North Carolina may be the HealthCare.gov state with the weakest dental plan competition.

Managers of HealthCare.gov have an early indicator of solid insurer interest in the 2017 open enrollment period: There is an increase in issuer interest in selling stand-alone dental plans (SADPs) through the insurance mall.

HealthCare.gov manages the plan menus for Patient Protection and Affordable Care Act (PPACA) individual exchange programs in 34 states.

In those 34 states, issuers have expressed an interest in a total of 161 SADP exchange relationships for the 2017 coverage year. A year ago, issuers were expressing an interest in having 141 SADP exchange relationships with HealthCare.gov for 2016.

HealthCare.gov is on track to run the Small Business Health Options Program (SHOP) exchange programs in 31 states for 2017, down from 32 this year. Meanwhile, carriers have expressed an interest in having 120 SADP group exchange relationships with HeallthCare.gov for 2017, up from 113 this year.

See also: For HealthCare.gov, 2017 menu season starts April 11

The U.S. Department of Health and Human Services (HHS) set up HealthCare.gov to handle PPACA exchange plan enrollment and administration in states that are unable or unwilling to do the job themselves.

HHS prepares the preliminary SADP issuer counts to help carriers comply with PPACA benefits requirements. PPACA normally requires the issuer of each major medical plan, or qualified health plan (QHP), sold through a PPACA exchange to offer dental benefits for children. If at least one dental insurer sells SADP coverage through a HealthCare.gov state’s exchange, then HHS lets the QHP issuers in that state leave the children’s dental benefits out of the benefits package.

HHS prepares the list only for the states in which it is in charge of their exchange plan menus. State-based exchanges, including some that now use HealthCare.gov systems because they had problems with their own systems, have their own separate strategies for handing the PPACA children’s dental coverage mandate.

Futhermore, the HHS definition of SADP’s “issuer” is complicated. In some cases, a parent company could own two or more separate issuers that sell SADPs in the same state. If one issuer sold SADPs through HealthCare.gov in three separate states, HHS would count that issuer as having three SADP exchange relationships, not just one.

HHS gets the preliminary SADP issuer counts through a voluntary notice program. Carriers that tell HHS they will sell SADPs through a state’s HealthCare.gov exchange in 2017 have no legal obligation to do so. It’s not easy to determine how the actual 2016 issuer counts compare with the numbers in the intent-to-offer table that HHS published a year ago.

But “we encouraged SAPD issuers only to indicate a serious intent to offer in a marketplace, because QHP issuers will design plans based on this report,” HHS officials say in the introduction to the new intent-to-offer table.

If a comparison of the preliminary issuer counts for 2016 and 2017 reflect real trends in issuer numbers, the number of issuers in the individual exchange dental plan market could increase substantially in Florida, Illinois, Texas and Virginia. The number of issuers in Texas, for example, could increase to nine, from five.

Meanwhile, North Carolina may be on track to have a less competitive individual exchange dental market: just one issuer told HHS it wants to sell 2017 SADPs there. A year ago, four issuers were saying they wanted to sell 2016 SADPs in North Carolina.

HHS has never released HealthCare.gov SHOP enrollment figures. Charles Gaba of ACASignups.net has speculated that HealthCare.gov group plan enrollment may be very low. But the number of HealthCare.gov group SADP issuers appears to be relatively stable in most states, with only modest increases or decreases in the number of issuers presented in the intent-to-offer table.

Two states that may be on track to have substantially fewer group SADP options are Nebraska and North Dakota. A year ago, the preliminary 2016 group SADP issuer counts were three for Nebraska and two for North Dakota. This year, HHS has just one issuer on track to sell 2017 group SADP coverage in each of those states. 

See also:

PPACA risk programs: Will those kidneys work?

HHS exchanges attract more dental insurers

    

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