Our Decision to Exit the ACA Marketplace

September 23, 2016 - We have made the difficult decision to exit the federal government’s public Health Insurance Marketplace, effective January 1, 2017.  This decision affects certain individual health plans, not Medicare Supplement or group plans.  

Serious issues with the health care law have made the public Marketplace unstable, which is driving increased costs and decreased competition and consumer choice. 

In fact, since we began selling our individual plans on the ACA’s public Marketplace, we have lost approximately $140 million. We have a responsibility to all our members to remain stable and secure, and that responsibility will be at risk if we continue to sustain losses due to our participation in the ACA Marketplace.

We will continue to offer some individual plans for sale on the private market through either a licensed agent or our website. We will evaluate the feasibility of a possible return to the public Marketplace in 2018 based on its improved stability.  

If you are affected by the discontinuation of our individual ACA Marketplace plans, the following FAQs may help answer your questions.  You may also call our Member Services Department at 888-592-8960 to speak to one of our representatives.

Frequently Asked Questions

Why have you decided to stop selling your individual plans on the ACA Marketplace?

Since we started selling our individual plans on the Public Marketplace when it was launched three years ago, we have lost approximately $140 million.  We have a responsibility to all of our 700,000 customers to remain financially secure and stable, and to do so, we just couldn’t continue to sustain these losses.  Without changes in the law, we don’t see the Public Marketplace stabilizing, and costs will continue to increase for both insurers and consumers.

What plans are impacted by this decision?

Effective January 1, 2017, we will no longer offer our Gold, Silver, Bronze and Catastrophic individual health plans for sale on the Public Marketplace.  We are also discontinuing our Gold and Silver plans sold outside the Marketplace effective January 1, 2017.  Coverage for current members covered under these plans will terminate on December 31, 2016.

Current members covered under our private Marketplace Bronze and Catastrophic plans will continue to have coverage, and these plans will also continue to be available for sale on the private market via our website, by one of our licensed representatives or through your insurance agent when Open Enrollment begins November 1.  

Does this mean you are no longer selling individual health plans?

No.  We will continue to offer our Bronze and Catastrophic individual plans for sale on the private marketplace and if you are currently covered under one of these plans, your coverage is unaffected by our decision to exit the public Marketplace.  Health care plans sold on the  private Marketplace meet all the ACA’s requirements for minimum essential coverage, but are not eligible for government assistance (tax credits) to help pay premiums.  In order to receive tax credits, consumers must purchase a health plan through the government’s public Marketplace.

If my plan is being eliminated, when will I be notified and receive additional information?

If you’re covered under one of the plans we are eliminating effective January 1, 2017, you will receive a letter from us via the US mail no later than October 1.  Open Enrollment begins November 1, so you will have plenty of time to shop and find a new plan before January 1.

If my plan is being eliminated, what are my coverage options?

If you are currently covered under one of our individual Gold, Silver, Bronze or Catastrophic plans sold through the public Marketplace, or our Gold and Silver plans sold on the private Marketplace, you will need to purchase new coverage for next year.  

If you are eligible for a subsidy, you’ll need to purchase your new plan through the federal government’s public Marketplace at www.healthcare.gov.  We are continuing to offer our Bronze and Catastrophic plans for sale on the private Marketplace, so if you’d like to enroll in either of those plans, you can go to our website www.nebraskablue.com, contact your agent or one of our individual sales reps.

How do I know if I have a public or private Marketplace plan?

Take a look at your Blue Cross and Blue Shield of Nebraska ID card and the three-letter alphabetic prefix that’s in front of your ID number.  If your prefix is YEM, you purchased your plan through the public Marketplace.  If your prefix is YEH, you purchased your plan on the private Marketplace.  If you receive a tax credit from the government to help you pay your premium, you have a public Marketplace plan.

I have coverage through my employer.  Is my coverage impacted by your decision to stop selling on the ACA Marketplace?

No.  This does not affect our customers covered under their employer’s group health plan.  

I have a Blue Cross and Blue Shield Medicare Supplement policy.  Is my coverage impacted by your decision to stop selling on the ACA Marketplace?

No.  This does not affect our customers covered under one of our Medicare Supplement plans.  Your coverage remains in force and unchanged.

I have one of your old pre-ACA plans.  Am I impacted by this change?

No.  If you’re covered under one of the grandfathered plans we were allowed to retain as part of the President’s “Keep Your Plan” promise, our decision to stop selling on the public Marketplace does not affect your coverage.  

