LEWISTON, Maine — Maine’s only health insurance co-op lost $4.5 million in November 2016, more than double what it had planned for.
However, its president said Lewiston-based Community Health Options is doing better than it was a year ago.
“Despite the difficulties we’ve gone through, we’re frankly a stronger company as a result,” said CEO Kevin Lewis.
In its monthly statement on Community Health Options, the Maine Bureau of Insurance this week noted:
— Community Health Options membership was 5.6 percent lower than expected in November.
— Premiums — the amount people pay Community Health Options for insurance — were 6.4 percent lower than planned for the month.
— Community Health Options used the last of the $43 million it had put in reserve for 2016, draining the account a month sooner than planned.
— Community Health Options’ cash, bonds and short-term investments were 26.6 percent lower than expected and were almost 12 percent lower in November than October.
But the bureau noted that claims — medical bills the co-op has to pay for — were 8 percent lower than expected. Community Health Options’ expenses also were 8.3 percent lower than planned. Both were spots of financial good news.
“As with other insurers, December results will have a significant impact on results for the entire year. The [Bureau of Insurance] is therefore closely following [Community Health Options’] operating results as it also works with the company to refine and finalize the 2017 plan,” the bureau said in its statement.
Co-ops are health insurance companies run by members for members, like credit unions. They were created through the 2010 federal Affordable Care Act to increase competition among health insurers and to provide consumers with greater choice in the marketplace.
Community Health Options began selling plans in 2013 and quickly rocketed to the top of Maine’s individual health insurance market, attracting members with its low premiums, broad network of doctors and hospitals and unique program benefits.
At one point, Community Health Options was the only profitable co-op in the country. That changed in 2015 when Community Health Options’ insurance claims were higher than expected and it began losing money.
The Maine Bureau of Insurance has been closely monitoring Community Health Options since early in 2016.
Last summer, Community Health Options filed suit against the federal government claiming it was owed nearly $23 million.
Lewis said the co-op is in a better financial position going into 2017 than it was going into 2016, and it has sufficient capital and enough surplus to accommodate members.
“We anticipate, given the adequacy in rates that we have for 2017, that we’ll continue to build upon our surplus,” he said.
Community Health Options has about 51,000 members, about half of whom bought plans through the federal marketplace.
If that federal marketplace gets dismantled as part of the Republican plan to repeal the Affordable Care Act, it is unclear how Community Health Options will be affected.
“Everyone I’ve heard has been indicating there’s going to be some replacement [of the Affordable Care Act]. The question is what are the details for those replacement plans and how is that going to support individuals and business that have benefited from coverage?” Lewis said.
Although President-elect Donald Trump and many Republican lawmakers are set on quickly repealing the Affordable Care Act, it currently remains law. Open enrollment for health insurance runs through Jan. 31.
According to the federal government, just over 77,300 Mainers signed up for health insurance through the federal marketplace as of Dec. 24 and got federal subsidies to help pay for that insurance that averaged $347 per month.