MNsure prepares for consumer puzzles in the individual market

The maddening chore that faces many health insurance shoppers this fall means that one-on-one help for consumers will be more important than ever.

Premiums are spiking. Doctor and hospital networks will be limited. And a new limitation called "enrollment caps" means that health insurance options could disappear at some point during the coming open enrollment season.

The troubles apply only to the individual market where about 5 percent of state residents purchase coverage, yet they are stoking debate on the campaign trail this fall and prompting some lawmakers to call for a special session of the Legislature. On Thursday, DFL legislators plan to hold a news conference to urge Gov. Mark Dayton to call such a session.

The changes create new challenges for a MNsure system that has had troubles in the past, but health exchange officials said Wednesday that they are prepared.

"We stand ready to help," said Allison O'Toole, the MNsure chief executive, following a board meeting in St. Paul. "More than ever, this year I think it's really important that people get help, because there are so many changes."

The problems don't apply to people with health insurance from their employer, or to those in government programs like Medicare.

The individual market, where 250,000 state residents purchase coverage, is undergoing sweeping change with the federal Affordable Care Act, which eliminated preexisting condition exclusions that insurers relied on to contain costs. Since the change kicked in during 2014, insurers have struggled to make the business profitable, and some have dropped out as a result.

To control costs, all health plan options in the market will feature limited networks of doctors and hospitals. Four of five health plans that sell individual coverage have enrollment caps for 2017 that limit their potential for further financial losses.

Losses drove Blue Cross and Blue Shield of Minnesota, the state's largest insurer, to dramatically scale back its presence in the market. Previously, the company's coverage featured a broad network of the sort where shoppers don't have to think much about whether their doctors or hospitals are in-network.

Next year, Blue Cross will sell coverage to individuals only through its Blue Plus HMO. And that's the one offering that won't have an enrollment cap.

"Because of the small number of available 'slots' for most health plans, many people will be required to purchase coverage from the narrow network Blue Plus plan," wrote Lynn Blewett, a health policy researcher at the University of Minnesota, in an online article published this week by the journal HealthAffairs.

"There are already concerns being raised about the networks not including major providers in certain areas ... and the ability of people to access their current providers," Blewett wrote. "The transition will be difficult and informing people of their choices, or lack of choice, is critical."

Once an insurer hits its enrollment cap, MNsure must remove the option from its website, so consumers don't think they can buy coverage when it's not available.

In addition, MNsure will need to communicate information with regulators and insurers so that health plans know if people are dropping out of capped plans, which would effectively open a slot for new enrollees.

The complex mechanics of making all this work consumed the MNsure board meeting in St. Paul on Wednesday, but the bottom line is that MNsure officials say they can handle it. The most important message is that if consumers see an option on the MNsure website and pick it, they've got the spot, O'Toole said.

"Until that plan is down, if people select that plan, they will be enrolled in that coverage," O'Toole said in an interview following the meeting.

That's good news for consumers who otherwise could be misled, said Heidi Mathson, past president of the Minnesota Association of Health Underwriters, a trade group for agents. Mathson raised concerns about the mechanics of the caps during the public comment portion of Wednesday's meeting.

"I think the majority of the population is going to feel very boxed in, like they don't have any choice," Mathson said.

Bloomington-based HealthPartners will limit enrollment to 72,000 people, while Minnetonka-based Medica will have a cap of 50,000. Sign-ups at Minneapolis-based UCare will be capped at 30,000, while Golden Valley-based PreferredOne will limit coverage to 1,700 people.

PreferredOne won't be accepting any new customers. The other three insurers are required by law to let current customers renew coverage, so the number of available slots for new enrollees could be significantly lower.

Minnetonka-based Medica, for example, must hold slots for about 43,000 current customers, which makes it look like there are only 7,000 spots available to new enrollees.

But Peter Brickwedde, an assistant commissioner at the Minnesota Department of Commerce, told the MNsure board that Medica might end up with more open slots if some of its customers find other sources of coverage.

Christopher Snowbeck • 612-673-4744