver plans through Maryland Health Connection for coverage beginning Jan. 1, 2018. ...

October 27, 2017
Anthem Inks Deal to Acquire America’s 1st Choice

Anthem, Inc. said Oct. 24 it has entered an agreement to buy America’s 1st Choice, a Florida-based Medicare Advantage (MA) insurer. The acquisition, which is expected to close in the first quarter of 2018, will add 127,066 MA and...

October 25, 2017
UnitedHealth Continues to Benefit in 3Q From Exchange Exits

UnitedHealth Group, the bellwether of publicly traded managed care companies’ quarterly financial health, reported strong third-quarter earnings Oct. 17. The insurer beat Wall Street’s expectations, largely on the performance of its Medicare &...

October 20, 2017
Covered California to Add CSR Surcharge to Silver Plans

In a prescient move, Covered California said Oct. 11 it is adding the cost-sharing reduction surcharge to silver plans for 2018 to stabilize premiums, in the absence of a federal commitment to make consistent CSR payments. ...

October 13, 2017
Anthem Pulls Out of Maine Individual Exchange

Anthem, Inc. said Sept. 27 it is pulling out of Maine’s Affordable Care Act individual-market exchange for 2018. However, the insurer will continue to offer off-exchange individual policies and group insurance in the state, according to CNBC on...

September 29, 2017
Medica, CHI Health Collaborate on Exchange Plan

Medica and CHI Health said Sept. 27 they are collaborating on a new health exchange plan option for individuals in 23 counties in Nebraska and two counties in southwestern Iowa, available Nov. 1 for coverage starting Jan. 1, 2018. ...

September 29, 2017
AHIP Medicaid Stakeholders Cheer Demise of Graham-Cassidy Bill

At the Sept. 26 session of America’s Health Insurance Plans’ (AHIP) National Conferences on Medicare, Medicaid & Duals, moderator Leanne Gassaway, AHIP’s senior vice president of state affairs, interrupted an ongoing session to share some news she...

September 29, 2017
Anthem Set to Grow Florida MA Market With HealthSun Purchase

Anthem, Inc. announced Sept. 20 it has finalized an agreement to acquire Florida-based Medicare Advantage insurer HealthSun Health Plans, Inc. HealthSun currently offers three Medicare Advantage (MA) plans with 39,233 members, according to AIS’s...

September 20, 2017
Anthem to Stay in Virginia Exchanges After All

Anthem Inc. announced Sept. 15 it has revised its decision to exit the individual exchange market in Virginia, and will now offer individual plans in 63 would-be “bare” counties in Virginia. ...

September 18, 2017
Sen. Sanders Introduces Single-payer Bill

Sen. Bernie Sanders (I-Vt.) introduced his “Medicare for All” single-payer bill on Sept. 13, drawing support from several likely 2020 Democratic presidential hopefuls. ...

September 15, 2017
As RFPs Roll Out, Competition Is Healthy Among Medicaid MCOs

Despite issues with starting up new contracts in some states and an increasing reliance on Medicare Advantage to lift earnings, publicly traded insurers reporting financials for the second quarter of 2017 continued to express interest in vying for...

August 24, 2017
Illinois Awards New Medicaid Contracts to Six Carriers

For its new program expanding Medicaid managed care statewide, Illinois awarded new contracts on Aug. 11 to six managed care organizations, including subsidiaries of incumbents Blue Cross and Blue Shield of Illinois, Centene Corp., Molina...

August 18, 2017
Montana Health CO-OP Resumes Accepting New Enrollees After Hiatus

After a nine-month hiatus to boost its financial reserves, the Montana Health CO-OP, a nonprofit Consumer Operated and Oriented Plan (CO-OP) created under the Affordable Care Act (ACA), resumed accepting new enrollees on Aug. 12, AP reports. ...

August 18, 2017
Anthem Exits Virginia Individual Marketplace

Anthem, Inc. announced Friday that it will be leaving the Affordable Care Act marketplace in Virginia for 2018. The “Individual market remains volatile” and is “shrinking and deteriorating” the company said in a statement on August 11, citing ...

August 14, 2017
Kaiser Reports $1B Net Income

Nonprofit Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals on Aug. 4 reported net income of $1 billion on combined total operating revenue of $18.1 billion for the second quarter. As of June 30, Kaiser Permanente’s membership...

August 11, 2017
Cigna 2Q Revenues Up 4% to $10.3 Billion

Cigna Corp. reported Aug. 4 that total revenues increased 4% to $10.3 billion for the quarter ended June 30, similar to other managed care companies’ strong second-quarter earnings performance. Quarterly net income was $813 million, or $3.15 per...

August 11, 2017
Evergreen, Minuteman CO-OPs Fall Into Receivership Amid Money Woes

Two of the handful of nonprofit Consumer Operated and Oriented Plans (CO-OPs) created under the Affordable Care Act (ACA) that remain in business recently entered state-controlled receivership. Both HMOs — Maryland’s Evergreen Health, Inc. and New...

August 11, 2017
Despite Exits, Nationwide Exchange Coverage Increases

Since the July 26 CMS press release detailing health insurance exchange participation by county, the number of U.S. counties without an exchange carrier has decreased 58% from 40 to 17, according to an August 9 coverage map released by CMS. The...

August 10, 2017
California Strategizes to Keep Exchange Plans for ‘Long Haul’

Covered California’s executive director recently unveiled a 12.5% average preliminary premium rate hike year-over-year among the 11 participating plans for 2018. In doing so, he stressed that all plans have opted to remain in the Affordable Care...

August 4, 2017
Unsubsidized Exchange Enrollees Face More Difficulties for 2018

For every 10 individuals getting health insurance on Affordable Care Act (ACA) exchanges, four of them aren’t eligible for subsidies. And, given that exchange plan options almost certainly will narrow and premium rates are likely to increase by...

July 28, 2017
Anthem’s 2Q Accents Exchanges, Need for Quick Clarity on CSRs

Anthem Inc. highlighted its continuing worries about 2018 participation and pricing in Affordable Care Act (ACA) exchanges during its second-quarter earnings call July 26. The Indianapolis-based health insurance giant touched on its continuing...

July 28, 2017
Humana, Oscar Health Partner on Products in Nashville

Louisville, Ky.-based Humana Inc. and New York-based startup Oscar Health said they have entered into a strategic partnership to offer commercial health insurance to small employers with 50 or fewer workers in nine counties around Nashville, Tenn....

