Anthem drops individual coverage in Wisconsin

Blames volatile and unpredictable market


Anthem Blue Cross and Blue Shield announced today it is dropping individual coverage in Wisconsin next year.


Individual insurance plans cover those who do not receive health insurance through their employer or a federal program. It is purchased through the Affordable Care Act’s marketplaces, and often covers the self-employed, lower-wage workers and early retirees.

Exceptions to Anthem’s coverage change are an off-exchange medical plan in Menominee County, as well as those who purchased grandfathered transitional individual or family health plans before December 2013. The change does not impact employer-based, Medicare Advantage or Medicaid plans.

Indianapolis-based Anthem Inc. has offered individual health insurance for more than 70 years, but said the volatile and unpredictable individual market in Wisconsin since the Affordable Care Act was introduced forced it to discontinue coverage.

Its members who have an individual or family plan will have coverage through Dec. 31.

“A stable insurance market is dependent on products that create value for consumers through the broad spreading of risk and a known set of conditions upon which rates can be developed,” the company said in a statement.

“We are pleased that some steps have been taken to address the long-term challenges all health plans serving the individual market are facing, such as improving the eligibility requirements that allow consumers to purchase a plan outside of open enrollment and improved risk adjustment. However, the Wisconsin individual market remains volatile, making planning and pricing for ACA-compliant health plans increasingly difficult due to a shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance, including cost sharing reduction subsidies and the restoration of taxes on fully insured coverage.”

“As the Wisconsin individual market continues to evolve, Anthem will continue to advocate solutions that will stabilize the market to allow us to return and offer consumers in Wisconsin individual health plan solutions in the future.”

Wisconsin Gov. Scott Walker said Anthem’s decision shows the Affordable Care Act is failing.

“Obamacare is collapsing,” Walker said in a statement. “Growing uncertainty in the health insurance market was created by Obamacare’s costly regulations and it is causing higher premiums and a lack of options. If we do nothing, more companies will back out and more people will lose coverage. Wisconsin families expect and deserve better health care coverage options and the time to act is now.”

Several insurance companies have made moves similar to Anthem, including Louisville, Kentucky-based Humana Inc. which discontinued its individual major medical insurance plans in Wisconsin beginning in 2017.

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Molly Dill, former BizTimes Milwaukee managing editor.

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