Marylanders hoping to buy health insurance from Evergreen Health through the state's online insurance exchange, which opened Tuesday, will have to wait.
In a bid to stay in business, Evergreen announced plans in October to be acquired by a group of investors and convert from a nonprofit to a for-profit insurer. It won't be allowed to sell health plans through the exchange unless and until the Centers for Medicare and Medicaid Services approves the proposal, Matt Jablow, an Evergreen spokesman, confirmed Tuesday.
Evergreen plans and pricing continue to be listed on the Maryland Health Connection in hopes the review will be concluded soon, said Andrew Ratner, an exchange spokesman.
But users who try to enroll in an Evergreen plan will be blocked and receive a pop-up message that reads:
"Evergreen plans are not available at this time. Maryland Health Connection expects to know soon if Evergreen plans will become available before open enrollment for 2017 ends. It is important to choose a plan by Dec. 15 to ensure Jan. 1 coverage. If you choose a plan now with a different carrier, you may still switch to Evergreen if those plans become available prior to the end of open enrollment on Jan. 31."
People can buy individual health plans directly from Evergreen, but only plans purchased through the exchange are eligible for income-based subsidies.
Evergreen is one of 23 consumer-oriented-and-operated health plans founded under the federal Affordable Care Act. Led by former Baltimore City Health Commissioner Peter Beilenson, the Baltimore-based insurer is one of a handful of the co-ops still in business, and its bid to convert to a for-profit insurer is an attempt to stay afloat.
Other co-ops closed or are in the process of winding down, unable to attract enough members, draw enough premium revenue and withstand the weight of new and costly regulatory hurdles created under the health reform law.
Evergreen sought a buyer after being crippled by new insurance rules that required it to make a "risk-adjustment payment" that amounted to $24 million in 2015 — more than a quarter of its $85 million revenue that year.
Evergreen has sued the federal government over the rule, which it says favors large insurers and disadvantages small firms.
An Evergreen spokesman said the organization had hoped to have an approval from CMS in time for the start of open enrollment on Tuesday.
As of 5 p.m. on opening day, the exchange reported enrollment of 1,200 private health plans about four times as many first-day enrollments as last year. Another 2,600 people enrolled in Medicaid and 400 people enrolled in dental plans Tuesday.
Organizations tasked with helping people sign up said they were pleased with the early turnout.
"The phones have been very active today with consumers calling to schedule appointments with their local navigator," said Mark Romaninsky, program director of Seedco, which manages exchange access programs for the upper Eastern Shore.
Evergreen, which has about 38,000 members, was one of four health insurers approved to sell health insurance through the online marketplace.
The Evening Sun
CareFirst BlueCross BlueShield, Cigna and Kaiser Permanente of the Mid-Atlantic States also are selling health plans through the exchange.
The number of insurers participating in Maryland's exchange, as well as other state-run exchanges and the federal marketplace, has dwindled since the marketplaces first opened in 2013, raising concerns about competition and choice for consumers.
Most recently, UnitedHealthcare pulled out of Maryland's exchange and others around the country for the 2017 enrollment season. The insurer covered about 10 percent of enrollees last year.
"In the interest of having a competitive market, we think it's critical they get approval," said Leni Preston, president of the state advocacy group Consumer Health First, of Evergreen's bid. "CareFirst still has a very larger percent of the market in Maryland and we think consumers need more choice."
Baltimore Sun reporter Meredith Cohn contributed to this report.
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