Despite the end of individual mandates and cost sharing payments to insurers, the individual marketplace for health care coverage under the Affordable Care Act will get more insurers and competition for consumers next year in Tennessee.

Two new health insurers are planning to enter the Tennessee market in 2019, including a new competitor for the Chattanooga area, while two other insurers want to enlarge their coverage areas next year in Tennessee. And after four years of double-digit rate increases every year, premium increases under the so-called Obamacare plans are expected to moderate in 2019 across the Volunteer State.

Two new entrants to Tennessee's health insurance market — the Minneapolis-based Bright Health and Ambetter plans offered by the St. Louis-based Centene Corp. — have applied to sell insurance on the individual marketplace next year. Meanwhile, both Cigna and Oscar, which entered Tennessee last year, want to expand their footprint to other parts of Tennessee.

"What's amazing is that even though the current administration has done away with the individual mandate (to require persons to buy insurance) and done away with cost sharing (payments to insurance providers to cover their increased risks for such plans), there's more competition coming and the likelihood of a flat rate increase next year. Carriers are making money now and there are some great signs that the marketplace is stabilizing and will likely be around for a long time," said Bobby Huffaker, president of the Chattanooga-based American Exchange, a broker for individual plans under the Affordable Care Act.

In Chattanooga, consumers buying on the individual healthcare exchange next year will again have a choice of carriers beyond the lone current provider of so-called Obamacare plans today from the Chattanooga-based BlueCross and BlueShield of Tennessee.

Celtic's Ambetter has applied to provide coverage in two of Tennessee's major service areas, including Chattanooga. Huffaker said his company has worked with Ambetter in other states "and we think that they will provide a good opportunity in Chattanooga and competition for consumers to choose from in this area.

"We don't know what rates will be offered yet, but we are encouraged to see more competition which benefits everyone," Huffaker said.

The health insurers must file their proposed rates for health care coverage in 2019 by next week and the Tennessee Department of Commerce and Insurance is due to approve the carriers and their rates for different areas of Tennessee by Sept. 25.

Open enrollment for consumers to sign up for one of the individual plans under the health care marketplace for 2019 will be from Nov. 1 to Dec. 15.

Tennessee's biggest health insurer, BlueCross of Tennessee, said earlier this year it expected to limit its individual rate hikes next year, or perhaps even stabilize or cut some rates, after finally reversing three years of losses from individual coverage plans under the Affordable Care Act.

BlueCross lost nearly $500 million in the first three years of the so-called Obamacare program. But after rate increases that more than doubled the initial price for such plans, BlueCross made a profit last year in the individual market of $113 million and the company expects to again be profitable in the individual market in 2018.

Individual health insurance rates still tend to be higher per capita than are group health insurance rates, but subsidies provided by the federal government to low- and moderate-income persons and families for marketplace exchange plans ower the consumer costs for such coverage for most individuals.

The individual health exchange plans under the Affordable Care Act currently cover about 228,646 Tennesseans, or about 3 percent of all residents in the state, according to the online news service BirdDog.

Roy Vaughn, senior vice president of strategic communications, said in May he expects BlueCross to moderate its rate increases for individual plans in 2019 and could end up without any significant change in prices.

"We had a very strong year operationally with all of our lines earning 4-star recognition [for customer service] and all of them being profitable in 2017," Vaughn said in May. "After three years of consecutive losses, we knew we had to get to some level of net income and our individual policy business ended up performing better than expected."

BlueCross announced two years ago it was limiting its coverage area under the individual marketplace exchange to cut its losses and risks. But the insurer returned to the Knoxville market this year year to ensure that no part of the state was left out of individual coverage.

"Overall, as the market remains somewhat uncertain, we will keep our current footprint – covering 81 of the state's 95 counties – in 2019," BlueCross spokeswoman Mary Danielson said Monday.

Celtic's Ambetter, a Centene Corp., health insurance marketplace product, intends to offer policies next year in the Chattanooga and Memphis areas. Celtic has not offered policies in Tennessee since 2016.

Bright Health intends to offer policies in the Knoxville, Memphis, and Nashville areas. Bright Health previously did not have a Tennessee presence.

Cigna Healthcare intends to enter the Knoxville area and maintain its presence in the Nashville, Memphis, and Tri-Cities rating areas.

Oscar, which entered the Tennessee market this year in Nashville, plans to also expand to the Memphis area next year.

"These new players in the market obviously see opportunities in these markets and I think that is going to be a good thing for these communities with more competition and more choices," said Jaycee Wooley, executive director of the Tennessee Health Care Coalition, which advocates for the Affordable Care Act and the expansion of Medicaid coverage under the act in Tennessee. "We still want Tennessee to join with what other states have done to expand coverage through Medicaid. But we think these new additions to the market are encouraging and show that despite all of the challenges, ACA (the Affordable Care Act) is still working and needed in our state."

Contact Dave Flessner at dflessner@timesfreepress.com or at 757-6340