UPDATED: WINhealth Partners Withdraws from Federal Marketplace

CHEYENNE, WY - On October 8, 2015, WINhealth Partners notified the Center for Medicare and Medicaid Services (CMS) that WINhealth is voluntarily withdrawing from the federal health insurance exchange.

WINhealth insurance plans will remain in effect for the remainder of 2015 but will not be available on the Marketplace for 2016.

“WINhealth has faced financial challenges in the health insurance market, so this announcement did not come as a surprise to the Department,” said Insurance Commissioner Tom Glause. Numerous meetings and discussions have been held between WINhealth and the Department. Ultimately, WINhealth’s Board of Directors voted to exit the federal marketplace and the Department of Insurance has increased its regulatory oversight.

WINhealth policies purchased through the Marketplace will remain in effect through December 31, 2015, so long as consumers pay their premiums. WINhealth is cooperating with the Department. “Consumers can see medical providers under their 2015 plan and continue to get the healthcare they need,” said Glause.

Consumers will have an opportunity to choose a new insurance plan during the Open Enrollment period - November 1, 2015 through January 31, 2016 for plans that will operate in the 2016 year. Consumers are encouraged to enroll in a new plan before December 15, 2015 to have coverage in place by January 1, 2016 and to avoid a break in insurance coverage.

The Wyoming Department of Insurance protects the rights of Wyoming consumers and regulates Wyoming’s insurance industry. For assistance and questions regarding the WINhealth transition, contact the Department of Insurance by email at: WINassist@wyo.gov or visit the Department of Insurance website at: www.DOI.WYO.GOV.

WINhealth sent along this release saying: As of October 8, 2015, WINhealth has chosen not to participate in the individual market, to include the federal exchange, for the 2016 plan year. The decision not to participate stems from a recent announcement from the federal government regarding the risk corridor program.

According to the Centers for Medicare and Medicaid Services CMS), “The goal of the risk corridor program is to support the Marketplaces by providing insurers with additional protection against
uncertainty in claims costs during the first three years of the Marketplace. The temporary risk corridor program provides payments to insurance companies depending on how closely the premiums they charge cover their consumers’ medical costs. Issuers whose premiums exceed claims and other costs by more than a certain amount pay into the program, and insurers whose claims exceed premiums by a certain
amount receive payments for their shortfall.”

This recent development from CMS came as a surprise to WINhealth. The financial impact of the federal government’s decision on WINhealth amounts to approximately $4.4M. The ambiguity of federal government repayments, both in timeline and amount, have created an environment of uncertainty and increased risk in the individual environment. For this reason, WINhealth has chosen not to participate in the individual market for 2016.

WINhealth’s President & Chief Executive Officer, Stephen Goldstone, stated “The federal government’s decision to significantly reduce the reimbursement we would receive under the risk corridor program
came as a complete surprise to WINhealth. This combined with the continuous delays in repayment has caught WINhealth flat-footed with no choice but to turn down participating in the exchange for 2016.”

Current WINhealth individual members will continue to have coverage through December 31, 2015, so long as they continue to pay their monthly premiums. Open enrollment begins November 1, 2015. All
individual members will need to choose a plan through a new insurance carrier between November 1, 2015 and December 15, 2015 for a plan that starts on January 1, 2016. Current WINhealth individual members can look at their options through the federal exchange by visiting healthcare.gov. Should WINhealth members have any questions about their current plan, they should contact WINhealth directly or their broker/agent. Should members have any questions regarding Open Enrollment, they should contact healthcare.gov or Enroll Wyoming.