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CareSource expanding into 22 more W.Va. counties ahead of exchange enrollment period

CHARLESTON, W.Va. — Residents in more West Virginia counties will have additional health plan options when the open enrollment period on the Mountain State’s insurance exchange, created in the Affordable Care Act, opens on Nov. 1.

In its 2nd year in West Virginia, CareSource, a nonprofit managed care provider based in Dayton, Ohio, is expanding its coverage area to include 32 counties.

“We’re excited to be in West Virginia. We’re committed to being here, committed to our members,” said Michael Ross, manager of CareSource’s West Virginia Marketplace.

“We’ve always had intentions of growing our footprint in West Virginia.”

In 2016, CareSource is providing health insurance coverage to more than 1,300 West Virginia residents in ten counties: Brooke, Cabell, Hancock, Kanawha, Lincoln, Marshall, Mason, Ohio, Putnam, Wayne.

In 2017, that coverage area will grow to 32 counties with additions of the following: Barbour, Boone, Calhoun, Clay, Doddridge, Fayette, Gilmer, Harrison, Jackson, Logan, Marion, Monongalia, Pleasants, Preston, Raleigh, Ritchie, Roane, Taylor, Tyler, Wetzel, Wirt, Wood.

The list includes, “a lot of rural areas, a lot of areas where we knew that people wanted choice,” Ross said.

The health insurance marketplace is for people who don’t have health insurance, as required by law, through an employer, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) or another source that provides qualifying coverage.

In 2014 and 2015, the only company offering health insurance plans on West Virginia’s marketplace was Highmark Blue Cross Blue Shield West Virginia and, in 2017, that company is again going to be the sole provider of exchange plans in all 55 counties.

Highmark accounts for the bulk of the exchange insurance enrollees. During the 2016 open enrollment period, Fall 2015, 37,284 total people enrolled in private plans.

Different policies are available on the exchange.

In addition to gold, silver and bronze plans, CareSource has added two additional silver plans for 2017: “simple choice,” a federal standard plan, and “marketplace silver” with lower premiums.

No matter the plan, health insurance will cost more in the New Year.

Both Highmark and CareSource proposed premium rate increases for 2017 with averages reportedly around 30 percent for Highmark and 40 percent for CareSource, according to analysis from

No specific numbers on reviewed rates were immediately available from either company.

CareSource officials said they were “analyzing rate results” from the West Virginia Offices of the Insurance Commissioner on Thursday.

“In most markets, there is across most health plans increased rates in the double-digits,” said Scott Streator, senior vice president for CareSource’s market and product group. He said premiums reflected the “true costs of health care.”

“Premiums in West Virginia are typically higher than other states. There seems to be more of a correlation of lower premiums with more competition,” Streator said.

“More affordable premiums,” he said, are usually seen in major metropolitan areas with additional competition among health systems.

Most CareSource members in West Virginia, which Ross estimated at 86 percent, would continue to receive federal government subsidies. “That will help offset the total premium costs, the out-of-pocket costs, and give them the better benefit for their dollar,” he said.

The typical CareSource West Virginia enrollee is 45 years old, according to Ross. More than 57 percent of 2016 enrollees were female with an average family size of 1-2. Upwards of 40 percent chose some form of the silver plan with advanced premium subsidies.

In the coming years, Streator said the goal was to grow CareSource’s membership in the Mountain State. “As an insurer, you want predictability,” he said. “Over time, that can reduce costs.”

Enrolling additional younger people, specifically millennials, Streator said, would also help bring down premium rates.

“It’s still a relatively young product,” Streator said of CareSource’s West Virginia plans. “It’s going to take several years to ramp up the membership that we need to have that continuous coverage that we need and provide the care that members want.”

According to new data the U.S. Census Bureau released this week, West Virginia’s uninsured rate in 2015 was six percent, down from 14 percent in 2013 before the major provisions of the Affordable Care Act were implemented.

“There are still people in West Virginia who don’t have health insurance and one of the reasons we chose to go the direction that we did was there were a greater number of people in those areas that we believe that we could help,” Ross told MetroNews.

“As a nonprofit health plan, CareSource sees this as a value and as a solution for, not just getting people covered, but getting people care,” Streator said.

In addition to West Virginia, CareSource operates in Kentucky, Indiana and Ohio.

Open enrollment on the exchange at begins on Nov. 1, 2016 and continues through Jan. 31, 2017. Dec. 15 is the deadline to enroll or make changes to plans for coverage to start on Jan. 1.

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