You got the rate increase you asked for.  Why are you still leaving the Marketplace?

Even with the approved rate increase we recently received from the Nebraska Department of Insurance, our projections show a significant and continual loss of money on these plans.  We have a responsibility to all of our customers to remain financially secure and stable, and to do so, we couldn’t continue to sustain these losses.  

Why are other carriers able to remain on the Marketplace and you’re not?

We can't speculate on another company's decisions or situation.  I do know that this was a very hard decision for us to make, but we need to remain financially secure and stable for all our customers, and we didn’t want the losses experienced by the ACA plans to negatively impact our other lines of business.

Have you lost money participating in the ACA Marketplace?

Yes.  BCBSNE lost $64 million in 2015 because of high claims from customers covered under an ACA-compliant individual plan and the failure of the federal government to fully fund the program.  In fact, since we started participating in the public Marketplace three years ago, we project that by the end of 2016, we will have lost approximately $140 million.

What is the risk corridors program?

The ACA’s risk corridors program was intended to help stabilize the individual market as millions more people obtained health coverage—many with very expensive medical conditions.  However, ultimately Congress funded only 12.5 percent of the program, resulting in significant losses for most insurance companies participating in the public Marketplace.

Do you want the ACA to be repealed so things can go back the way they were?

The ACA has brought about many positive changes to the health care system, including ensuring people have access to health insurance regardless of their medical condition, the requirement that most insurance companies spend at least 80% of the premiums they receive on paying claims and quality improvement measures, and providing consumers with tax credits to help them pay for their insurance.  
However, there remain some serious problems with the law that are having the opposite intended impact, driving up costs, eliminating competition and narrowing consumer choice. All of these issues are fixable.

We are committed to providing health insurance to as many people as possible and want to continue to do so, but we need some changes to the law to help stabilize the ACA and our ability to effectively serve all of our customers.

Do you think the Affordable Care Act can survive? Is the Marketplace going to collapse?

We can’t speculate on that, but the increasing instability of the ACA is a serious and ongoing concern.  In all too many cases, the ACA is actually causing decreased choice and increased costs.  Changes in the health care law are needed to stabilize the ACA, and Blue Cross and Blue Shield is working with regulators at all levels to advocate for this.

So what should be done to “fix” the ACA?

We recommend three key changes to the health care law to help fix the problems with the ACA:

  • Special enrollment periods need to be enforced.  It’s important to verify upfront that people accessing coverage through a special enrollment period are actually eligible.   The government should be validating eligibility at the time of enrollment. Also, eligibility for a special enrollment period should depend on whether the individual for some reason lost prior coverage.  Otherwise people will only purchase coverage when they need medical care, then drop it when they don’t need it anymore, which drives up costs for everyone.

  • Make changes to the risk pool, so it’s as large as possible and the age rating slope is steeper, so that more of the young and healthy enroll.

  • Give states more control over plan benefit design.  The current system is too centrally controlled. Even in Canada, with national health care, the provincial governments set benefits.

What are you doing to control costs?

Our goal is simple: we want our members to get the best possible health care at the lowest possible cost.
Blue Cross and Blue Shield of Nebraska rewards hospitals, doctors and nurses based on the quality of care provided and for improving and maintaining the patient’s health. We are partnering with Nebraska hospitals, doctors and nurses on prevention, wellness, disease management and coordinated care programs—all with the goal of better health. 

Our patient-focused care programs help doctors and nurses choose evidence-based medical treatments that will best meet the unique needs of each patient and help people get healthy faster and stay healthy longer. We do this by using payment approaches that pay for care coordination and offer rewards for improved outcomes and lower costs. We also support doctors in their efforts to make their practices more effective, efficient and patient-focused. 

What should I keep in mind when I’m looking for a new plan?

Take a look at the plan’s provider network.  Make sure your hospitals, doctors and other health care providers are in that plan’s provider network.  Likewise, check to make sure the prescription drugs you and your family members take are on the new plan’s drug list (also called a formulary).  Also, it’s a good idea to let your doctors know that you will have a new insurance company starting January 1, so that they’ll know to bill 2016 charges to us, and 2017 charges to your new carrier.



The percentage of the bill you pay after your deductible has been met.


A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 


The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.


Includes behavioral health treatment, counseling, and psychotherapy

in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)


Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.


If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.


The amount you pay to your health insurance company each month. 

Preventive services

Health care services that focus on the prevention of disease and health maintenance.


Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).


A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.