Health Plan Weekly

After years of having just one, limited option available to combat respiratory syncytial virus (RSV) in at-risk populations, the U.S. market this year has suddenly become rich with new products. Yet insurance coverage limitations and supply issues are frustrating efforts to keep elderly adults and very young babies from contracting what can be a life-threatening illness. 

This May, the FDA approved both GSK’s Arexvy and Pfizer Inc.’s Abrysvo for people who are 60 and older, and in August, federal regulators approved Abrysvo for use in people who have been pregnant for 32 to 36 weeks, with the goal of protecting their infants after birth. Additionally, in July, the FDA approved Sanofi/AstraZeneca’s Beyfortus (nirsevimab-alip), a monocolonal antibody injection indicated for preventing RSV in newborns and infants born during or entering their first RSV season, and for children up to 24 months old who remain vulnerable to severe disease throughout their second RSV season. 

Centene Corp. reported sterling results in the third quarter of 2023, with the firm exceeding its quarterly earnings target and executing $773 million in share repurchases in that time. Executives promised further improvement on Medicare Advantage Star Ratings and touted notable individual marketplace enrollment growth during the quarter.

Centene executives credited the strong results to membership growth and low utilization in the firm’s Affordable Care Act marketplace book of business. Executives also said that the firm, which mainly has members who are enrolled in managed Medicaid plans, has capably weathered the return of eligibility redeterminations, which were suspended during the bulk of the COVID-19 public health emergency and resumed in the spring. The firm’s total Medicaid enrollment during the third quarter declined by only 2.9% year over year to 15.24 million members.

Two recent surveys from KFF and WTW indicate employer-sponsored health plans are concerned with rising health care costs, driven by factors such as inflation, increased utilization and rising prescription drug expenditures. However, the results suggest that employers are becoming more hesitant to raise health insurance costs for workers at a higher rate than their salary increases. 

While the average annual family premiums for employer-sponsored coverage increased 7% this year to $23,968 after not increasing a year ago, according to the KFF Employer Health Benefits Survey, workers’ average wages increased 5.2% and inflation was up by 5.8%. During the past five years, premiums increased 22%, while wages rose by 27% and inflation increased 21%.  

The average annual premium for employer-sponsored health insurance in 2023 was $8,435 for single coverage and $23,968 for family coverage, a 7% increase from 2022, according to the Kaiser Family Foundation 2023 Employer Health Benefits Survey. On average, premiums for single and family coverage grew 22% since 2018. Over the past 10 years, the growth seen in the average premium for family coverage outpaced the rate of inflation (47% vs. 30%), whereas the average family premium and average wages grew at comparable rates (47% vs. 42%).

In 2024, the average monthly premium for a benchmark silver plan on the federal Affordable Care Act exchange will rise by 4% compared to 2023, CMS revealed on Oct. 25. Premiums for a benchmark plan, or the average second-lowest-cost silver tier plan, are used to calculate advance premium tax credits (APTC) that rise in tandem with premium rates. CMS noted that the year-over-year benchmark plan premium increase of 4% between 2023 and 2024 is the same as the increase seen between 2022 and 2023. Also continuing next year will be enhanced subsidies that make ACA exchange plans much more affordable than they were before the American Rescue Plan Act (ARPA) of 2021. To that end, the average benchmark plan rate after premium tax credits are applied, for a 40-year-old at 150% of the federal poverty level, will continue to be $0 in 2024 — compared to $55 before ARPA was enacted.