July 14, 2017
Senate Unveils Proposed Revisions to BRCA

On July 13, Senate Majority Leader Mitch McConnell (R-Ky.) unveiled his proposed revisions to the Better Care Reconciliation Act (BRCA), keeping intact dramatic cuts to Medicaid and adding a proposal spearheaded by Sen. Ted Cruz (R-Texas) to let...

July 14, 2017
Medicaid Plan Exits May Disrupt Enrollees, but Not Care Quality

Medicaid enrollees and states may experience some temporary turbulence when managed care organizations choose to leave a state, but a new study finds that plan exits do not create significant changes in market-level quality or self-reported...

July 14, 2017
CareSource to Begin Serving Georgia Medicaid Enrollees

Nonprofit CareSource was set to begin covering nearly 250,000 enrollees in Georgia’s Medicaid managed care program on July 1, which the insurer describes as the largest single-day spike in membership in its 28-year history. ...

June 30, 2017
CO-OP Minuteman Health to Convert to For-Profit

Minuteman Health, Inc. (MHI), a Boston-based HMO created under the Affordable Care Act’s Consumer Operated and Oriented Plan (CO-OP) program, said June 23 that it will convert to for-profit status under a new name, Minuteman Insurance Co., as of...

June 30, 2017
Exchange Savvy to M&A Potential: Investor Days Spark Interest

When touting future prospects and trying to inform large audiences about what sets them apart from rivals, many companies take the investor day route. Two major health insurers held such events recently, capitalizing on significant publicity of...

June 30, 2017
Nevada Governor Vetoes Medicaid for All

At the eleventh hour, Nevada Gov. Brian Sandoval (R) vetoed legislation that would have created the Nevada Care Plan, a landmark Medicaid-for-All health care delivery model. ...

June 23, 2017
Senate’s Version of AHCA Would Slash Medicaid Funding, Too

When Senate Majority Leader Mitch McConnell (R-Ky.) on June 22 released a “discussion draft” of his team’s revisions to the American Health Care Act (AHCA), some observers reacted swiftly to what the *Washington Post* described as “rolling back...

June 23, 2017
CMS Actuary Expects Fewer Uninsured From AHCA Than CBO Does

CMS’s chief actuary on June 13 offered more analysis of the potential financial and coverage effects of House Republicans’ American Health Care Act (AHCA), passed May 4 and aimed at repealing the Affordable Care Act (ACA). ...

June 16, 2017
What Effect Will Anthem-Express Scripts Fallout Have on Industry?

As the simmering feud between Anthem, Inc. and Express Scripts Holding Co. looks to finally have an end date, it’s anyone’s guess as to how the PBM industry will look when the dust settles. Evercore ISI, however, offered some potential outcomes...

June 8, 2017
Anthem to Administer Maine Employee Plan

Anthem Blue Cross and Blue Shield will administer Maine’s employee health insurance plan beginning July 1 after winning the $5.5 million-per-year contract away from Aetna Inc., the *Portland Press Herald* reported. ...

June 2, 2017
Insurers Form Pacts, Set Stage For NC Medicaid Transformation

Far in advance of an RFP for three statewide managed care contracts, insurers are already laying the groundwork for a major overhaul of North Carolina’s Medicaid program. As the state anticipates transitioning its 1.9 million Medicaid enrollees...

May 25, 2017
UnitedHealth Group Closing Harken Health

UnitedHealth Group said it is closing Harken Health, an individual insurer that promised patients unlimited free primary care visits as long as they used Harken’s clinics. ...

May 19, 2017
CMS Wants to Shift SHOP Exchange Enrollment From HealthCare.gov

CMS said May 15 it intends to propose rules, taking effect Jan. 1, 2018, that would allow small employers in states with federally facilitated Small Business Health Options Program exchanges under the Affordable Care Act (ACA) to enroll directly...

May 19, 2017
Zoom Health Plan Winds Down Insurance Business

Oregon start-up insurance company Zoom Health Plan Inc. is winding down operations, according to the Oregon Department of Consumer and Business Services (DCBS). All current Zoom Health Plan individual policies will be canceled effective Dec. 31,...

May 16, 2017
Molina’s Board Shows Namesake Brothers the Door

Investors cheered the decision by Molina Healthcare, Inc.’s board of directors to replace Chairman, CEO and President J. Mario Molina, M.D., and Chief Financial Officer (CFO) John Molina on May 2, with some viewing it as the equivalent of a “For...

May 5, 2017
UnitedHealth Begins Year With Growth, Gains

UnitedHealth Group started the year off with higher-than-anticipated revenue growth and strong enrollment gains, including the addition of about 675,000 Medicare Advantage members, about half of whom are in employee retiree programs, executives...

April 28, 2017
UnitedHealth Cruises to Strong 1Q, Growing Despite Big ACA Pullout

UnitedHealth Group reported strong first-quarter 2017 financial results on April 18, beating Wall Street analysts’ estimates — and in keeping with the industry giant’s solid earnings performance in multiple product lines reported three months ago....

April 21, 2017
Alabama Authorized to Launch RCO-Based Managed Medicaid System

After a one-year delay in the implementation of a five-year Section 1115 demonstration to transform its Medicaid program, Alabama was authorized to launch a statewide managed care delivery system run by provider-based Regional Care Organizations ...

April 13, 2017
March MA Enrollment Jumps Nearly 38K From February

Total enrollment in Medicare Advantage and other prepaid plans grew month-over-month by nearly 38,000 lives to 19,631,399 as of the March 1 payment date, according to CMS data reflecting enrollments accepted through Feb. 3. Enrollment in MA and...

March 31, 2017
Illinois Medicaid Seeks to Expand Managed Care With Fewer MCOs

As part of an ongoing process to streamline its managed Medicaid program, the state of Illinois is in the midst of soliciting bids from insurers who will compete for a limited number of statewide contracts to serve a larger swath of Medicaid...

March 31, 2017
CMS Releases Report, Data on 2017 OEP

As of Jan. 31, more than 12.2 million consumers either signed up or reenrolled in coverage through federally facilitated exchanges (FFEs) and state-based marketplaces (SBMs)—roughly 9.2 and 3 million, respectively, according to a March 15 CMS...

March 27, 2017
What Role Will Carriers Play in Trump’s ACA Replacement Plan?

