On WV’s Affordable Care Act marketplace, Peak Health enters, Caresource exits

A new health insurance company will join West Virginia’s health insurance marketplace for 2027, as another company exits.

The marketplace — a provision of the Affordable Care Act, commonly called Obamacare — is an option for people who want to buy health insurance but don’t have an employer-sponsored plan. Open enrollment for 2027 coverage begins Nov. 1 and continues through Jan. 15.

Peak Health — owned by WVU Medicine, Marshall Health and Valley Health — is joining West Virginia’s marketplace. Caresource will exit. Highmark Blue Cross Blue Shield will continue to offer plans on West Virginia’s marketplace. 

Peak President Amos Ross told West Virginia Watch the company, which formed in 2021, didn’t initially plan to join the marketplace for 2027. They agreed to join “on a very accelerated timeline” when the state of West Virginia asked them in May and asked if they would join in light of Caresource leaving. 

“Having a single carrier in a market is not good from a choice or price standpoint,” he said. “So we had to dig pretty deep to figure out the plan to get into the market by Nov. 1. But happy to say that we are ready here.”

Vicki McDonald, a spokeswoman for Caresource, said the company’s decision to leave the marketplace was driven by rising healthcare costs and an evolving national landscape. 

“CareSource continuously evaluates its programs to ensure they are effective and sustainable, allowing us to deliver the greatest impact on our members’ health and well-being,” she wrote in an email.

Highmark Blue Cross Blue Shield has been a part of West Virginia’s ACA marketplace since its inception. Ellen Galardy, Highmark’s president of federal business, said the company’s priority in the ACA marketplace this year is stability. 

“We know that with CareSource’s exit from the market, a lot of people are going to have questions about their insurance and what’s covered and what doctors are in network,” she said. “And I think the most important message for most West Virginians who have their ACA coverage through Highmark is to expect very little change. I hope that reassures people that while we always encourage people to make sure the plan still works for them. The message is really about stability.”

Caresource customers encouraged to shop around for coverage 

Caresource plans will be effective through the end of the year. People who let their plans automatically renew will be enrolled in plans either Peak Health or Highmark, depending on their location and other factors. 

Jeremy Smith, program director for First Choice Services, which runs West Virginia’s ACA navigator program, said auto-enrolling isn’t the best option. 

“We encourage people strongly to actively re-enroll themselves,” he said. “So go back into their healthcare.gov account, update their application with their new income, and then actively look at the new plans and prices. We strongly encourage anyone and everyone that’s on the marketplace to do that.”

Plan rates will be announced in the coming days.

Highmark Blue Cross Blue Shield has requested an on-average rate increase of 18%. Most of West Virginia’s enrollees get subsidies, which will increase to match the rate increases, said Louise Norris, a health policy analyst with healthinsurance.org.

“For the ones who don’t, unfortunately, premiums are climbing even higher for 2027,” Norris said. “But for the ones who do get a subsidy, the amount of that subsidy will really depend on what those final rates end up looking like in each area.”

Galardy said the approved rate ended up being slightly different than what the company asked for. She said she expects the two companies’ rates to end up being similar.

“What we’re seeing is kind of Highmark and Peak’s rates are really pretty close,” she said. “So it would say that all of us are really kind of ending up in that same space.”

She added that Highmark is glad that the marketplace will have competition with the addition of Peak Health. 

“I don’t think what any community wants is to have fewer choices,” she said.  “So while Highmark feels strongly that we’re offering good products, and I would argue probably the best network access around, I am personally happy to hear that West Virginians will have options, and I think it keeps everyone on their toes.”

Norris said people should pay attention to the premium changes — which could be significant depending on what kinds of prices Peak Health offers. 

Last year, enrollment on ACA plans dropped by about 10,000 compared to the year before after enhanced subsidies for plans expired at the end of 2025, making the plans unaffordable for some. 

“Overall affordability for people who get a subsidy should stay roughly similar in 2027 to what it has been this year, but that’s still significantly less affordable than it was in 2025,” Norris said. “So some folks who were able to make it work in early 2026, might not be able to continue that all the way into 2027.” 

Ross said Peak Health’s goal is to have the lowest prices on the marketplace. The company will offer coverage in 45 West Virginia counties. Ross said they plan to expand in later years. 

Out of pocket limits will also increase next year, Norris said. This year’s plans have an out-of-pocket limit of $10,600 per person. Next year the limit increases to $12,000 per person. 

People who receive subsidies on the health insurance exchange are required to update their income. Those whose income estimates were lower than their actual income may have to pay back excess subsidies.

Local help available for those signing up

People who enroll in plans by Dec. 15 will start their coverage Jan. 1. Those who sign up after that will have coverage starting Feb. 1. 

Smith also warned people to be careful not to enroll with a scam site. The correct website to enroll is healthcare.gov. If it’s not a .gov website, people are probably in the wrong place, he said. 

“There’s been a lot of people that get phone calls and they end up enrolling in stuff that’s not even real insurance, and then they don’t know it till it’s too late,” Smith said. “So be really careful who you trust and who you’re talking to.”

For help enrolling, Smith recommends using a local insurance agent or a local assistor. First Choice is the state’s navigator program for ACA plans. 

People can call First Choice at 304-356-5834 to set up an appointment with a navigator, Smith said. The agency’s website, https://wvnavigator.com, also has information about enrolling.

“We still have some availability in November,” he said. “People can call if they need help.”