Many Healthcare.gov consumers face fewer choices next year

Many Healthcare.gov consumers in Wisconsin will have fewer choices next year, according to a map of health plans’ service areas released by the Office of the Commissioner of Insurance last week.

Two carriers — Chorus Community Health Plans and Molina Healthcare — are leaving Healthcare.gov.

Chorus confirmed its departure this summer. Molina did not return a request for comment. During an earnings call last week, Mark Keim, chief financial officer, said they will leave “difficult geographies” and reduce their county footprint nationwide by 20 percent.

Fond du Lac County will have just one carrier on the exchange next year. Sixteen counties will have two insurers, up from one this year.

As with this year, most counties will have three to four carriers. The highest number of insurers participating in a county next year will be five, compared to eight this year.

Five insurers are scaling back service areas:

Quartz will offer Healthcare.gov coverage in 12 counties next year, down from 42 this year. Spokeswoman Myranda Tanck said they withdrew from some regions as they could not offer a “competitive product under the current economic conditions.” Withdrawing will help better control cost pressures and ensure they can offer a “competitive, high-value product” in the remaining areas they serve, she said. Quartz will be in Buffalo, Columbia, Crawford, Dane, Dodge, Green, Jackson, La Crosse, Monroe, Pepin, Trempealeau and Vernon counties.
Anthem Blue Cross and Blue Shield of Wisconsin is withdrawing from 10 counties: Columbia, Dane, Green, Iron, Langlade, Price, Rock, Taylor, Vilas and Walworth. It will offer Healthcare.gov coverage in 53 counties next year. Spokeswoman Emily Snooks said they are “streamlining” their offerings. “Wisconsin consumers benefit from the state’s highly competitive health benefit market and will have a choice of competitively priced, comprehensive health plans for 2026,” she said.
Group Health Cooperative of South Central Wisconsin will exit five counties — Adams, Grant, Juneau, Iowa and Lafayette — and offer individual plans in Columbia, Dane, Green and Sauk counties. Spokeswoman Kate McLaughlin said they made a “strategic decision” to focus resources in the four counties where the majority of their members live. She said the 2026 plan year comes with “several market uncertainties, including service area changes among other carriers and questions surrounding the potential loss of the enhanced premium tax credits.”
CareSource, which owns Common Ground Healthcare Cooperative, said last month it was exiting 11 counties in the state and will remain in 13 for next year. “This decision was not made lightly and is driven by the need to maintain sustainable operations amid rapidly shifting dynamics across the industry,” the insurer noted then.
Dean Health Plan by Medica will exit Manitowoc County, a “difficult” decision “driven by provider and market dynamics,” spokesman Rick Thiesse said. It remains in 25 counties.

Aspirus Health Plan, HealthPartners, Medica, MercyCare Health Plans, Security Health Plan and UnitedHealthcare are not changing their service areas.

Network Health will expand to Waupaca and Waushara counties. It will cover 11 counties.

CEO Coreen Dicus-Johnson said they previously were served the two counties, but exited a few years ago when Ascension Wisconsin sold “certain provider system assets” to Aspirus Health, an out-of-network provider.

Now that they’re owned by Froedtert ThedaCare Health and ThedaCare is a contracted provider, they are “once again able to provide local, high-quality coverage to the people who call these counties home,” she said.

This article first appeared in the Wisconsin Health News daily email newsletter. Sign up for your free trial here.