Leaders from some of the nation’s largest health plans, along with the industry’s two trade groups, turned up at the White House on Feb. 27 to meet with President Trump — and his recently confirmed HHS secretary — to discuss replacing the...

March 3, 2017
With Major Insurers Single, Are MA Sponsors Willing to Mingle?

The ironic Valentine’s Day breakups of two of the biggest proposed health insurance mergers played out like the cover of a gossip magazine, with two partners definitively calling it quits, one suing for divorce and one clinging to its rejecter....

March 2, 2017
Virginia Chooses Six MCOs to Lead New Duals Effort

The Virginia Dept. of Medical Assistance selected six managed care organizations to serve the Commonwealth’s first ever Medicaid managed long-term services and supports (LTSS) program. ...

March 2, 2017
CMS February Data Show MA Enrollment Surpassed 19.5 Million

The final results from the 2017 Annual Election Period (AEP) indicate strong growth in Medicare Advantage, in which more than 19.5 million seniors are now enrolled, and imply the MA program is growing at a slightly faster pace than it has in...

March 2, 2017
Rhode Island Exchange Sees Decline, Technical Problems

During the 2017 open enrollment period (OEP), state-based exchanges increased enrollment between 3.5% and 31.5%, with one exception: Rhode Island. HealthSource RI, Rhode Island’s health exchange, saw enrollment decrease more than 20% from 2016. At...

February 24, 2017
Exchanges Are More Volatile Than Viable

While there are indications that the public insurance exchanges are beginning to stabilize after four years, public insurance carriers continue to bleed red ink. ...

February 17, 2017
4Q 2016 Earnings for Centene, Humana, WellCare Indicate Growth

Centene Corp. ended 2016 with 11.4 million members — up 6.3 million members, or 124%, from the end of 2015, the company said Feb. 7 when it reported its fourth-quarter 2016 earnings. In addition to its Medicare and Medicaid business, the company...

February 10, 2017
Block Grants Would Slash Federal Medicaid Budget, Constrain Growth

Moving Medicaid to a block-grant program could cut federal spending by $150 billion over five years, while switching to a per capita cap model would trim costs by $110 billion, according to an analysis from Avalere Health. But states, particularly...

February 10, 2017
With Aetna-Humana Deal Blocked, What MA Opportunities Remain?

Two weeks after a federal judge agreed with the Dept. of Justice’s recommendation to block Aetna Inc.’s planned acquisition of Humana Inc., Aetna is still weighing its options. Chairman and CEO Mark Bertolini during a Jan. 31 conference call to...

February 9, 2017
Some SBEs Report Double-Digit Enrollment Gains for 2017

With the Jan. 31 conclusion of the open-enrollment period (OEP), state-based exchanges (SBEs) say sign-ups are up markedly from a year ago, with a large boost coming during the final two days for some states. ...

February 3, 2017
Judge Says Aetna Tried to Duck Antitrust Scrutiny; Investors Sue

It was a rough week for Aetna Inc. On Jan. 26, just three days after a court blocked its proposed $37 billion takeover of Humana Inc., investors filed a class-action lawsuit against the company — prompted by U.S. District Judge John D. Bates...

January 27, 2017
Enrollment Snapshot Suggests Big January Jump in MA Figures

Medicare Advantage enrollment as of the Jan. 1, 2017 payment date reached 19.4 million beneficiaries, or 33.9% of total Medicare-eligible individuals, according to CMS data posted Jan. 17. While the January figures typically do not provide a...

January 25, 2017
Trump Takes First Stab at Killing ACA With Vague Exec Order

An executive order issued the first day of President Donald Trump's administration symbolizes his first hit to the Affordable Care Act (ACA), and while it’s rather nonspecific, it’s the broad language contained in it that has some industry...

January 25, 2017
Court Blocks Aetna-Humana Deal; Is Anthem-Cigna Next?

A federal judge on Jan. 24 blocked Aetna Inc.'s proposed $37 billion takeover of Humana Inc., ruling that the resulting merged company would likely "substantially lessen competition" for Medicare Advantage (MA) in areas where the two companies...

January 24, 2017
Anthem Extends Deadline to Acquire Cigna

Anthem, Inc. extended its deadline to acquire rival Cigna Corp. by three months as it waits for a federal court to decide if the deal will be allowed, Reuters reported Jan. 19. ...

January 23, 2017
SNPs Hope for Permanency, Stars Fixes, Enhanced Dual Integration

A major change in risk-adjustment methodology that went into effect for 2017 alleviated a deep concern of many Medicare Advantage plans with large percentages of dual eligibles. But topping their wish list this year is permanent authorization...

January 11, 2017
HealthCare.gov Signups Increase From 2016

As of Dec. 31, 8.7 million people had signed up for coverage through HealthCare.gov — up 1.8% from the same date a year ago, CMS reported Jan. 4. ...

January 6, 2017
Here’s How a Regional Non-Profit Crossed State Lines Four Times

President-elect Donald Trump and Republican lawmakers want to give health insurers the ability to sell individual coverage across state lines. But Minnetonka-based Medica has been doing just that for the past several years. Last year, the regional...

December 16, 2016
Medica Exit From Minn. Medicaid Leaves Lives Up for Grabs in 2017

Citing substantial losses incurred this year and a failure to secure actuarially sound payment rates for the second year of a new contract, longtime Minnesota insurer Medica has informed the Minnesota Dept. of Human Services (DHS) that it will...

December 15, 2016
CO-OP Evergreen to Leave Individual Market for 2017

Evergreen Health Cooperative Inc. — a Maryland-based Consumer Operated and Oriented Plan (CO-OP) — will not issue or renew individual policies for the 2017 plan year, the Maryland Insurance Administration (MIA) announced Dec. 8. Evergreen had...

December 9, 2016
In Friendly MA Climate, Time Is Right for WellCare-Universal Deal

WellCare Health Plans, Inc.’s planned acquisition of Universal American Corp. (UAM), unveiled last month, came with a whole host of positives, starting with a projected 34% membership boost in its Medicare Advantage business. Analysts say the...

December 2, 2016
President-Elect Trump Picks Devoted ACA Adversary to Lead HHS

President-elect Trump on Nov. 28 said he intends to appoint Rep. Tom Price, M.D. (R.-Ga.), an outspoken critic of the Affordable Care Act (ACA), to head HHS. Trump also plans to nominate Indiana consultant Seema Verma as CMS administrator. Both...

