Republican-led states historically opposed to the Affordable Care Act are seeing an influx of health insurance options for 2025 as insurers see a new market opportunity.
Centene, Elevance Health, UnitedHealth Group’s UnitedHealthcare and Oscar Health are among the companies with large businesses selling individual coverage, also known as Obamacare, via the government’s healthcare.gov exchange.
The new products from these health insurers will debut Friday, the first day of open enrollment, which runs to December 15 for coverage that starts January 1, 2025.
These expansions come amid the increasing popularity of Obamacare with record enrollment for individual coverage purchased on exchanges under the ACA in part because tax credits have continued and been enhanced to more Americans under the Biden-Harris administration. And that has helped such coverage to hit record enrollment of more than 20 million Americans this year, which is more than double what it was under former President Trump, who fought unsuccessfully for years to dismantle the ACA and campaigned, along with other Republicans, to repeal the law considered the signature achievement of former President Barack Obama.
Health insurers see a particular opportunity in states led by Republican governors or GOP-dominated legislatures that didn’t expand Medicaid coverage to poor Americans under the ACA. The ACA’s Medicaid expansion expanded Medicaid coverage to most adults with incomes of up 138% of the federal poverty level or a little more than $20,000 for an individual in 2024 while giving states an “enhanced federal matching rate for their expansion populations,” according to a KFF analysis. It’s a better deal than before the ACA, when Medicaid programs were funded via a much less generous split between state and federal tax dollars.
Just 10 states have still not adopted Medicaid expansion and those are key areas ripe for expansion, health insurers say. Those states are: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming, according to KFF’s latest tally.
Oscar Health, which is known for offering individual coverage across the U.S., is selling plans in 504 counties across 18 states in 2025, compared to 446 counties this year. The majority of Oscar’s growth targets are in Ohio, Indiana, Texas, Florida and Georgia.
“More than half of Oscar’s growth over the last several years has been in states that have chosen not to expand Medicaid despite federal funding,” said Oscar chief executive officer Mark Bertolini. “Oscar continues to expand the individual market to serve more working and lower-income families, early retirees, entrepreneurs, independent contractors, and gig workers. The exchanges are a lifeline for many and will continue to be regardless of the outcome of the election.”
Here are other examples of Red State Medicaid expansion:
* – Elevance Health, which operates Blue Cross and Blue Shield plans in 14 states, and this year sells individual health plans in 943 counties in these markets is expanding into Florida, Texas and Maryland to offer plans in 72 counties across these states.
“We will offer individual health plans in 17 states and 1,015 counties,” an Elevance spokeswoman said. “In Maryland, Florida and Texas, we will offer individual health plans under our Wellpoint brand.”
* – For 2025, UnitedHealthcare will be expanding its individual and family plans available on the ACA’s marketplaces to 139 counties in four new states: Indiana, Iowa, Nebraska and Wyoming. The expansion of UnitedHealthcare’s Obamacare footprint is also adding 119 new counties in the 13 states were the insurer already sells such coverage.
* – Centene, which is the nation’s largest provider of Obamacare, Tuesday said the company will expand its geographic footprint, “adding 60 new counties across 10 states in 2025, which includes expansion into Iowa.” That means Centene’s Ambetter Health, which was already the biggest provider of individual coverage under the ACA with more than 4,4 millon health plan members, will be available in 29 states across the U.S.
