The only Consumer Operated and Oriented Plan (CO-OP) carrier that earned a profit in 2014 will stop selling individual and family coverage for 2016 after Dec. 26.
Community Health Options, the Maine-based CO-OP that serves Maine and New Hampshire, will freeze non-group enrollment at the year-end level because of concerns about higher-than-expected claims, according to Maine Insurance Commissioner Eric Cioppa and New Hampshire Insurance Commissioner Roger Sevigny.
The CO-OP will stop taking applications for 2016 non-group coverage outside the Patient Protection and Affordable Care Act (PPACA) public exchange system Dec. 15.
And the company will stop taking applications for 2016 non-group coverage through the PPACA exchange system Dec. 26. Also, the company will continue to sell and renew 2016 group coverage as usual, the company says, which is in accordance with Maine and New Hampshire regulations.
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PPACA provided CO-OP startup loan funding, in an effort to increase the level of competition in the commercial health insurance market. The U.S. Department of Health and Human Services (HHS) has prohibited the nonprofit, member-owned CO-OPs from having health insurers as owners or investors. HHS has also prohibits CO-OPs from ever selling their operations to other entities, which, in effect, limits their ability to get loans.
Maine and New Hampshire both have HHS-run public exchange programs using the HealthCare.gov enrollment systems.
Community Health Options has been beating its growth forecasts. It reported $5.9 million in net income for 2014 on $168 million in revenue.
The company has been covering about 80 percent of the 75,000 people who bought coverage through the Maine exchange for 2015. The company has also been selling coverage for New Hampshire residents.