December 1, 2016
3Q Earnings for Select MCOs Reflect Medicaid Cost Pressures

While reporting third-quarter 2016 earnings over the last month, several publicly traded carriers have boasted improved performance in their Medicare Advantage products. But for some, cost pressures on the Medicaid side contributed to increases in...

November 18, 2016
WellCare Unveils Plans to Acquire Universal American

WellCare Health Plans, Inc. has entered into a definitive agreement with Universal American Corp. to acquire Universal American for $10 a share, for a total equity value of $600. This move follows WellCare’s Oct. 5 announcement that it had entered...

November 17, 2016
Where ACA, Medicaid Businesses Lag, MA Growth Picks Up Slack

As publicly traded carriers with multiple lines of business reported third-quarter 2016 earnings from mid-October through Nov. 1, Medicare Advantage products largely helped insurers offset losses in the Affordable Care Act (ACA) exchange...

November 3, 2016
Arise Health Plan to Exit Wisconsin Public Exchange

Arise Health Plan, a WPS Health Solutions subsidiary, Sept. 29 said it will withdraw participation in the 2017 Wisconsin public health insurance exchange, according to the *Milwaukee Journal Sentinel.* ...

September 30, 2016
UnitedHealthcare’s Harken Health to Exit Atlanta, Chicago Markets

UnitedHealthcare subsidiary Harken Health said on Sept. 29 that it is withdrawing its participation on public exchanges in 2017, leaving the exchanges in Illinois and Georgia, where it previously offered plans in Chicago and Atlanta, according to ...

September 30, 2016
Nebraska Blues to Exit Individual Exchange in 2017

Blue Cross and Blue Shield of Nebraska (BCBSNE) says it has decided to exit the state’s federally facilitated public exchange individual market in 2017, according to a statement on the insurer’s website. ...

September 28, 2016
Harken Health Lost $70 Million in First Half of '16, Names New CEO

Tom Vanderheyden, CEO of Harken Health Insurance Co., has stepped down amid substantial losses, *The Minneapolis Star Tribune* reported Sept. 9. Stevan Garcia, who has been an executive at UnitedHealth since 1998, will take over as the company's...

September 14, 2016
New Jersey CO-OP to Be Shuttered; Six of 23 Are Now Left

Health Republic Insurance of New Jersey is the latest Consumer Operated and Oriented Plan (CO-OP) to fizzle. The New Jersey Dept. of Banking and Insurance announced that the insurer has consented to be placed in rehabilitation due to its ...

September 14, 2016
For Some MA Insurers, 2Q16 Offered Membership, MLR Improvements

As publicly traded Medicare Advantage insurers late last month and in early August reported earnings for the second quarter of 2016, several touted gains in MA enrollment, higher premium yields and improved medical loss ratios. But those with MLR...

August 18, 2016
Medicaid MCOs Show Big Growth, But Problems on MLRs, Pay Rates

The plus side of the ledger for Medicaid managed care in the second quarter was membership and revenues, which several publicly held managed care organizations (MCOs) said had big gains. But those same gains also contributed to the minus side...

August 8, 2016
Another Insurer to Exit New York's Struggling Duals Demo

Magellan Health, Inc. will exit New York’s ailing Fully Integrated Duals Advantage program at the end of this year because of “lower than anticipated FIDA enrollment,” Chief Financial Officer Jonathan Rubin said during the company’s second-quarter...

August 8, 2016
How Did Horizon Succeed on the Exchanges as Others Staggered?

While many Blues plans have suffered substantial financial losses on the public insurance exchanges, Horizon Blue Cross Blue Shield of New Jersey is touting record enrollment in the individual market. Between 2013 and 2016 membership in that...

June 27, 2016
UnitedHealth Group Names John Rex as CFO

In a move that has Wall Street applauding, UnitedHealth Group on June 9 named John Rex, formerly executive vice president and chief financial officer for its Optum unit, as the CFO for the parent company, effective immediately. ...

June 13, 2016
After Mulling Exit, BCBSNC Seeks 18.8% Hike

After losing more than $400 million on the public exchanges in 2014 and 2015, Blue Cross Blue Shield of North Carolina (BCBSNC) considered pulling out. The company says it paid out $1.29 billion in claims for the sickest 5% of its exchange members...

June 13, 2016
WellCare Grows SC Medicaid Business With Advicare Purchase

WellCare Health Plans, Inc. on June 1 said it finalized the purchase of certain assets of Advicare Corp.’s Medicaid business, adding approximately 30,000 lives to the 61,000 Medicaid members already served by WellCare of South Carolina. ...

June 13, 2016
State, MCOs Plan to Bring Fallon Members Back to One Care

It was nearly a year ago when Fallon Total Care unveiled plans to exit One Care, Massachusetts’s CMS-based Medicare-Medicaid alignment initiative, attributing its decision to the demonstration’s disappointing financial outlook. While only a...

June 6, 2016
Ohio CO-OP InHealth Mutual to Cease Operations

On May 26, Ohio became the latest state to close its Consumer Operated and Oriented Plan (CO-OP) formed under the Affordable Care Act (ACA) when Lt. Gov. Mary Taylor (R) was appointed receiver for Coordinated Health Mutual, Inc. ...

May 27, 2016
N.M. Blues Jumps Back Into Individual Exchange for 2017

After dropping out for the 2016 plan year, Blue Cross Blue Shield of Mexico, a subsidiary of Health Care Service Corp. (HCSC), filed to sell coverage through the state-run exchange for the 2017 plan year, according to the New Mexico Office of...

May 26, 2016
Wellmark Partners With Health Systems for Iowa Exchange

After sitting on the sidelines for the past three years, Wellmark Blue Cross and Blue Shield will sell individual and small-group coverage through HealthCare.gov when the open-enrollment period begins Nov. 1. For its new exchange products, the...

May 26, 2016
Plan M&A Trend Remains Intact Despite Slow Pace of Deal OKs

Leavitt Partners recently released fresh survey data showing more than 250 health plan industry veterans foresee the consolidation trend in their sector to continue for some time, even as one of the two pending mega-deals of Anthem, Inc. and Cigna...

May 23, 2016
Modified Rule Could Help Surviving CO-OPs

An interim final rule (CMS-9939-IFR) released May 6 could help the surviving Consumer Operated and Oriented Plans (CO-OPs) find their financial footing. ...

