Wellmark Abandons Individual Policyholders in South Dakota

Wellmark announced Tuesday that it will no longer offer individual health insurance plans in South Dakota. Here’s Wellmark VP Laura Jackson’s pleasant farewell to 8,000 South Dakota policyholders:

Here’s the text sent to policyholders:

As you know, Wellmark’s mission is to create affordable health insurance for people to access quality health care. For the majority of the past 75 years, we’ve been able to achieve that. Unfortunately, for the past two years, our members with individual health plans in South Dakota under the Affordable Care Act (ACA) have had to endure double-digit increases. In addition, Wellmark has lost approximately $32 million over the last two years in this market in South Dakota. We’ve discovered as this year goes on, that we expect these trends to continue unless changes are made at the Federal level. It’s apparent that continuing to offer plans with broad networks, combined with the rich benefits of the ACA, are not consistent with managing continually rising costs.

While we could seek additional premium increases to mitigate rising costs, this is not sustainable for our members’ pocketbook.  Therefore, in South Dakota, Wellmark will no longer sell or renew individual ACA plans with a Jan. 1. 2017, effective date. This affects less than 8,000 (2%) of our 378,000 members in South Dakota. Members who currently have an individual ACA plan will continue to have coverage through Dec. 31, 2016.

The change above does not affect people with grandfathered or grandmothered plans (those that generally purchased their individual health plan prior to Jan. 1, 2014).  It also does not affect our members with plans through their employer or those with Medicare supplement plans.

Although the ACA has done many positive things, it has also had its challenges. Those challenges vary by state. Fortunately, in 2017, the ACA gives states the ability to begin addressing those challenges with the goal of stabilizing the individual under 65 health insurance market.  We look forward to working with South Dakota policymakers on those solutions in the near future [Wellmark news alert, 2016.09.27].

Wellmark is canceling plans in Iowa, too, to address $99 million in losses there over the last two years. However, Wellmark says it doesn’t have to cut off as many policyholders in Iowa as in South Dakota, because Iowa allows the more restrictive HMOs that South Dakota does not.

Wellmark isn’t cutting its employer-based coverage in South Dakota or Iowa, so once again, our Rube Goldberg health coverage system is deterring independent entrepreneurship and pushing people to work for bigger companies instead of working for themselves.

For the sake of individual entrepreneurship, not to mention sparing individual policyholders the hassle of having to change insurers due to the vagaries of the for-profit market, it’s time to let Americans buy into the largest, most reliable health insurance pool in the country (56.9 million enrollees in July 2016, compared to 26.2 million and 22.1 million for the nearest competitors). Enact the public option. Let working Americans choose to enroll in Medicare.

p.s.: Wellmark has 378,000 members in South Dakota—apparently 370,000 as of January 1, 2017. Medicare covers 160,000 enrollees in South Dakota, up from 139,000 in 2011.

18 Responses to Wellmark Abandons Individual Policyholders in South Dakota

  1. This is why we need single payer. If only we had someone running for President that believed in it and was willing to engage in that “contentious debate.”

  2. Just guessing the Chamber of Commerce that supports so many entrepreneurs will come down hard on this. Same for the Farm Bureau and others that support our farmers.

  3. Where is the “right to life” outrage machine when it comes to policy to make health care a human right and not just another vehicle for profit in the US?

  4. Sanford and Avera seem to be doing just fine and seem also to be very competitive with Wellmark, so what gives? Most folks think that Wellmark pays the claims and the others do not, but that does not seem to be the case like this as an example http://www.weareiowa.com/news/local-news/treatment-agency-suing-wellmark-for-fraud-12-million So what gives? The number of Medicare subscribers in Wellmark plans clearly show that the company is a viable insurer…as long as the government is involved. Cory is spot on, Medicare for all is the solution that we can clearly see from Wellmark’s own business plan here in South Dakota.

  5. Thanks Mr. Lansing, yes we are getting hosed. Wellmark got a 45% rate increase last year and had gotten a 30% rate increase for this year without comment. Now, we see an overnight frantic call that cancels the plans just like what was done in the old days before the ACA.

    If the plans closed from Wellmark, how will they continue to do business with plans that they cannot add policy holders to? The ones that have the old plans are getting older and with that age, comes the more likely large claims for cancer, and heart issues, etc.. How will the state justify the raising of those premiums when these plans are not viable anymore? Wonder what the last sentence means for sure “We look forward to working with South Dakota policymakers on those solutions in the near future” Could that mean a bigger push for Medicaid Expansion? Naw, makes to much sense.

  6. Joe Nelson

    Wait a second, I thought that if you liked your plan, you could keep your plan?

  7. You are correct, you can still keep the plan you liked “The change above does not affect people with grandfathered or grandmothered plans (those that generally purchased their individual health plan prior to Jan. 1, 2014). It also does not affect our members with plans through their employer or those with Medicare supplement plans.”

  8. Rich Jones

    The present business model ALL health insurance carriers have in the self insured market won’t work with Obamacare. They will all continue to lose $. So all they can do now is focus on pockets of population near facilities like they have done in Iowa & create large HMO networks. So, if you live off the grid & in a small area of little population you are going to find little to no coverage for you. Sorry, that’s the reality of the new “hand out” market

  9. Steve Parson

    For those of you who want single payer SO bad have you actually participated in one?

  10. Yup, paid in in Canada. Also had friend get swift, efficient care in Canada, no bill. Pretty slick.

  11. Yeah, Rich, that darned “hand out” economy has destroyed us handing out police and fire protection, too. People should obviously handle their own disasters with their own resources. Now if you’ll excuse me, I have to step out and buy a new hacksaw to amputate my own leg if I have an accident.

  12. happy camper

    My insurance went way up to try to pay for this new higher risk pool that hadn’t been covered, many have new claims to pay and then drop the policy shortly after services not even paying the penalty. For example with a shut-off notice from a utility the penalty is gone so people are gaming it. You can’t make easy exclusions or it will cost the pool too much and not be sustainable. It needs amendments and could be good law. Don’t believe everything Blue Cross says either since their goal is to make money. Too bad the ACA didn’t require them all to be not for profit so the members benefit like a credit union.


  13. I’ve never liked any of my health insurance plans, so I guess I missed that outrage. ;-)

  14. Republican legislators are where the blame is. Lets be clear. If the Medicaid Expansion would have happened when presented, we would be looking at premiums much lower and with much less of a yearly impact. How in the world can I make that call? Simple, just look at North Dakota for one. They adapted Medicaid Expansion and now had about a 7% rate increase in premium yet again. Where we have had 70% and higher (Wellmark had a 45% rate increase last year and was approved for a 30% increase this year before they pulled the plug). In one year, Dakotacare had almost a 67% rate increase. Unsustainable, you bet and it is caused by a republican legislature that hates Obama so much they will let you keep paying high premiums to prove their point. Call your legislator and ask them to help you pay for your premium as it is there fault that it has gone through the roof.

  15. Happy grandma


    Wellmark is policyholder owned unlike some other Blue Cross Blue Shield companies.

  16. No access Happy grandma. There is this though https://en.wikipedia.org/wiki/Wellmark_Blue_Cross_Blue_Shield

    So as an owner of Wellmark, what did you think of the 250 million dollar payout for a new building? Just curious on how that all worked.