Durham on list for Coventry heath plans sales

Sep. 25, 2013 @ 04:58 PM

Durham and other Triangle counties are on the list of where a second health insurer plans to sell insurance through North Carolina’s federal health exchange, which is launching Tuesday as part of the federal health care overhaul.
A spokesman confirmed Wednesday that Coventry Health Care of the Carolinas health plans will be sold in 39 counties through the exchange. The list of counties includes Durham as well as Chatham, Alamance, Orange, Person and Wake.
That means two insurers that plan to participate in the exchange in the state, alongside Blue Cross and Blue Shield of North Carolina, the state’s largest insurer. Blue Cross plans to sell insurance in all 100 of the state’s counties.
A third insurer, FirstCarolinaCare Insurance Co., withdrew its plans to sell on the state’s exchange. A subsidiary of a Pinehurst-based health system, the insurer had planned to sell plans on the exchange in six counties in the system’s service area.
While it will be Coventry plans that will sell on the exchange, the insurer has since been acquired by Aetna Inc.
The companies, acting separately, had submitted plans to sell insurance on the exchanges of several states prior to the acquisition.
In North Carolina, all plans sold on the exchange are Coventry plans while in others, some originated with both, said Walt Cherniak, a spokesman for Aetna.
The acquisition was a factor in the company’s decision to withdraw from exchanges in some states, Cherniak said, as part of an “ongoing review” of Aetna’s overall strategy.
Aetna has withdrawn from exchanges in Maryland, Georgia, New York, Louisiana, West Virginia and Idaho.
He said the company is looking to participate in exchanges in states where it can be the most competitive and also “deliver the greatest value to our customers.”
“We focused on our market presence in each state, how successfully we could work within the state’s regulatory environment, and if we had a market-leading cost structure and could influence care management effectively,” Cherniak said.
Adam Linker, a health policy analyst at the N.C. Justice Center, a Raleigh-based group that advocates for low-income people, said he believes Coventry “had some success” in negotiating contracts in some of the state’s urban areas. But he said he expects there to be limited competition in other parts of the state in the first year.
“Hopefully we’ll have a little bit more competition in the second year,” he said.
The exchange launches Tuesday as part of President Obama’s health care overhaul.
Next year, federal law will require people to have insurance or face a penalty.
To help people pay for coverage, federal subsidies will be available for people within a certain range of the federal poverty limit in the form of tax credits.