Of the 2,740 parent/county instances of overlap on the individual market, slightly more than half are from national carriers. Provider Sponsored Health Plans, such as Kaiser, offer 21 percent, and not-for-profit Blues plans offer 17 percent. But large national carriers lead the list of the parent companies with overlap plans in the most counties.
It is easy to see why overlap plans are important to enrollees and policymakers, from the standpoint of continuity of care as well as affordability. Given the near certain migration of enrollees from the employer segment to the marketplace and Medicaid, it is likely that insurer interest in these segments will increase as well, and links to Medicaid may shape the pattern of future marketplace participation.
During their First Quarter earnings call, United Health Group responded to a question about marketplace entry, by saying that they will choose states based on "the efficiency of their networks, ability to compete, and desire to expand Medicaid." Shortly thereafter, United filed to enter the individual markets in Washington and Maryland, where they currently participate in Medicaid. As can be seen in this interactive tool, there are approximately a dozen other states where United currently participates in Medicaid, but not the marketplace. There are similar possibilities for Anthem and Centene. On the other hand, companies with little Medicaid presence may find it hard to be competitive in new ACA markets.
Over time, the links between Medicaid and marketplace participation have grown, with increased marketplace participation of Medicaid MCOs, a high prevalence of overlap, and an association between overlap and affordability at the county level. These trends suggest that Medicaid participation may facilitate entry and improve the ability to be competitive in the marketplace. As the importance of both segments grows, their geographies may be increasingly intertwined, and Medicaid participation may shape the contours of entry in an increasingly competitive individual market.