AmeriHealth Caritas Enters ACA Exchange Program Due to Approaching Medicaid Redefinition


The Philadelphia-based insurance company said Tuesday that Medicare and Medicaid managed care provider AmeriHealth Caritas will enter the Affordable Care Act market in 2022.

AmeriHealth, which covers 5 million lives in 13 states and the District of Columbia, will unveil six different ACA health plans at different levels in 25 North Carolina counties in this year’s open recruitment from November 1 to January 15. said it plans to model its exchange plans around Medicaid proposals that focus on the social determinants of health affecting the patient, and AmeriHealth’s health care management and wellness programs. AmeriHealth, which was unable to provide comments on time, recently invested in these models.

In late September, AmeriHealth spearheaded a $ 38 million Series B round of Wider Circle Series B, demonstrating a demonstration of confidence in the Redwood, California-based startup’s strategy to improve patient health literacy and outcomes through hyperlocal social media. The investment came from AmeriHealth’s Social Determinants of Life division, which launched late last month and will invest in companies that seek to bridge health inequalities. AmeriHealth is the largest shareholder in Wider Circle.

Going forward, the insurer plans to expand its out-of-pocket exchange offerings to other countries and target those transitioning from Medicaid. AmeriHealth’s focus on this population is a smart growth strategy as the economy improves, stops receiving unemployment benefits, and begins the process of redefining Medicaid after the public health emergency ends, according to University of Southern California professor Glenn Miller.

“If people are leaving Medicaid because their income is increasing, because they are back at work, I think this is a good step for companies in the field to think, ‘How do we get the people who are switching? “” Melnik said. “You want to make it as convenient as possible for people, for example:” I have the same doctors, I just have a different card. ”


Nearly 90%, or 15 million, of people who received Medicaid coverage during the COVID-19 pandemic could be dropped from the program after the public health emergency ends, according to a recent report by the Urban Institute. Researchers estimate that one third of adults who lose coverage may be eligible for subsidized private health insurance in the ACA markets.

AmeriHealth isn’t the only insurance company betting on current Medicaid members transitioning to exchange coverage. The most competitive open enrollment is expected this year, according to data compiled in consumer guide, with more than 10 insurers planning to enter new markets in the 2022 target year, and some current members will expand their presence. The individual market is one of the most lucrative lines of business for insurers, second only to the lucrative Medicare Advantage market.

“The easier and cheaper you make the search process, the more successful you will be,” Melnik said. “It makes sense that if there is a transient surge, insurers will figure out how to transfer their current members to their products on the exchange.”

But verifying their eligibility for exchange, Medicaid or other insurance will be a huge task as so many people have moved or lost their homes during the pandemic and recent natural disasters. said the Commonwealth Foundation. The sheer number of redeterminations will also test a system that has historically left people uninsured during major disruptions. Blacks and Hispanics will be particularly vulnerable to loss of coverage because they make up a large proportion of Medicaid enrollments; these people were disproportionately infected with COVID-19 and were affected by the pandemic of economic and social consequences.

“What you need is a transparent handover system,” Melnik said.

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