Why Geisinger’s health plan stays on the ACA exchange


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Danville, Pa.-based Geisinger Health Plan has maintained a steady presence in Pennsylvania’s individual ACA exchange, despite other insurers leaving the state’s marketplace.

Over the last two years, a number of U.S. insurers decided to exit states’ ACA exchanges, citing financial losses as well as concerns regarding future stability of the individual market. Pennsylvania’s individual ACA exchange is no exception. Hartford, Conn.-based Aetna, for instance, pulled out of ACA exchanges for 2017 in 11 states, including Pennsylvania. Additionally, Minnetonka, Minn.-based UnitedHealthcare left ACA exchanges in Pennsylvania and nearly 30 other states for 2017.

Ultimately five insurers remained on Pennsylvania’s individual ACA exchange for 2017 and will remain in the market for 2018 — Geisinger Health Plan, Pittsburgh-based UPMC Health Plan, Harrisburg, Pa.-based Capital BlueCross, Philadelphia-based Independence Blue Cross and Pittsburgh-based Highmark.

Because some insurers left the state’s individual ACA exchange, Geisinger Health Plan experienced an increase in membership, says Kurt Wrobel, the plan’s CFO and chief actuary. The plan currently has 47,000 members, up from more than 30,000 in 2016. About 60 percent of the plan’s enrollment is individuals with Medicaid, Medicare or plans on the state’s individual ACA exchange.

Geisinger Health Plan also requested a rate increase for 2018 that it says is consistent with other insurers in the state. According to the Pennsylvania Department of Insurance, the five insurers that will continue selling on Pennsylvania’s individual ACA exchange for 2018 requested average statewide rate increases of 8.8 percent for individual plans.

Regarding Geisinger Health Plan’s choice to stay on the ACA exchange in Pennsylvania, Mr. Wrobel says it comes down to Geisinger’s commitment to the people of central Pennsylvania. “As a nonprofit, our primary stakeholders are the people, so with that we’re going to have a different calculation as far as our interest in staying in a program. While policy improvements are still needed, we’ve stayed in the program and we believe it’s workable as it stands now.”

One significant advantage Geisinger Health Plan has is its connection with Geisinger Health System. Geisinger Health Plan representatives said that connection allows it to develop programs such as care management programs for members, and many of the plan’s case managers work directly with physicians’ offices to provide more support and connectivity to members’ physicians.

“We think that’s a really clear differentiator. Within that, we have more robust care management systems and programs that allow us to control costs and improve outcomes, especially relative to traditional insurance companies,” Mr. Wrobel says.

As far as the future, the health plan will remain on Pennsylvania’s individual ACA exchange as long as it has a workable program.

Mr. Wrobel says Geisinger Health Plan wouldn’t rule out expanding to ACA marketplaces in other states at some point, but it’s not a high priority right now.

Overall, without the elimination of cost-sharing reductions, which help insurers subsidize the cost of coverage for low-income Americans, Mr. Wrobel believes Geisinger Health Plan could see greater stability moving forward.

“It’s our hope we can move beyond discussions, beyond all the financial issues with the program and really get to the meat of what we try to do as a health plan, which is provide cost-effective quality care,” he says. “I think we all look forward to the day when there’s sufficient stability — and that’s what we have in the Medicare and Medicaid program as well as the employer group program — where the focus is on that operational excellence of providing cost-effective quality care and we can move beyond these discussions about financial issues.”


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