Fallon Health dropping out of commercial health insurance market | #healthcare | #elderly | #seniors
Fallon Health will no longer provide commercial health insurance coverage, the Worcester company said Wednesday, instead focusing on government programs including Medicare and Medicaid.
Fallon, which has roughly 260,000 members, said it hopes to become the region’s leading provider of government healthcare programs, a decision it said is consistent with its mission that includes servicing high-needs individuals. It was the state’s first health plan to cover Medicaid recipients in 1979, and the first to operate an inclusive program for the elderly in 1995.
“It supports the needs of the communities we serve and it fills an important need in the commonwealth,” Fallon CEO Richard Burke said in a statement. “The COVID-19 pandemic exposed significant health care disparities in society, and we believe Fallon is well-positioned to address barriers to health access and equity.”
[Related: Fallon Health reports strong 2020]
The shift will begin Thursday. Existing commercial members will be able to stay on for 18 months.
Fallon, a nonprofit, was already increasing its share of members on Medicare, Medicaid and other government health programs. Between 2017 and 2020, members of Fallon’s government-sponsored programs grew from 31% to 57% of membership, Fallon said. Those programs also provide Fallon with a disproportionate share of its revenue at 84% of all such income.
Fallon, one of Worcester’s largest employers, has regularly been a distant fourth among the state’s health insurance plans by revenue and membership. Blue Cross Blue Shield of Massachusetts is the largest, followed by Harvard Pilgrim Health Care and Tufts Health Plan, which merged effective at the start of 2021.