Community Health Options, a Lewiston-based health insurance cooperative, has gotten approval to withdraw from the New Hampshire insurance market in 2017.
The plan was approved this week by the Maine Bureau of Insurance, which has been monitoring CHO’s finances as it tries to recover from a $31 million loss in 2015. The nonprofit cooperative has set aside more than $45 million in reserves to try to avoid another big loss this year.
In 2014, CHO was the only cooperative in the nation set up to operate under the Affordable Care Act to turn a profit. But as it expanded in 2015, including a move into the New Hampshire market, its losses snowballed.
As of July 31, the insurer had 11,438 customers in New Hampshire and 65,188 in Maine. It has about 72 percent of the individual insurance market in Maine.
“Withdrawal from New Hampshire will allow Health Options to focus on its primary market in Maine and on rebuilding its reserves,” Maine’s insurance superintendent, Eric Cioppa, said in a statement announcing the decision. “In the past year, the company has worked to reduce expenses, improve operations and better align premium rates with claims experience. Consolidating their business is expected to further improve the company’s stability.”
“We really need to focus our capital on where we really have the lion’s share of our customers,” said Kevin Lewis, chief executive officer of CHO.
By pulling out of the New Hampshire market, the cooperative will simplify its operations and allow it to react to events quicker, Lewis said. “It’s really helping to deal with anything that might come around the corner,” he said.
Cioppa said New Hampshire’s insurance regulators, along with the Centers for Medicare and Medicaid – the federal agency that oversees the ACA insurance marketplace – have also approved the plan. The New Hampshire Insurance Department commissioner, Roger Sevigny, said the state is open to CHO trying to return to the New Hampshire market in 2018.
CHO’s individual New Hampshire customers will need to find a new insurer when open enrollment begins on Nov. 1. They will receive letters from CHO explaining the process. Those letters will go out next week, CHO officials said.
Those covered under the insurer’s group plans in New Hampshire will be covered until their plan’s renewal date. No new group plans will be sold for 2017 and the insurer won’t renew existing group plans in New Hampshire after October.
Lewis said individual New Hampshire customers who prefer working with a nonprofit cooperative will be able to sign up with Minuteman, an insurer based in Massachusetts. There are also three other insurers who participate in the Granite State’s marketplace.
“It’s a pretty good field of competition in New Hampshire,” he said.
And it’s possible that CHO will re-enter the New Hampshire market a few years down the road.
“Hopefully, we’re leaving on the best of terms,” Lewis said.
In its latest update on CHO’s finances, the bureau said the cooperative is continuing to track closely to the plan laid out at the beginning of the year to restore its financial stability. It posted its second quarter results Wednesday.
Paid and incurred claims were both lower than the plan expected in July, and expenses were slightly higher than the plan for the month, but are lower on a year-to-date basis. The cooperative’s net loss for the month was 13 percent better than the plan, but is 5.6 percent worse for the year to date.
“In summary, CHO’s reported year-to-date results for 2016 business and operations through the first seven months of 2016 were generally consistent with its plan,” the bureau concluded.
Edward D. Murphy can be contacted at 791-6465 or at: