BISMARCK, N.D. — Medica plans to leave North Dakota’s health insurance exchange in 2018, but coverage will remain available through two other insurers, the state’s insurance commissioner said Thursday.
Commissioner Jon Godfread said Minnetonka, Minnesota-based Medica does not intend to sign an agreement with the federal government to offer individual health insurance through the North Dakota exchange next year.
Medica cites the uncertainty over cost-sharing reductions under the Affordable Care Act, Godfread said. The federal government makes those payments to insurance carriers to help low-income customers with out-of-pocket costs, such as co-payments and deductibles.
The company originally decided to file rates in North Dakota with funding for cost-sharing reductions included, but then requested that the North Dakota Insurance Department approve premium rates for 2018 assuming those would not be paid. The department said that would have led to an additional increase in those rates, on top of Medica’s initial rate increase. The department declined to approve those rates.
Without knowing what Congress planned to do with cost-sharing reductions, Godfread said his department had to move forward with rates that assumed those payments would be made. If the department approved Medica’s rates without those payments, and Congress does fund the payments, the commissioner said it was unknown if the department could then reduce the rates to reflect the change.
“With this in mind, the Department felt it was our responsibility to err on the side of caution and protect North Dakota consumers from any unnecessary increases,” Godfread said in a statement. He noted that North Dakotans who buy health insurance on the federally run exchange will now have fewer options.
With federal deadlines approaching, Medica said the insurer and the Insurance Department had to be make decisions “without clarity being provided,” and that Medica “could not be put in the position of being financially liable” if the federal government fails to fund cost-sharing reductions. The company said it remains hopeful it could be available on North Dakota’s exchange next year if the federal government provides clarity.
Medica provides coverage for 3,073 individuals of the 20,691 on North Dakota’s exchange. Blue Cross and Blue Shield of North Dakota, the largest provider, and Sanford Health Plan still will be available, Godfread said.