Table of Contents
- Chorus Health Plans Market Exit
- Rising Healthcare Costs Drive Decision
- Impact on Wisconsin ACA Marketplace
- Medicaid Business Remains Priority
- What This Means for Members
- Industry-Wide ACA Challenges
- Timeline and Next Steps
Chorus Health Plans Market Exit
Chorus Community Health Plans (CCHP), the insurance division of Milwaukee-based Children’s Wisconsin, has announced its withdrawal from the individual and family Affordable Care Act (ACA) marketplace effective after 2025. This significant decision affects approximately 140,000 members across Wisconsin and marks another major shift in the state’s health insurance landscape.
The announcement came through an official letter dated June 26, addressed to healthcare providers throughout the CCHP network. Mark Rakowski, president of Chorus Community Health Plans, outlined the company’s strategic decision to exit the competitive ACA marketplace and refocus resources on their core business operations. Chorus
Rising Healthcare Costs Drive Decision
The primary factor behind CCHP’s market exit centers on unprecedented increases in medical and pharmaceutical costs. Healthcare inflation has reached critical levels, making it increasingly difficult for insurers to maintain sustainable operations in the individual marketplace while providing affordable coverage options for consumers.
Pharmaceutical costs, in particular, have experienced dramatic increases over recent years. Specialty medications, new treatments, and rising drug prices have created significant financial pressure on insurance providers. These cost pressures are further compounded by increased utilization of healthcare services as patients return to normal care patterns following the COVID-19 pandemic.
Medical cost inflation extends beyond pharmaceuticals to include hospital services, physician fees, and advanced medical technologies. Healthcare systems nationwide are grappling with labor shortages, increased operational costs, and the need to invest in new medical equipment and facilities.
Impact on Wisconsin ACA Marketplace
CCHP’s departure will significantly impact Wisconsin’s ACA marketplace, particularly in the 15 counties where the insurer currently offers coverage. This withdrawal reduces competition and consumer choice in these areas, potentially leading to higher premiums for remaining plans.
The affected counties include both urban and rural areas throughout Wisconsin, where CCHP has been a significant player in providing affordable health insurance options. Rural counties may be particularly impacted, as they often have fewer insurance options available to residents.
Wisconsin’s ACA marketplace has already experienced several insurer exits in recent years, making CCHP’s departure part of a broader trend affecting the state’s healthcare coverage landscape. This consolidation often results in reduced competition and can limit consumer choice in selecting health insurance plans.
Medicaid Business Remains Priority
Despite exiting the ACA marketplace, Chorus Community Health Plans will continue focusing on their Medicaid business, which represents more than 90% of their total enrollment. This strategic decision allows the organization to concentrate resources where they have established expertise and can maintain financial sustainability.
The Medicaid program provides healthcare coverage for low-income individuals and families, and CCHP has built strong capabilities in serving this population. By focusing on Medicaid, the organization can leverage its existing infrastructure and provider networks more effectively.
Medicaid plans typically operate under different financial structures than ACA marketplace plans, with state oversight and funding mechanisms that can provide more predictable revenue streams. This stability makes Medicaid business more attractive for many insurers facing uncertain market conditions.
What This Means for Members
Current CCHP members with ACA marketplace plans will need to find alternative coverage options during the next open enrollment period. The organization will work with affected members to ensure a smooth transition and provide information about available alternatives in their areas.
Members should expect to receive detailed communications about the transition timeline and available options. It’s crucial for affected individuals and families to research alternative plans early and understand how the change might impact their healthcare costs and provider networks.
The loss of CCHP as an option may result in higher premiums for some members, depending on the alternatives available in their counties. Members should carefully compare available plans during open enrollment to find coverage that best meets their healthcare needs and budget requirements.
Industry-Wide ACA Challenges
CCHP’s exit reflects broader challenges facing the ACA marketplace nationwide. Insurance companies across the country are struggling with rising medical costs, regulatory requirements, and the need to maintain adequate profit margins while providing affordable coverage.
The individual marketplace has proven particularly challenging for insurers due to its risk pool characteristics and pricing constraints. Unlike employer-sponsored insurance, the individual market often attracts members with higher healthcare utilization needs, creating financial challenges for insurance providers.
Many insurers have found it difficult to accurately predict costs and set sustainable premiums in the individual marketplace. This uncertainty has led to numerous exits and consolidations across various state marketplaces throughout the country.
Timeline and Next Steps
The 2025 plan year will be the final year for CCHP’s individual and family ACA marketplace coverage. Current members will have their coverage honored through December 31, 2025, after which they must transition to alternative insurance providers.
Open enrollment for 2026 coverage will be critical for affected members, who should begin researching alternatives well before the enrollment period begins. The Wisconsin Office of the Commissioner of Insurance will likely provide resources and guidance to help consumers navigate the transition.
Healthcare providers in CCHP’s network will also need to prepare for potential changes in patient insurance coverage and may need to contract with additional insurance companies to maintain patient access to care.
This strategic shift by Chorus Community Health Plans represents a significant change in Wisconsin’s health insurance landscape, emphasizing the ongoing challenges facing the ACA marketplace and the importance of sustainable healthcare financing models.
