Humana Inc. (NYSE:HUM) says it will eliminate some individual major medical offerings in 2016 and is not sure how it will serve the individual market in 2017.
Humana discussed its concerns about the state of the individual health insurance market Friday, when it released its third-quarter earnings.
Individual claims have been higher Humana expected, in part because enrollees have been making heavy use of emergency room services and out-of-network providers.
Because claims have been so high, the individual commercial medical business has been losing money this year, the company said.
The company is responding by reducing the number of individual products it will offer in 2016, both inside the Patient Protection and Affordable Care Act (PPACA) exchange system and outside the PPACA exchange system. Some of the products dropped will be broad-network plans and platinum-level exchange plans.
The plan cuts could affect about 100,000 people, Humana said.
“The deterioration in claims experience for this line of business in [the third quarter of] 2015, if it continues, would reduce the likelihood of achieving the level of profitability the company had previously anticipated for this business in 2016,” Humana said. “The company continues to evaluate its participation in this line of business for 2017.”
Aetna Inc. (NYSE:AET) hopes to acquire Humana sometime between June 30, 2016, and Dec. 31, 2016, and Humana has stopped holding routine earnings conference calls with securities analysts while the deal is pending.
The company as a whole is reporting $314 million in net income for the quarter on $13 billion in revenue, compared with $290 million in net income on $12 billion in revenue for the third quarter of 2014.
The company’s retail segment, which includes individual medical coverage sold outside of the Patient Protection and Affordable Care Act (PPACA) exchange system and through the PPACA exchange system, is reporting $325 million in pretax income for the latest quarter, down from $346 million in the year-earlier quarter.
The company ended the quarter providing or administering medical coverage for 14 million people, 3.1 percent more than it was covering a year earlier.
Enrollment in the company’s individual Medicare Advantage plans increased 14 percent, to 2.7 million, and the number of people using the company’s Medicare supplement insurance coverage jumped 22 percent, to 157,100.
Enrollment in fully insured in group plans fell 3.7 percent, to 1.2 million, and the number of people covered by the company’s individual commercial medical plans shrank 11 percent, to 963,700.
The number of people covered by Humana plans sold through the PPACA exchange system increased 1.4 percent, to 609,600. The number with Humana individual coverage purchased off-exchange rose 62 percent, to 204,800.
But Humana saw use of older, “grandfathered” or “grandmothered” individual policies, which do not have to comply with all of the new PPACA underwriting and benefits mandate rules, fall 58 percent, to 149,300. The increase in use of PPACA compliant policies was not big enough to offset the drop in use of the old-rules policies.