Some payers expanded this year to reach half of the U.S. population, while others were forced out of business in some states altogether. Here are seven recent payer moves to enter or exit markets:
Texas orders payer to cease all operations
Salvasen Health is out of business in Texas after the state's insurance department ordered the Houston-based payer to stop selling health plans April 26. The order was effective immediately and was issued to owner and CEO Barry Glenn because the company was selling plans without a state license. Salvasen and Mr. Glenn are banned from applying for a Texas insurance license for 10 years. Salvasen marketed health insurance products across the country and sold about 65,000 unauthorized health plans. In March, the payer was banned from Wisconsin after selling health plans that were not ACA-compliant. Minnesota and Nevada have also taken actions against the company.
Harvard Pilgrim Health Care exits Connecticut
Harvard Pilgrim Health Care is ceasing operations in Connecticut after 2022. The Canton, Mass.-based payer sent an email to brokers and stakeholders April 19 saying its parent company, Point32Health, is withdrawing commercial plans from the state. Coverage for over 12,000 members will continue until their contracts end, but Harvard Pilgrim will no longer quote and sell new commercial policies. Harvard Pilgrim first entered Connecticut about a decade ago, hoping to win market share with its nonprofit model. The payer merged with Tufts Health Plan in 2021 to form Point32Health.
Bright Health to exit 6 states
Bright Health said April 14 it will no longer offer individual and group health plans after 2022 in Illinois, New Mexico, Oklahoma, South Carolina, Utah and Virginia. The six states are forecasted to contribute less than 5 percent of the company's total annual revenue.
Sidecar Health enters Illinois, now reaches half of US
El Segundo, Calif.-based Sidecar Health expanded into Illinois in early March. The nontraditional payer arms members with a benefits credit card that they can use to pay the cash price for care. The company's entry into Illinois marks the 18th state in which it offers coverage, providing half of the U.S. population with access to its plans.
UCare looks to expand into Iowa
Minneapolis-based UCare said in early March it would bid on a contract that would allow the health plan to manage care for a large group of beneficiaries in Iowa's Medicaid program. UCare will compete for a contract with Iowa that Anthem subsidiary Amerigroup currently holds, which covers more than 400,000 people. Contracts are expected to be awarded this summer, and coverage for beneficiaries would start in July 2023. UCare said its Iowa expansion would start with Medicaid, but it is also considering adding Medicare and commercial plan offerings.
Humana's CenterWell Senior Primary Care to expand to 12 state markets
Humana subsidiary CenterWell Senior Primary Care is expanding into 12 states, the company said Jan. 20. Between 2022 and early 2023, CenterWell will create an additional 26 care centers and enter Arizona, Kentucky and Tennessee for the first time. Humana plans to grow the primary care organization by 40 to 60 centers, bringing the total up to 260 locations between CenterWell and Conviva.
Medica paid over $230M for majority stake in Wisconsin payer
Medica paid nearly $233 million in 2021 to buy a 55 percent stake in Madison, Wis.-based Dean Health Plan. Dean Health Plan has nearly 500,000 members across Wisconsin, Missouri, Illinois and Oklahoma. Medica serves about 1.5 million members. The deal closed in December and extended Medica's existing operations in Missouri and Wisconsin, while adding a few counties in Illinois near St. Louis. Medica also began selling individual plans in 2022 in Phoenix and a Medicare plan in parts of Wyoming, bringing the payer's overall service area to 12 states.