May 11, 2016
Arizona Restores KidsCare Program

Arizona Gov. Doug Ducey (R) on May 5 signed legislation to restore KidsCare, a federal Children's Health Insurance Program (CHIP) for children from low-income families, according to the Associated Press. ...

May 10, 2016
Sen. Cantwell Wants to Bring BHP Back to Washington State

Sen. Maria Cantwell (D-Wash.) and Rep. Jim McDermott (D-Wash.) are calling on state leaders to bring back the state’s Basic Health Plan (BHP), which they contend would create a more affordable health insurance option for the 162,000 Washingtonians...

May 4, 2016
Premera Subsidiary to Leave Oregon Market at Year’s End

Premera Blue Cross subsidiary LifeWise Health Plan is pulling out of Oregon after doing business in the state for more than two decades, the company said April 21. LifeWise Oregon has fewer than 50,000 individual and group members, down from 163...

April 29, 2016
Public Exchange Enrollees Were Financial Drag on Blues in 2015

A handful of Blues plans last month released 2015 financial results indicating the fiscal hit they took from underpriced insurance exchange products. Some reported their first financial losses in more than a decade, while others said losses on the...

April 29, 2016
Centene Says Exchange Margins Are Better Than Expected

As of March 31, Centene Corp. had more than 680,000 members enrolled in coverage purchased through an insurance exchange across 15 states. That number is expected to decline to 550,000 due to normal attrition. ...

April 28, 2016
In Iowa, UnitedHealth Is Out, Wellmark Is In

UnitedHealth told Iowa state regulators that it will not sell individual insurance coverage — on or off the state’s public exchange — for 2017, the Iowa Insurance Division said April 25. ...

April 28, 2016
Molina to Buy Universal American’s New York Medicaid Plan

Molina Healthcare, Inc. on April 19 said it agreed to purchase Universal American Corp.’s Total Care Medicaid plan in upstate New York. Total Care is a prepaid health services plan that serves nearly 40,000 members under New York’s Medicaid and...

April 22, 2016
Covered California Votes to Allow Sales to Undocumented Residents

On April 7, Covered California’s board voted to allow undocumented residents to purchase non-subsidized health coverage through the state-run exchange. Under the Affordable Care Act, undocumented residents are not eligible for federal premium...

April 13, 2016
Idaho Exchange Runs Into Enrollment Problems

Several months after signing up for coverage through Idaho’s insurance exchange, many people have not yet been enrolled in a plan. Moreover, Idaho’s state-run exchange is months late sending hundreds of Idahoans a document they need to file their...

April 13, 2016
Veteran Health Plan Execs Found New Insurer Bright Health

On April 6, three veteran health plan executives unveiled a new insurer based in Minneapolis led by Bob Sheehy, former UnitedHealthcare CEO (a unit of UnitedHealth Group). Called Bright Health, the carrier is prepared to launch nationally in the...

April 8, 2016
Fairview Health Services, UCare to Combine

Fairview Health Services and Medicare Advantage plan sponsor UCare on April 5 said they agreed to combine and that they aim to finalize the transaction by mid-summer 2016. The insurer lost about half of its business this year after Minnesota...

April 7, 2016
Attempts to Block Insurer Deals Are Seen as Increasingly Likely

Now that the Centene Corp. acquisition of Health Net, Inc. became a done deal March 24, attention has shifted to the two other — and bigger — pending purchases of insurers with major stakes in Medicare Advantage. And several observers are saying...

April 7, 2016
Carriers Have a Tough Time Keeping Exchange Enrollees

The majority of people who purchase insurance through HealthCare.gov stay enrolled in their selected plan for one year or less, according to an analysis from consulting firm Avalere Health LLC. ...

April 7, 2016
Calif. Exchange Can’t Explain Why Some Enrollees Were Dropped

Some people who purchased health insurance through California’s state-run insurance exchange are complaining that they’ve been unexpectedly dropped by their carriers, despite having paid premiums on time, according to an April 5 *Sacramento Bee* ...

April 7, 2016
Centene Completes Health Net Acquisition

Centene Corp.’s acquisition of Health Net, Inc. received approval from both the California Dept. of Insurance (CDI) and California Dept. of Managed Health Care on March 22, allowing the deal to close on March 24, according to statements by the two...

March 25, 2016
New Startup Canopy Health Says Young Enrollees Are Prime Target

A new health insurer has sprouted up in a market segment where others have stumbled of late in the form of Denver-based Canopy Health Insurance (unveiled earlier this month as Melody Health Insurance). The new player wants to be known as the go-to...

March 25, 2016
Prime Wins Bid for Rhode Island Blues Plan Contract

Prime Therapeutics LLC won a five-year deal to manage the pharmacy benefits for approximately 300,000 commercial, individual market and Medicare members of Blue Cross & Blue Shield of Rhode Island, effective Jan. 1, 2017. ...

March 18, 2016
Health Insurance Start-Up Hires Former CO-OP CEO

Melody Health Insurance, a Denver-based start-up focused on the individual insurance market, recruited the former CEO of two now defunct Consumer Operated and Oriented Plans (CO-OPs) to head its Western markets. ...

March 16, 2016
Exchange Enrollment Climbs 8.5% From a Year Ago

As of Jan. 31, about 12.7 million individuals selected, or were automatically re-enrolled into, 2016 coverage sold through a public insurance exchange, the HHS Assistant Secretary for Planning and Evaluation (ASPE) reported March 11. ...

March 16, 2016
More Than 41K New Horizon Enrollees Chose Tiered Plan OMNIA

Horizon Blue Cross Blue Shield of New Jersey on March 10 said an estimated 41,258 of its new enrollees in the individual market who were previously uninsured chose the tiered health plan OMNIA. The OMNIA option created a firestorm in New Jersey,...

March 11, 2016
WellCare to Replace Aetna in Nebraska’s New Medicaid Program

On March 8, the Nebraska Department of Health and Human Services’ Division of Medicaid and Long-Term Care changed its recommendation for one of the three insurers previously announced to administer its Heritage Health program. ...

March 11, 2016
2016 CO-OP Enrollment Update

Executives from five Consumer Operated and Oriented Plans say diversifying beyond the individual exchange market and not relying too heavily on the risk-corridors program kept them clear of the financial abyss that swallowed a dozen other CO-OPs. ...

