WINhealth Won’t Participate in Individual Market in 2016

WINhealth announced today in Cheyenne that it will not participate in the individual market, including the federal exchange for the 2016 plan year.

This means those who have purchased WINhealth individual plans will have coverage through Dec. 31, 2015 as long as they pay their monthly premiums. Those individual members will then be required to choose a new plan through a new insurance carrier during the next enrollment period of Nov. 1-Dec. 15. Clients of WINhealth will still need a qualifying event in order to change plans before the open enrollment period.

Those who have WINhealth Insurance plans which were purchased through a group sale (such as employer-provided insurance) will not be impacted, according to WINhealth’s Director of Marketing, Communications and Community Relations, Caitlin Rooney.

According to a WINhealth news release, the decision not to participate stems from a recent announcement from the federal government regarding the risk corridor program and its decision to significantly reduce the reimbursement WINhealth would receive under the risk corridor program. WINhealth estimate the change would cost it $4.4 million.

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.”