Aetna will pull out of the 10 counties in Kentucky where it offers health insurance via the state health exchange starting in 2017.
The company reported Monday that it lost $430 million since January 2014, when Kentucky and many other states opened their insurance exchanges. Aetna said it would continue to offer small group and off-exchange individual coverage in some Kentucky counties next year.
Aetna is leaving exchanges in 11 states.
Under the Affordable Care Act, insurers selling on the exchanges must offer policies to consumers regardless of any pre-existing health conditions. Consumers are also allowed to cancel their policies at any time, which insurers have said caused financial headaches.
In addition, the cost of some policies sold on the exchange is offset by federal subsidies.
“If they’re currently receiving government subsidies that may not continue with an off-exchange product,” said Aetna spokesman Rohan Hutchings.
Aetna will notify current policyholders before open enrollment in November that their coverage will be discontinued. The company will offer those consumers off-exchange options.
The company said pulling out of the exchange is a financial decision.
“Lots of that magnitude couldn’t continue for subsequent years so we had to make a decision on reducing costs,” Hutchings said. “We had to make structural changes facing the public exchanges. We can’t responsibly maintain our footprint.”
The departure leaves consumers in Boone, Campbell, Owen and Kenton counties with only two exchange plans. Other counties affected are Fayette, Jefferson, Madison, Henry, Oldham and Trimble.
Consumers will have fewer choices and may also face dramatically increased premiums. For instance, the Kentucky Department of Insurance approved 2017 insurance rate increases of up to 22.9 percent for Anthem Health Plans, 27.9 percent for Baptist Health Plan customers and 47.18 percent for Golden Rule Insurance company customers.
Off-exchange plans still have to meet the Essential Health Benefit requirements in ACA, such as mental health, substance abuse, emergency and prescription drug coverage. But-off exchange plans can only base premiums on geography, family size, age and tobacco use.
Subsidized coverage — offered to people earning up to 400 percent of the federal poverty level (about $47,000 for an individual or $97,000 for a family of four) — is available only via the public exchanges.
Aetna is currently trying to buy Louisville-based insurer Humana. The $37 billion deal is the subject of a lawsuit from the Justice Department.
