Highmark Loses $773M In ACA Plans

March 15--About 150,000 people abandoned health insurance plans they had bought from Highmark Inc. on the individual market -- including Obamacare plans -- for 2016, the insurer announced Tuesday.

Enrollment dropped from about 350,000 members for 2015 to about 195,000 members for 2016 for individual plans sold on and off the federal marketplace, said Alexis Miller, Highmark's senior vice president of individual and small group markets.

After setting some of the lowest premiums in the country for the federal marketplace's first two years, Highmark lost about $773 million on the plans as treatment costs blew past premiums. The people who bought the plans were older and sicker than people who have Highmark insurance through their employers, and more people picked Highmark plans on the marketplace than expected, Miller said.

"Our share in the market was considerably higher than we had anticipated in 2014 and 2015, and I think now what you're seeing is a market adjustment," she said.

About 53,000 people are enrolled in Highmark's individual plans in Western Pennsylvania, according to the insurer.

The enrollment total included changes from the Affordable Care Act's second open enrollment period, which ended Jan. 31. Highmark announced the total number of people who were enrolled and had made at least one premium payment since signing up.

Other insurers in the region have not released their equivalent enrollment numbers. A UPMC spokesman has said that its health plan gained a significant share of the Western Pennsylvania market for Obamacare plans but has not released specific numbers.

Highmark has taken aggressive actions to cut losses related to the federal marketplace plans, shrinking networks of hospitals and doctors, reducing or eliminating commissions for brokers who sell the plans, and reducing by 4.5 percent what it pays doctors to treat patients with the plans.

Highmark's total enrollment, including people with employer-based insurance and Medicare Advantage, was about 5.2 million people, said Tony Benevento, Highmark's senior vice president of regional markets. Benevento said that number shows Highmark retained 95 percent of members across markets.

Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676 or [email protected].

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