March 11, 2016
Highmark, UPMC Both Gain, but Aetna Loses MA Members in W. Pa.

Bitter rivals Highmark Inc. and UPMC Health Plan both turned in a strong Medicare Advantage enrollment performance in their western Pennsylvania service area during the recently completed 2016 Annual Election Period (AEP). The two Pittsburgh-based...

March 10, 2016
Slavitt: Exchanges Are Now Bigger Than Coffee Industry

After just three years, public insurance exchanges have become a $40 billion industry, “bigger than the coffee industry,” acting CMS administrator Andy Slavitt told attendees at America’s Health Insurance Plan’s annual Exchange Forum on March 8. ...

March 9, 2016
Feds Now Will Demand Verification for All ACA Special Enrollments

In a nod to health insurers’ continued displeasure over loosely managed Special Enrollment Periods (SEPs) for individuals seeking coverage on HealthCare.gov public exchanges, CMS on Feb. 24 took a bolder move in requiring that anyone seeking to...

February 26, 2016
Independence Exploring Potential Mergers, Consolidations

Philadelphia-based Independence Health Group, Inc. is exploring strategic options such as a merger or a consolidation of business functions to better compete with publicly traded competitors that are on the verge of merging, The Wall Street...

February 26, 2016
State Regulators Come Up With Plan to Keep Moda Health Afloat

In January, concerns about Moda Health Plan, Inc.’s (MHP) “excessive operating losses and inadequate capital and surplus” prompted the Oregon Dept. of Consumer and Business Services (DCBS) to take control of the company’s financial decisions. On...

February 16, 2016
Moda Has Plan to Stabilize Finances

The Oregon Department of Consumer and Business Services, Division of Financial Regulation, on Feb. 8 issued a consent order outlining a plan for Moda Health Plan, Inc. “to stabilize its financial position and continue to serve its customers.” As...

February 12, 2016
Nebraska Awards Aetna, UnitedHealth Medicaid Contracts

Incumbents Aetna Inc. and UnitedHealth Group should be able to build on their market strength in the Nebraska Medicaid market after the state on Feb. 5 awarded the two insurers contracts for its Medicaid managed care services program, according to...

February 12, 2016
Some MCOs See Slower MA Growth, but Two Cite Acquisition Appetite

Two of the smaller publicly held players in the Medicare Advantage market may be looking to grow in it by acquisitions this year. But one of those firms — WellCare Health Plans, Inc. — along with Humana Inc. indicate they will be growing only...

February 12, 2016
Centene Nearly Doubles Exchange Enrollment from 4Q2014

Centene Corp., a publicly traded Medicaid managed care company, ended 2015 with 146,100 members who had signed up for coverage through public exchanges in a dozen states — that’s up from 74,500 in the fourth quarter of 2014 and a slight drop from...

February 10, 2016
Open Enrollment Results Provide Clues to 2016 Market Share Shifts

CMS announced Feb. 4 that 12.7 million people enrolled in 2016 plans during the open enrollment period that concluded Jan. 31 — 3.1 million from state-based exchanges and 9.6 million from the federally facilitated exchange. Nationwide, the agency...

February 8, 2016
Iowa Set to Launch New Medicaid Managed Care Program in March

After a handful of setbacks, IA Health Link, Iowa’s new Medicaid managed care program, will launch March 1, pending final CMS approval. The program will coordinate physical, behavioral, in-home and long-term care services for about 560,000...

February 5, 2016
Michigan Merger Between Health Alliance Plan, HealthPlus Completed

The merger between Health Alliance Plan (HAP) (MCO 177) and HealthPlus of Michigan (MCO 362) became effective Feb. 1, resulting in a single company that will maintain the HAP name and remain headquartered in Detroit, according to a press release...

February 2, 2016
Anthem Gains Members Despite Tumbling Exchange Enrollment

Blues plan operator Anthem, Inc. finished 2015 with 38.6 million members — 1.1 million more than it had at the end of 2014 — the company said Jan. 27 when it reported fourth-quarter earnings. Sustained growth in Anthem’s Medicaid managed care...

January 29, 2016
Anthem Lost 33,000 Exchange Lives in Fourth Quarter

Anthem, Inc., which operates Blue Cross and Blue Shield plans in 14 states, finished 2015 with 791,000 lives covered by policies sold on public insurance exchanges. That number is down 33,000 from the end of the third quarter of the year, but up...

January 28, 2016
UnitedHealth Lost $720 Million on Exchanges in 2015

UnitedHealth Group says it lost $720 million on qualified health plans (QHPs) sold on public insurance exchanges for 2015, including $245 million in the fourth quarter. In November, the company predicted it would lose $425 million on the exchanges...

January 20, 2016
CMS Eliminates Six More Special Enrollment Periods

CMS is following up on its vow to crack down on “unintended loopholes” provided by special enrollment periods (SEPs), which provide individuals with opportunities to sign up for public exchange plans outside open enrollment, but also make it...

January 20, 2016
Aetna CEO Certain Humana Buy Will Close This Year

Aetna Inc. CEO Mark Bertolini on Jan. 12 said he remains certain the insurer’s deal to purchase Humana Inc. will close this year despite reports that 15 state attorneys general have joined the Dept. of Justice review of both the proposed Aetna...

January 19, 2016
CMS’s Slavitt Vows HHS Agency Will Crack Down on SEP Loopholes

CMS intends to tighten existing rules that allow people to sign up for health coverage outside of the official open-enrollment period. While special enrollment periods (SEPs) have helped boost exchange enrollment numbers, the broad parameters make...

January 15, 2016
Blues Plans Increased HMOs, EPOs on Exchanges for 2016

For the 2016 plan year, more than half of the products being sold on public exchanges by Blue Cross and Blue Shield plans are HMOs and exclusive provider networks (EPOs) — an increase of 41% from 2015, according to information released Jan. 13 by...

January 13, 2016
Aetna Projects Flat Exchange Enrollment

Aetna Inc. said it expects that enrollment in its individual plans will be "at least flat" for the first quarter of 2016, Credit Suisse equities analyst Scott Fidel said in a research note on Jan. 11. ...

January 13, 2016
Kentucky Gov. Moves to Shut Down State Exchange

Kentucky Gov. Matt Bevin (R) in a Dec. 30 letter to federal officials stated that he plans to dismantle kynect, the state’s public health insurance exchange, moving the state to the federal exchange for next year. The move would not affect the...

