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Changing landscape: Fewer PPOs, CO-OPs in marketplace plans


Consumers are likely to see some major changes as they shop for a health insurance plan with the opening of the Affordable Care Act's third open enrollment period.

For one, there will be fewer Preferred Provider Organizations (PPOs) on the exchanges in 2016, according to an analysis by the Robert Wood Johnson Foundation. Two-thirds of the insurance companies offering PPO plans last year on the marketplaces have either reduced the number of these plans they offered or will stop offering them at all in 2016.

The analysis found that in 22 states with insurance exchanges, PPOs were dropped or reduced, either because companies left the market or discontinued their PPO plans.

And of course, consumers in some states will find their consumer operated and oriented plans (CO-OPs) have shut down and are no longer an option. The number of insurance choices is changing in some parts of the country, with the exit of CO-OPs and the withdrawal of some larger insurers such as Blue Cross Blue Shield of New Mexico, according to an analysis of insurer participation in the marketplaces in 2016 by the Kaiser Family Foundation.

Despite the withdrawals of some plans, the KFF analysis notes the Department of Health and Human Services has said the average number of insurers per state is increasing slightly in 2016 and that nine out of 10 consumers on the federal exchange will have three or more insurers to choose from. That's true for residents in most counties in states using Healthcare.gov, the analysis found.

But it also found that 40 percent of counties on Healthcare.gov will have just one or two insurers, an increase from 35 percent in 2015. Three insurers is considered the minimum necessary for market competition, so consumers in those counties may not benefit from competition to hold down premiums or offer plans with better value, the analysis states.

And as FierceHealthPayer previously reported, many insurers are altering their plan offerings in 2016 amid the challenges of the exchange market. In all, the number of plans available on the federal marketplace may decrease by as much as 12 percent.

To learn more:
- read the Robert Wood Johnson Foundation analysis
- check out the Kaiser Family Foundation analysis

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Insurers may have lost $4B on Affordable Care Act plans in 2014
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