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California health insurance    Health Exchange in California    Aetna Leaves Market

Aetna To Leave the California Individual and Family Market

We wrote last week on the California Health Exchange's list of participating carriers for the individual market and there were some notable exceptions.

One of those carriers, Aetna of California, officially notified the public and their current individual membership that they will no longer participate in the Individual market in California.

Let's take a closer look at their statement and what it means for their members and California individuals and families.

The official statement from Aetna

We'll boil down the key points of their statement.

Starting July 1st, Aetna will no longer offer their Advantage plans for individuals, families, and self-employed Californians.

Applications which request effective dates Aug 1st or after will be closed at this time. Any application that is still in process as of June 24th, 2013 (no matter what effective date is requested) will also be closed.

This means that applications finalized before June 24th with a requested effective date prior to August 1st will likely be extended coverage (if approved) but only temporarily as we'll see in the next paragraph.

Effect on existing Aetna IFP members

All existing Aetna IFP members including the recent additions mentioned above will be allowed to remain on their policy till Dec 31st, 2013 after which, their coverage will end. This times exactly with the start of the Health Exchange plans on the market Jan 1st 2014 which are guaranteed issue (no qualification is required based on health). A member can cancel their coverage between now and Dec 31st, 2013 by contacting member services (number on back of ID card). We'll have the new rates and benefits available October 1st for Exchange and non-Exchange plans available from all the major carriers for Jan 1st effective dates.

We'll notify via our Facebook feed when the new rates are available.

The cancellation of coverage and participation of the market described above does not apply to Aetna's California Group health insurance or Medicare offerings.

So that's the official newsfeed...what's our take on it?

Our take on Aetna's notification

Ultimately, Aetna's market share for the California IFP market was slightly greater than 5% so they're not a huge player in the market but they are one of the big, nationwide health insurance carriers which is unsettling.

 Their are four major carriers participating in the California Exchange (Anthem Blue Cross, Blue Shield of California, Kaiser, and Health Net) plus many regional players. We've been around the health insurance market long enough to also remember what big fans Aetna's leadership was about Health Reform only to have them not participate in the largest marketplace (California) which is disconcerting.

The other issue is that anyone with a Grandfathered Status will lose that protection which can mean very large increases in premium if they don't qualify for health subsidies.

There's a chance that Aetna will wait out the first year to see how it all settles down but a cynic might also say they want to avoid the more high risk applicants that will flock to the program Jan 1st, 2014 at initial enrollment. Time will tell.
If you're a Aetna member
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