Failing or Doing Fine?
How Obamacare’s Marketplaces Are Shaping Up for 2018

By Hannah RechtHannah Recht

Competition in Pennsylvania Stays Steady

Pennsylvania released 2018 insurer filings today, and assuming the Affordable Care Act remains law, all of the state's marketplace companies plan to return next year. As typically happens, a few companies made minor changes in the counties they'll serve. Competition in the state remains strong—95 percent of Pennsylvania enrollees will have a choice between two or more companies next year.

2018 Marketplace Participation

Every summer, insurance companies are required to submit their Affordable Care Act marketplace plans for the upcoming year to state insurance agencies. Companies are still deciding where to offer plans in 2018—and how much to charge for them. Each year some companies exit, some expand and others stay put. Bloomberg News is analyzing these filings as they’re released and speaking with insurers and state agencies to learn how the marketplaces are shaping up for 2018.

Based on the latest data, most of the 12 million people who got health insurance through Obamacare’s individual marketplaces will have the same number of companies to choose among next year as they did in 2017. These maps will change as insurers finalize their plans before signing contracts in the fall.

Change in Number of Insurers From 2017
↓ Decrease
↑ Increase

Most marketplace enrollees had multiple insurance companies to choose among this year, and most will again in 2018. In 2017, 83 percent of enrollees received help paying their premiums.

In four Indiana counties, parts of Ohio and rural Nevada, no insurer has yet filed or publicly announced plans to sell marketplace plans. About 25,000 people enrolled in marketplace plans in these so-called “bare” counties in 2017. Insurance departments in each state are working to convince companies to re-enter those areas.

Number of Marketplace Insurers for 2018

Previous Updates

Medica Expands in Wisconsin, Dakotas Keep Their Companies

Today is the deadline for insurance companies to file their 2018 plans in Wisconsin. One company, Medica, announced today that they’ll offer plans in 21 counties next year, eight more than they offered this year. A spokesperson for the company also confirmed that they’ll continue selling in the same counties in Minnesota, North Dakota, Nebraska and Iowa.

Bloomberg News has also confirmed that coverage options in North Dakota and South Dakota won't change next year. Spokespeople for Sanford Health Plan and Avera Health Plans in South Dakota confirmed that each will continue to sell marketplace plans statewide. In North Dakota, Sanford and Blue Cross Blue Shield will continue selling statewide while Medica will continue selling in 49 counties there, according to spokespeople for the companies and the North Dakota Insurance Department.

2018 Marketplaces Take Shape

Proposed marketplace offerings for the next year typically fluctuate until states and companies set final plans in the fall. Ongoing efforts to repeal Obamacare are adding even more uncertainty for 2018. In their filings, many companies have also noted that the Trump administration’s non-enforcement of the individual insurance mandate and uncertainty over the continuation of cost-sharing subsidies have caused substantial rate increases for next year. Several companies also wrote in their filings that if cost-sharing subsidies are not funded they will withdraw from the marketplace entirely.

Major Exits and Expansions

A few multistate companies have announced that they won’t be returning next year. Humana is exiting the individual market in the 11 states where it currently sells plans. Aetna is also leaving the few states where it sold marketplace plans in 2017, but will begin selling marketplace plans in parts of Nevada.

Anthem, which sells under the Blue Cross Blue Shield brand, is exiting the marketplace in Ohio, Indiana, Wisconsin and most of Nevada but will continue to sell marketplace plans in several other states.

Still, some companies plan to expand their coverage next year. Centene, which sells under brands including Ambetter, Celtic and Health Net, announced in June that it would sell Affordable Care Act plans in three additional states: Kansas, Missouri and Nevada. The company also said it will expand in six states where it already offers Obamacare plans: Florida, Georgia, Indiana, Ohio, Texas and Washington. Centene will be exiting Massachusetts, however, citing low enrollment.

We don’t yet know where Centene plans to expand in Florida, Texas or Ohio.

Centene 2018 Footprint: What We Know
Existing service area
New in 2018
Expanding, new counties not yet public

Oscar Insurance Corp., which currently sells marketplace plans in parts of New York, California, and Texas, also announced plans to enter several states and expand in California and Texas.

What We’re Watching

As of mid-July, there are about 25,000 people living in counties where no marketplace insurers signed up to sell plans next year. Company decisions are still in flux, and this number will likely change multiple times before open enrollment begins.

Earlier this year, it looked like parts of Tennessee and parts of Missouri could also be so-called “bare” counties, but Blue Cross Blue Shield of Tennessee and Centene, respectively, later filed to sell in those areas. In previous years, every county has had at least one insurance company selling marketplace plans by the time open enrollment began in the fall.

We’re watching Nevada closely. Four companies filed to sell plans this year in Clark, Washoe and Nye counties - where 91% of the state’s enrollees live. No companies filed to sell plans in the other 14 Nevada counties, where about 8,000 people total enrolled in marketplace plans this year. Earlier this summer, the state legislature passed a "Medicaid-for-all" bill that would allow people to buy Medicaid coverage on the state exchange beginning in 2019, but Republican Governor Brian Sandoval vetoed that plan.

There are also 20 counties in Ohio that may have no insurers lined up after Anthem, Humana and Premier Health Plan announced their exits from the state. According to a spokesperson for the Ohio Department of Insurance, no companies have filed to sell in those 20 counties as of July 12, but companies still have time to revise their plans. Ohio will release 2018 filings after final determinations are made in August.