Medica's status as the last health plan selling coverage on government-run insurance exchanges for Iowa and Nebraska helped the insurer double its individual market enrollment for 2018.

In the market where self-employed people under age 65 buy coverage, Medica saw enrollment grow to 196,479 people as of March across Minnesota and five other states where the insurer sells the coverage. Last year, the comparable tally was about 91,000, according to a Star Tribune analysis of regulatory filings.

Medica garnered national attention last year when red ink pushed other insurers to exit the Iowa and Nebraska markets, leaving the Minnetonka-based insurer as the only option for individuals seeking coverage that complies with rules in the federal Affordable Care Act (ACA).

"We do expect our business in the individual market to return to profitability in 2018," said Geoff Bartsh, a Medica vice president, in a statement to the Star Tribune on Monday. "It's early in the year, but it appears that approved rates for 2018 will cover the claims expenses across our service area."

The numbers only apply to the individual market, a small slice of the health insurance world for people who don't get coverage from an employer or a government program like Medicare.

The federal health law fundamentally changed the individual market by stopping carriers from denying coverage to people with pre-existing conditions. The ACA also created government-run insurance exchanges that were meant to make shopping easier for consumers. The changes, which took effect in 2014, were seen as a chance for new players to enter markets.

Medica has been somewhat unusual in sticking with a strategy of growth via ACA markets, even as some of the nation's largest carriers, including Minnetonka-based UnitedHealthcare, have retreated from the exchanges.

"Since there were a lot of exits there were lots of opportunities for remaining carriers to pick up new members, whether they really wanted to or not," said Katherine Hempstead, a researcher with the Robert Wood Johnson Foundation, in an e-mail.

For decades, Medica has been known primarily as a Minnesota insurer, and the nonprofit still sees a much bigger share of its revenue from employer groups and people with Medicare coverage.

In the individual market, the insurer now has more than 88,000 subscribers in Nebraska and 45,000 in Iowa, compared with roughly 39,000 in Minnesota.

In 2013, Medica had about 49,000 individual market customers in Minnesota, which has seen an overall decline in the individual market enrollment.

In Iowa and Nebraska, many with individual market coverage have held onto pre-ACA health plans that regulators have allowed to continue despite new rules under the federal health law. In Kansas, Medica is one of three insurers selling ACA-compliant coverage, Bartsh said, but the only carrier doing so on a statewide basis.

In 2016, Medica said it lost $55.8 million on $332.5 million of revenue in the individual market. Last year, the insurer said its losses in the market narrowed to about $4.8 million on $750.6 million in revenue. Medica also sells individual policies in North Dakota and Wisconsin.

"Continued instability in this market was recognized by state regulators, which allowed us to set prices that aligned better with the health care needs of our members," Medica said in a statement.