Insurer participation in New Mexico’s exchange has been much more consistent over the years than insurer participation in other states. There are six insurers offering plans for 2022, but that’s expected to drop to five in 2023, with True Health’s exit from the market.
There were four insurers offering plans statewide in New Mexico every year except 2015 and 2021, when there were five. But there has been some musical chairs in terms of which insurers offered plans each year.
The Santa Fe New Mexican reported that there were only two health insurance companies offering individual coverage in New Mexico pre-ACA, so competition has increased in the state under the ACA. John Franchini, New Mexico’s former Superintendent of Insurance, explained in 2016 that in terms of access to coverage and plan choice, New Mexico “in a much better place than we were four years ago. It’s getting better and better.” And insurer participation has grown even more since then.
In 2014, plans were available in the New Mexico exchange from Blue Cross Blue Shield of New Mexico (Health Care Service Corporation), Molina Healthcare of New Mexico, New Mexico Health Connections (one of the few ACA-created CO-OPs still operational as of 2020, but NM Health Connections closed at the end of 2020), and Presbyterian Health Plan.
In 2015, Christus Health Plan joined the exchange, and the four existing insurers continued to offer plans. The five insurers offered a total of more than 40 plans through the New Mexico exchange in 2015.
But for 2016, the New Mexico exchange dropped back down to four insurers after Blue Cross Blue Shield of New Mexico opted to leave the exchange at the end of 2015. In the summer of 2015, Blue Cross and Blue Shield of New Mexico filed a proposal to increase premiums for 2016 by an average of 51.6%. The announcement generated headlines nationwide, standing out even among some of the relatively steep rate increases proposed in other states. BCBS had about a third of the market share in the New Mexico exchange in 2015, so their proposed rate increase would have had a significant impact on the market.
But the New Mexico Office of the Superintendent of Insurance (OSI) denied the proposed rate hike, stating that the data submitted with the rate proposal didn’t justify a rate increase of more than 24%. BCBS rejected the rate change offered by the state, but came back in the following days and submitted new rates that they claimed had an average rate increase of 11.3%. But the OSI has said that they didn’t consider the secondary proposal to be a “real offer or realistic offer” and it was not accepted.
BCBSNM confirmed in late August that they would not be offering individual plans in the New Mexico exchange in 2016. They continued to offer one individual off-exchange plan — a bronze level HMO — with rates unchanged from 2015. This avoided a full market exit, meaning that BCBS preserved their option to return to the individual market with additional plans in 2017, which they decided to do (long-standing HIPAA rules prevent an insurer from returning to a market for five years after a full market exit).
So for 2016, plans were available in the New Mexico exchange from Christus, Molina, Presbyterian, and NM Health Connections. Individual market PPOs disappeared from the New Mexico exchange in 2016 (HMOs and EPOs help insurers control costs, so they’ve been steadily replacing PPOs in many markets).
Insurer participation changed again in 2017, but the total number of exchange insurers remained at four. Presbyterian Health Plan announced in July 2016 that they would transition to only offering off-exchange coverage in 2017. They noted that their on-exchange enrollees were incurring 30% more claims than their off-exchange enrollees, and Presbyterian determined that their on-exchange business was not sustainable. Through 2021, Presbyterian only offered off-exchange plans, although they returned to the exchange in 2022.
Blue Cross Blue Shield of New Mexico returned to the exchange for 2017. BCBSNM requested an average rate increase of 83.1% for their HMO product, but later revised it to 93.25 and regulators approved the requested rate hike. BCBSNM did not raise the rates on their remaining off-exchange HMO product for 2016, so the 93.2% rate increase was in relation to the 2015 rates.
For 2018 and 2019, there were no changes. Covered continues to be available from BCBSNM, Christus, Molina, and NM Health Connections. Presbyterian initially filed rates and plans to once again participate in the exchange starting in 2019, but ended up withdrawing that filing, noting that “due to concerns with current market environment, PHP has decided to continue offering plans only off the exchange.” So Presbyterian’s plans continued to be available only outside the exchange in 2019, and they didn’t return to the exchange until 2022.
And although Molina threatened to exit New Mexico altogether at the end of 2018 when their Medicaid managed care contract was not renewed, that did not come to pass. An updated Molina rate filing, submitted in mid-August 2018, indicated that Molina was still planning to participate in the exchange in 2019, despite the fact that they still had a pending challenge to the Medicaid bidding process at that point. Molina’s plans continue to be available in the New Mexico exchange in 2022, just as they have since 2014.
There were four insurers in New Mexico’s exchange in 2020. but there were some changes: Christus, which had offered plans in the New Mexico exchange since 2015, failed to meet New Mexico’s QHP certification requirements, so its plans had to terminate at the end of 2019. Christus covered about 1,100 people in New Mexico’s individual market in 2019, all of whom needed to select new plans for 2020.
But True Health obtained individual market certification in New Mexico and offered coverage in the exchange as of 2020 — so New Mexico continued to have four exchange insurers. It’s noteworthy that True Health was created in order to take over New Mexico Health Connection’s employer-sponsored plans as of 2018 and allow NMHC to focus on the individual market. But as of 2020, both True Health and NMHC were offering individual market plans in the New Mexico exchange, in direct competition with each other.
Evolent paid $10.25 million to acquire NMHC’s commercial insurance membership, and True Health New Mexico established an administrative services agreement that allowed them to support NMHC’s ongoing operations in the individual market, while letting NMHC continue to be an independent non-profit. The administrative services relationship ended, however, at the end of 2019. For 2020, NMHC partnered with Friday Health Plans Management Services for plan administration. And in early 2021, True Health was acquired by Bright Health (more on that below; Bright Health is exiting six states at the end of 2022, including New Mexico).
New Mexico Health Connections closed its doors at the end of 2020 (leaving just three CO-OPs remaining nationwide, with plans available in five states).
But Friday Health Plans and Western Sky Community Care (Centene/Ambetter) joined New Mexico’s exchange for 2021, bringing the total number of participating insurers to five. All marketplace insurers in New Mexico are required to offer plans statewide, so residents throughout New Mexico can choose from among all five insurers in 2021 (it’s quite rare for all plan available in a state’s marketplace to be available statewide, but New Mexico requires this, making the marketplace more robust, even in rural areas, than many other states’ marketplaces).
For 2022, Presbyterian Health Plan rejoined the exchange, bringing the total number of participating insurers to six.
For 2023, however, True Health/Bright Health and Friday Health Plans are both exiting the market in New Mexico, leaving New Mexico’s exchange with four insurers offering plans for 2023.