Cigna Announces 2024 Marketplace Plans

As the insurer limits expansion, what will others do amidst premium increases and continued enrollment growth?

Conservative, aggressive, or somewhere in between? Expansion strategies will be revealed as payers announce their Marketplace portfolios for plan year 2024.

Cigna Healthcare is one of the first, falling in the conservative camp despite sizeable Exchange enrollment growth since 2022. Per a press release, the payer will expand its Marketplace plans in 15 counties—all in North Carolina, with a focus on Charlotte and Winston-Salem—while exiting Missouri and Kansas.

What will other payers do? While big Marketplace players will likely make more big moves, expect the needle to move as a whole as subsidies continue and Medicaid redeterminations drive those who lose coverage toward the Exchanges.

Cigna Marketplace trends

Cigna's Marketplace updates for 2024 land the payer in 350 counties across 14 states: Arizona, Colorado, Florida, Georgia, Illinois, Indiana, Mississippi, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, Utah, and Virginia.

While the new North Carolina counties total up to 200,000 customers, 2024 curbs Cigna's recent expansion—four new states in the previous two years which more than doubled its Marketplace enrollment from 337,000 to 821,000 by the end of 2022.

"We take a thoughtful and deliberate approach to our geographic presence to ensure our plans meet high standards for affordability, network quality, and comprehensive coverage," said Chris DeRosa, president of Cigna's U.S. Government business since January of this year. He previously served as president of National Accounts and COO of US Markets for Cigna Health Benefits.

Cigna cost-sharing and benefits

Zero-dollar (insert benefit here) is a common selling point for Marketplace carriers. Select Cigna plans will offer $0 cost-share on medical deductibles, designated benefit copays, and preferred generics.

Where there is cost-sharing, Cigna reports that its copays range from $0-$70 for primary care and $30-$110 for non-emergency care. Select plans offer first-dollar coverage and "predictable copays" for outpatient lab exams during the deductible period. Cigna's Patient Assurance Program caps covered eligible insulin costs at $25 per month for a 30-day supply.

As noted in Cigna's press release, many customers will have access to 24/7 virtual medical and behavioral healthcare, with a $0 copay for some primary care and minor acute urgent care. The payer will also offer up to $325 in annual wellness incentives for those eligible, and affordable prescriptions including preferred generics and insulin.

"Health and well-being are key to a person's overall vitality, which is why we provide comprehensive medical, behavioral, and pharmacy benefits and a host of other features that make it simple for customers to access affordable care when and where they need it," DeRosa added in the press release.

Payer Marketplace participation as a whole

The Marketplace has seen both constancy and disruption since it launched in 2013. Some carriers, like Cigna, have participated from the beginning.

"Cigna has continuously maintained our presence in the ACA Marketplace over the past ten years, and we are proud to continue using our expertise to help customers have a healthier future," noted DeRosa.

The same is true of other carriers, namely BlueCross BlueShield, Centene, and UnitedHealthcare—all of which either started with or have grown to a robust presence since plan year 2014.

This is not the case for all payers, whether startup or stalwart. Among the former, Oscar Health has continued to grow while Bright Health—which had steadily increased participation since 2018—exited the Marketplace in 2023. Humana also exited last year after a small but brief re-entry since 2017. A company spokesperson noted Humana's focus is its Medicare core (individual, group, supplement and prescription drug plans); Medicaid, Military, and Specialty dental, vision and life plans; and its CenterWell healthcare services business.

Sitting somewhere in between is Aetna. Before 2022, the payer had not offered Marketplace plans since 2017.

Growth by pandemic and subsidy

While no one would wish for a pandemic as a growth driver, COVID-19 was a boon for the Marketplace. Enrollment set records in 2022 (14.5 million) and again in 2023 (16.3 million)

Overall Marketplace premiums are expected to rise but with an influx of new customers due to Medicaid redeterminations, shouldn't adversely affect an overall enrollment that is likely to grow.

KFF reports a 6% median premium increase with insurers citing increased medical and prescription drug costs as well as utilization. "Although most Marketplace enrollees receive subsidies and are not expected to face these added costs, premium increases could result in higher federal spending on subsidies," Kaiser adds.

That spending could change after plan year 2025, when expanded subsidies will end unless Congress extends them. The broader subsidies were enacted by the American Rescue Plan and continued under the Inflation Reduction Act. depend on which political party assumes the White House in 2024.

While it's up to Congress to act, the Executive branch can influence how well the Exchanges are supported and promoted. As The New York Times noted in January about the subsidy impact: "The Biden administration has taken other steps to encourage enrollment in the plans, including increasing advertising and enrollment assistance and providing a longer window for sign-ups than during President Donald J. Trump's administration. But it appears the money is mattering more than anything else."

The 2024 Marketplace Open Enrollment Period begins November 1 and ends January 15, 2024.