January 13, 2016
CMS Changes Could Aid Slow-Starting Duals Demo Growth in 2016

The focus in the ongoing CMS-backed demonstration for Medicare-Medicaid dual eligibles will begin shifting in 2016 from enrollment to actual results. And with that shift plus ongoing actions being taken by CMS’s Medicare-Medicaid Coordination...

January 11, 2016
More Than 11.3M Have Enrolled in Public Exchange Plans

HHS on Jan. 7 said more than 11.3 million people have enrolled in coverage on public exchanges across all 50 states and the District of Columbia. This marks the first time the agency has put out numbers for all the exchanges. ...

January 8, 2016
Can Blues Plans Bounce Back From Public-Exchange Challenges?

Several Blues plans say they lost money on the public health insurance exchanges in 2014. Blues plan operator Health Care Service Corp. (HCSC), for example, said it lost $382 million on exchanges last year. Some Blues plans fared better that...

December 30, 2015
SEP Enrollment Might Have Added to United’s Exchange Woes

After methodically expanding its presence on public insurance exchanges over the past three years, UnitedHealth Group stunned the industry Nov. 19 when it told investors that it might exit the exchanges entirely for 2017 due to deep losses. ...

December 11, 2015
Maine, N.H. CO-OP to Suspend Enrollment

Community Health Options, the Consumer Operated and Oriented Plan (CO-OP) serving Maine and New Hampshire, will suspend offering new individual coverage for the 2016 plan year before open enrollment for public exchanges ends Jan. 31, 2016....

December 10, 2015
UnitedHealth CEO Says Exchange Expansion Was 'Bad Decision'

At a Dec. 1 investor meeting in New York, UnitedHealth Group CEO Stephen Hemsley said his company should have waited longer before expanding its reach through public insurance exchanges. Hemsley told investors that it was, "for us, a bad decision,...

December 2, 2015
Colorado Access Exits Commercial Market

Colorado Access, a 501(c)4 nonprofit health plan, has confirmed that its subsidiary, New Health Ventures (dba Access Health Colorado), is not enrolling new members for 2016. The health plan will also cease offering Medicare Advantage plans next...

December 1, 2015
Land of Lincoln Withdraws From SHOP Exchange

Land of Lincoln, Illinois’s Consumer Operated and Oriented Plan (CO-OP), has stopped offering its small group policies on the state’s federal-partnership exchange, the health plan told AIS, confirming a *Chicago Tribune* article explaining the...

December 1, 2015
Columbia United Providers Withdraws From WA Market

Columbia United Providers (CUP) said it will stop offering any new or renewal individual health plans in the Washington state for 2016. Initially, the insurer was offering five plans on the state’s 2016 individual marketplace. ...

November 24, 2015
Advantage Health Solutions to Exit MA, SNP Market

Provider-owned insurer Advantage Health Solutions Inc. is terminating its Medicare Advantage products Dec. 31 under an agreement reached with CMS Nov. 4, according to the Indianapolis Business Journal. The publication also said that the Indiana...

November 23, 2015
Avera to Buy DAKOTACARE; Enrollment Would Approach 200K

Avera Health, owner of Avera Health Plans (MCO 352), says it will purchase DAKOTACARE (MCO 353), a move that would push the health system’s enrollment to nearly 200,000 members and make it South Dakota’s second largest insurer, Avera said in a...

November 19, 2015
N.Y. Regulators Will Shutter Health Republic on Nov. 30

The New York State Department of Financial Services (NYDFS) and the New York State of Health public insurance exchange are taking additional actions to protect people who have health coverage through Health Republic, one of a dozen Consumer...

November 11, 2015
Now 12 CO-OPs Won’t Be Back; Will HHS Help the Others Survive?

On Nov. 4, three days after the open-enrollment period began, the Michigan Dept. of Insurance and Financial Services announced Consumers Mutual Insurance, the state’s Consumer Operated and Oriented Plan (CO-OP), would run off its business and not...

November 5, 2015
Most New and Departing MA Plans in 2016 Are HMOs, KFF Study Finds

The vast majority (77%) of the 259 new Medicare Advantage plans for 2016 will be HMOs, according to an analysis released Oct. 14 by the Kaiser Family Foundation of the CMS “landscape files” for MA. Kaiser also found that 61% of the 203 exiting MA...

October 30, 2015
Aetna, Anthem Portray Rocky Road for ACA Exchange Lines

Aetna Inc. and Anthem, Inc. posted fundamentally strong third-quarter 2015 earnings, but both carriers raised concerns about the individual Affordable Care Act (ACA) marketplaces, which have developed a darkening cast about them in recent weeks. ...

October 30, 2015
Another CO-OP, Community Health Alliance, to Cease Operations

Community Health Alliance (CHA) has opted to wind down its operations and will not offer insurance coverage in 2016, the Tennessee Department of Commerce & Insurance (TDCI) and CHA announced on their websites. The insurer said it currently covers...

October 20, 2015
Oregon’s Health Republic Insurance the Latest CO-OP to Fold

Health Republic Insurance, one of Oregon’s two Consumer Operated and Oriented Plans (CO-OPs), said Oct. 16 it will not offer plans in 2016 and will cease operations effective Dec. 31, 2015. Following in the footsteps of two other recently...

October 20, 2015
Colorado DOI Shutters State’s CO-OP for 2016

The Colorado Division of Insurance (DOI) has closed Colorado HealthOP’s operations, preventing it from selling 2016 plans on the state’s health exchange. The DOI cited concerns about the Consumer Operated and Oriented Plan’s (CO-OP’s) financial...

October 20, 2015
Cigna Works Directly With SoCal Provider on New HMO, EPO Products

Mirroring moves made across the health plan-provider and employer-provider spectrum, Cigna Corp. said it formed a joint venture with Irvine, Calif.-based St. Joseph Hoag Health to offer Orange County employers integrated HMO and exclusive provider...

October 20, 2015
Aetna, Anthem CEOs Lay Out Case For Deals; Others Aren’t So Sure

Aetna Inc. CEO Mark Bertolini and Anthem, Inc. CEO Joseph Swedish appeared before a Senate Judiciary Committee panel on Sept. 22 to address antitrust concerns tied to their carriers’ pending purchases of Humana Inc. and Cigna Corp, respectively. ...

