Other than state officials, few people are more relieved by the newfound success of Maryland’s revamped health exchange than Dr. Peter Beilenson.
Beilenson’s insurance company, Evergreen Health Cooperative, had a rough go of it during the first open enrollment period, which began last year. The malfunctioning exchange translated into measly enrollment numbers for the fledging insurance company.
But now, with the Maryland Health Connection website working properly, Beilenson is in much higher spirits. In the two and a half weeks since the second open enrollment period began, about 800 Marylanders signed up for individual coverage with Evergreen via the exchange, he said.
Last year, he said, Evergreen signed up 400 individuals — during the entire six-month enrollment period.
“So obviously, we are in vastly better shape than we were before,” Beilenson said.
Although Evergreen’s market share is increasing — from about 0.7 percent last year to about 4 percent currently — it’s still tiny compared to that of the dominant carrier in Maryland, CareFirst BlueCross BlueShield. In 2014, about 94 percent of individual enrollees choose a plan with CareFirst.
About 37,000 people have signed up for private health plans on the exchange since it reopened Nov. 15 for the second enrollment period, which is for coverage that begins in 2015.
Based on the 2014 breakdown, it’s safe to assume that many, if not most of those people chose CareFirst. However, CareFirst officials declined to disclose Thursday how many of the 37,000 new enrollees the company captured.
Spokesman Scott Graham said it’s “too early” to comment.
“We won’t have a clear view of individual enrollment through the exchange until mid-January at the earliest,” he said.
Andy Ratner, a spokesman for the exchange, also declined to share the breakdown, even though he acknowledged the state has the information.
Evergreen is one of two dozen health insurance co-ops across the country created in response to a provision in the Affordable Care Act. Together, they received $1.9 billion in federal loans, with Evergreen getting
$65.4 million. The goal was to introduce more competition into the marketplace and, presumably, bring down prices.
One major reason Evergreen has been able to entice more consumers to sign up is that the company substantially reduced its average premiums for 2015. On average, premiums for Evergreen plans dropped by 10.3 percent compared to 2014.
Only one other carrier on Maryland’s exchange reduced premiums by a larger amount: Kaiser Permanente.
But Beilenson said he wasn’t concerned to see Kaiser’s premiums drop so significantly. CareFirst is still Evergreen’s bigger competitor, he said — by a long shot.
Graham, the CareFirst spokesman, said the company was not interested in commenting about “anything related to Evergreen,” and a spokesman for Kaiser did not respond to requests for comment Thursday.
Beilenson does not expect Evergreen to suddenly rocket past CareFirst; he’ll be happy with 6 percent of the market, he said.
“It goes to show that even with having better pricing and better policies, it’s hard to compete against the monolithic [companies] in the exchange,” he said. “The brand name is clearly still there, even though our policies are unquestionably better and our rates are in most cases better.”
However, in many cases, Evergreen’s plans are not obviously cheaper than other plans offered on the exchange.
For example, a 40-year-old non-smoker living in the Baltimore area might pay a premium of $276.92 a month for a Silver-level plan with Evergreen. For a similar plan with another carrier, the same person may pay a few dollars less than that, or as much as $400 a month.
But affordability isn’t only about premiums. Consumers must also consider a plan’s deductible, out-of-pocket maximum and co-pay. They should estimate how many appointments they might need and how many prescriptions they might fill to determine what cost-sharing structure makes sense for them.
Many of Evergreen’s plans come with both higher premiums and higher deductibles than comparable plans from other carriers. Even so, they may turn out to be a better deal for some people, Beilenson said, such as individuals who require a great deal of medical services.
People suffering from chronic disease might benefit from Evergreen’s model, which is based on the Patient Centered Medical Home concept. In a Patient Centered Medical Home, teams of physicians and nurses collaborate more closely to monitor and treat each patient.
More services are offered in one location, which Beilenson said makes it easier to ensure patients follow through with required care, particularly preventive care.
Beilenson said he expects a surge of consumers to sign up during the last few weeks of open enrollment, which ends Feb. 15.