CareSource to pick up nearly 40,000 new customers

Downtown Dayton-based CareSource will pick up nearly 40,000 new customers next year as a result of the decisions by Aetna, UnitedHealthcare and other major health carriers to exit federal health insurance marketplaces in Ohio and Indiana, company officials said Tuesday.

CareSource President and CEO Pamela Morris said she was informed Friday that the Centers for Medicare and Medicaid Services (CMS), which oversees the marketplaces, would automatically re-enroll displaced policyholders with health insurers still in the marketplaces to avoid interruption in their coverage.

Affected marketplace members will be matched with remaining health insurers who best fit their needs, offering comparable health plans with similar benefits and costs in the same geographical areas, Morris said. As a result, CareSource, which already has more than 100,000 marketplace members in four states, will pick up 14,000 new members in Ohio, and 25,000 in Indiana for coverage beginning in 2017.

“Some people, I’m afraid, would have let their coverage lapse had this not happened,” Morris said. “I applaud CMS for taking this step to have more seamless coverage for these consumers, and not leave them on their own to start navigating again to find another plan.”

CareSource, primarily a nonprofit Medicaid managed care company, will help fill the void in the marketplaces left by the pullback of some of the nation’s largest health insurers as well as the shutdown of more than a dozen health insurance co-ops, including Coordinated Health Mutual, which insured nearly 22,000 Ohioans before declaring bankruptcy earlier this year.

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Some of the companies will sell health plans in fewer markets while others plan to withdraw completely as a result of huge financial losses. The upheaval has caused some to question the long-term sustainability of the marketplaces.

President Barack Obama on Tuesday attempted to assuage those fears by contacting more than a dozen marketplace insurers, including CareSource, to enlist their help in keeping the marketplaces afloat.

“The sentiment was that his administration is committed to making some adjustments to ease some of the performance issues that the plans have had,” according to Morris, who said she received a personalized letter from Obama via email. “But some of this is going to take legislative involvement. Some of the adjustments that need to be made aren’t things that he or his team can make happen without congressional action. So we’re certainly hoping that the new Congress next year will be willing to step up and help address some of the financial challenges.”

Republicans currently control both houses of Congress and many of those members, along with GOP presidential nominee Donald Trump, have vowed to get rid of the Affordable Care Act, or Obamacare. The insurance exchanges were one of the key building blocks for the federal health care program.

Morris acknowledged CareSource has experienced struggles of its own with its marketplace business. But like other nonprofits with lower operating costs, the company has been more successful in the marketplaces than many of its competitors, leading to to the company’s exponential growth over the past few years.

CareSource recently moved into new office space on the third and fourth floors of Kettering Tower, where it will house about 260 workers. Overall, the company has about 2,000 employees in the Dayton area, and 2,900 company wide.