October 12, 2015
  • Timeline of CVS/Aetna Acquisitions, Joint Efforts

    An AIS Health graphic showing 10 years of market moves and joint ventures from Aetna and CVS.

  • 2018 Insurers on Federally Facilitated Exchanges

    A workbook examining insurers on 2018 federally facilitated exchanges on the individual market, by state, and their average deductibles and out-of-pocket limits, by metal tier.

  • Special Report: Top 10 Fastest-Growing Health Plans Thrive by Diversifying Product Lines

    A DHP analysis on the top 10 fastest-growing health plans with more than 1 million members.

  • DHP Sample Spreadsheets for Prospective Customers

    Sample workbook to demonstrate the data layout of the Enrollment Data Spreadsheets.xlsx document available as an instant In-App Download to DHP subscribers.

  • Exchange Insurers 2017 vs. 2018

    This worksheet allows you to see at a glance which insurers intend to enter, leave or expand their presence on each state’s exchange for 2018. This is a working document to be updated as more information becomes available.

  • DHP Analysis-Market Moves of Specific Organizations 2016-2017

    Rundown of acquisitions, market exits and entrances, and decisions made by specific organizations with regard to direction of the industry and changes to their own agendas. Compares 2017 edition to 2016.

  • Enrollment Data Spreadsheets

    Enrollment data spreadsheets correlating to the data in Chapters 2 and 3 of the 2017 edition.

  • Enrollment Field Hierarchy and Definitions

    Definitions of each enrollment field included in AIS's Directory of Health Plans, with a graphical representation of how the different enrollment categories relate to one another and which enrollment fields add up to which.

  • Publication Notes for 2017 Edition

    Full text of publication notes explaining caveats and major events affecting enrollment, since some of these notes may be truncated in the Online Search Results or Excel spreadsheets.

  • Mailing Lists

    Mailing lists of health plan executives.

  • Supplemental Spreadsheets

    Supplemental spreadsheets of parent organizations, subsidiaries, Medicare plans, PDP plans and ACOs related to the primary health insurance records in AIS's Directory of Health Plans.

  • Index of Health Insurance Entities

    Alphabetical index of all entities listed in AIS's Directory of Health Plans, including former names, aliases, affiliates, owners, subsidiaries and product names by which the plans are well-known.

  • Directory of Health Plans

    PDF of the full book as published for the 2017 edition.

  • Health Plans by State

    2,058-page PDF report of health plan listings by state, allowing a full view of all health plans participating in a particular state.

  • ACO Directory

    BONUS Excel spreadsheet of accountable care organizations and other value-based contract agreements entered into by health plans listed in AIS’s Directory of Health Plans, as well as CMS ACOs.

  • MCO ID Master

    For DHP users comparing DHP files on a year-over-year basis, this spreadsheet tracks all numbers assigned to health plan records in the MCO ID key field, starting with the first edition of AIS's Directory of Health Plans, published in 2004.

October Update: DHP Editors Update Search Engine with Revised Data

Your DHP editors last week made several updates to data in your subscriber dashboard. Several changes in enrollment resulted from substantial contract shifts and corrections, and new health plan executives and updated pharmacy benefit manager (PBM...

October 10, 2017
September Update: DHP Editors to Make Updates in the Coming Weeks

Your DHP editors would like to let you know that several updates will be coming in the next few weeks. There have been several changes in enrollment resulting from substantial contract shifts and corrections, as well as new health plan executives...

September 13, 2017
June Update: All Downloads Posted, New Report Added

DHP editors have posted all of the standard In-App Downloads containing data and supporting documentation for 2017. As we analyze the data, we have made numerous minor updates to the search engine data and spreadsheets, including a tweak to the...

June 14, 2017
AIS Health to Exhibit at AHIP Institute & Expo June 7-9

AIS Health will be manning a table at the AHIP Institute & Expo 2017 in Austin next week, and we would love a chance to meet any of our data subscribers who might be there—BJ Taylor, Erin Trompeter and I will be hanging out to offer tips on how to...

May 30, 2017
Medicare Fee-for-Service Enrollment Updated

Your DHP editors would like you to know that we've updated the Medicare fee-for-service (FFS) figures to eliminate potential overlap between FFS beneficiaries and members also enrolled in employer plans. This reduces the overall FFS figure by...

May 25, 2017
Welcome to AIS’s Directory of Health Plans 2017!

If you are accessing the DHP dashboard today, thank you for purchasing the 2017 edition of AIS’s Directory of Health Plans—Online version. The search tool is currently populated with 2017 data. Please note that we may continue to refine this over...

May 10, 2017
Open Enrollment Report Now Available

AIS editors have just posted a new report, 2017 Open Enrollment Results, in the In-app Downloads section. The report contains a table of the latest available public exchange enrollment reported for each state, along with a list of...

February 24, 2017
February Update: ACO Directory Updated; 2017 Research Cycle Begins

DHP editors have updated the **ACO Directory** In-App download to include the most recent accountable care agreements. Be sure to head to subscriber-only dashboard to see new value-based contracts between insurers and providers, including several...

February 13, 2017
DHP Examines What's Ahead For 2017

As public exchange participation deadlines hit, AIS editors have been tracking the latest market moves and exits. Even more insurers have announced exchange withdrawals following CMS’s Sept. 23 deadline, greatly reducing the number of options for...

October 11, 2016
DHP Examines Recent Market Moves That Will Impact Enrollment in 2017

Several recent developments will directly affect enrollment numbers in 2017. Molina Healthcare has agreed to purchase through all-cash transactions worth about $117 million “certain assets” related to Aetna’s and Humana’s Medicare Advantage (MA)...

August 9, 2016
Welcome to AIS's Directory of Health Plans Demo Dashboard

This demo database has been created with pretend data designed to simulate the live version of AIS's Directory of Health Plans, now populated with brand-new 2016 data. The data provided in the online search tool below is an approximate simulation...

June 17, 2016
2016 Data Is Now Available

It’s here! 2016 data is now posted for subscribers. Data reflects contracts being served during 2016. All In-App Downloads currently contain data from the new edition, and data in the search engine is updated to reflect the most recent figures. ...

May 13, 2016
AIS's Directory of Health Plans Now Available Online!

The powerful enrollment database used for years by health industry leaders for accurate market-share analysis can now be accessed online. *AIS's Directory of Health Plans*, aka "the bible" of the health insurance industry, is now available as an...

October 22, 2015