Commentary

Three things North Carolina consumers need to know about Aetna’s Marketplace exit

On Monday, the health insurance giant Aetna announced it would scale back its offerings on the Health Insurance Marketplace, where consumers can shop around for individual health insurance plans and qualify for financial help from the federal government to afford their coverage. While Aetna ostensibly cites high costs as the reason it is pulling back from 15 states to only four, new evidence shows the move may well be part of an attempt to bully the federal government into approving a pending business deal.

Regardless of the cause, Aetna will not be offering health insurance plans in North Carolina’s Marketplace in 2017, meaning that consumers in 39 counties will no longer see these plans on the Marketplace next year. Currently, Blue Cross Blue Shield of North Carolina has filed to offer plans in all 100 counties, and Cigna has filed to enter into six counties in the Triangle area.

So, what does all this mean for North Carolina consumers?

  1. Your Aetna coverage lasts until the end of the year, so keep paying premiums and getting care.

While Aetna is pulling back from the Marketplace for 2017, the plans it has sold for 2016 are still valid for the rest of the year. If you’re enrolled in a plan from either Aetna or Coventry Health Care of the Carolinas (which is owned by Aetna), you should keep paying your monthly premiums and continue to access the health care services and prescription drugs you need through the end of the year.

  1. Financial help from the Marketplace will protect you from any premium increases next year.

This year, 91.5% of North Carolinians who have Marketplace plans were able to qualify for financial assistance that lowers the cost of their monthly premiums. These subsidies, called premium tax credits, change every year to make up for changes in the premiums of plans available on the Marketplace. While media coverage tends to focus on the gross change in premiums from year to year, most enrollees don’t experience big changes in premiums thanks to their premium tax credits.

  1. Starting on November 1, you can shop around for affordable coverage for 2017.

The Open Enrollment period for 2017 coverage from the Health Insurance Marketplace starts on November 1, 2016. Whether you had a plan from Aetna, UnitedHealthcare (which also will not offer NC plans in 2017), or Blue Cross Blue Shield of NC, you can go back to the Marketplace by visiting www.HealthCare.gov or calling 1-800-318-2596 to shop around for your new options. Thanks to premium tax credits, as well as a benefit that lowered out-of-pocket costs for two-thirds of North Carolina enrollees this year, you’ll still be able to find coverage that fits your budget and meets your needs.

Don’t forget—free, expert in-person enrollment assistance is available from navigators and other assisters. You can call 1-855-733-3711, use the Get Covered Connector, or visit your local Community Health Center to schedule an appointment with an experienced assister who can help you understand and navigate your options.

One Comment


  1. Gailya Paliga

    August 24, 2016 at 9:44 am

    I agree with this, and hope the government starts taking these insurance companies to task – http://www.latimes.com/business/hiltzik/la-fi-hiltzik-obamacare-hardball-20160809-snap-story.html

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