Insurance cooperatives and provider-owned health plans are vying heavily for small business customers in federally-run insurance exchanges, appearing alongside (or in the absence of) Blues and national firms.
Many of the small business markets the federal government is overseeing have at least three or four insurers selling in most the state, while several have only one or two insurers offering the bulk of the variety. Small businesses in Arkansas, Kansas, Missouri, North Carolina, New Hampshire and West Virginia have only one health plan issuer, all of them Blue Cross licensees.
Non-traditional insurers are making a large showing, however, particularly in the Midwest. Among the four insurers selling the greatest variety of health plans are Physicians Health Plan, in Indiana, Blue Cross and Blue Shield of Texas, CoOpportunity Health, an Affordable Care Act co-op operating in Iowa and Nebraska, and Anthem Blue Cross and Blue Shield.
There's a good deal of competition in the larger markets, too.
In Texas, Blue Cross and Blue Shield of Texas is selling the largest variety of small business plans in virtually every part of the state, much as the company is doing for individual policies in the federal marketplace. Blue Cross and Blue Shield of Texas, which recently added a regional president for Houston and southeast Texas, is selling 4,064 small business plans, while First Care Health Plans, an HMO started by a hospital and physicians in Amarillo in 1985, is selling 540 policies in many of the same counties, but with limited pricing options.
In Florida, there are five different licensed issuers, three of them for Blue Cross and Blue Shield of Florida, and two for Health First Health Plans, an insurer owned by the four hospital network Health First in central Florida, launched earlier this year in partnership with the Florida Hospital in Orlando.
In Pennsylvania, six insurers are selling a total of 2,289 different small business plans, including several Blues plans -- Highmark, the state's largest insurer and the new owner of a health system in greater Pittsburgh, Philadelphia-based Independence Blue Cross, Blue Cross of Northeastern Pennsylvania, and Capital Blue Cross serving central Pennsylvania and greater Harrisburg.
And then there are two provider-owned plans available mostly in the western and central parts of the state: UPMC Health Plan, owned by the western Pennsylvania integrated delivery network, and Geisinger Health Plans, owned by Geisinger, the central Pennsylvania health system.
In Ohio, Anthem Blue Cross and Blue Shield is selling the largest variety, 616 plans. SummaCare, a health plan started by the Akron-area Summa Health System in the 1990s, is selling 301, while regional insurer AultCare is selling 204, Medical Mutual, Ohio's oldest and largest insurer, is selling 176, Catholic Health East-owned HealthSpan is selling 136, and Kaiser Foundation Health Plan is selling 81.
In Indiana, Physicians Health Plan, a physicians-owned non-profit, is selling dozens of pricing varieties in the small business HIX market, offering 5,160 different plans, while Anthem Blue Cross and Blue Shield is selling 460 plan with one price for each tier. Anthem and Physicians Health Plan are selling in many of the same counties, and in some rurals parts of the state Anthem is the only small business qualified health plan.
In Illinois, at state with some 274,000 small businesses, Blue Cross and Blue Shield is competing with Land of Lincoln Mutual Health Insurance Company, an ACA-supported co-op launched by the Illinois Chamber of Commerce, and Health Alliance Medical Plans, an Urbana-based insurer started by the Carle Clinic multi-speciality physician network. Each insurer is selling between 900 and 1,000 plans.
In some of the smaller state markets, in Alabama, UnitedHealthcare is selling the bulk of the variety, 804 differently priced policies, while Blue Cross and Blue Shield of Alabama is 335 different plans. In Delaware, Aetna's CoventryOne is selling 18 plans and Highmark is selling 15.
In Iowa and other parts of the northern Midwest, non-traditional insurers have the some their largest presence in the small business HIX market.
An Affordable Care Act-supported co-op, CoOpportunity Health, is selling a large variety of small business plans across the state: 1,918. Gundersen Health System, which operates in Iowa, Minnesota and Wisconsin, is sponsoring a health plan with 140 different options in certain parts of the state.
Avera, a hospital network in Sioux City, is selling 90 plans. Sanford Health Plans, the insurance division of the South Dakota-based Sanford Health System, the nation's largest rural non-for-profit system, is selling 40 health plans in northwestern Iowa, and 12 plans are being offered in south central Iowa by the regional health system Alegent Creighton Health.
Alegent Creighton and CoOpportunity Health are also selling in Nebraska, alongside Blue Cross and Blue Shield and Coventry, and Avera and Sanford are also selling in South Dakota, alongside Dakota Care, the state's largest HMO and owned by physicians.