Health Plan Weekly

  • News Briefs

     Enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) grew by 10.8% between February and November 2020 to approximately 78 million, according to an issue brief by the Kaiser Family Foundation (KFF). The growth in the safety-net insurance programs follows a two-year trend of declining enrollment. “Increases in enrollment reflect changes in the economy (as more people experience income and job loss and become eligible and enroll in Medicaid and CHIP coverage) and provisions in the Families First Coronavirus Response Act (FFCRA) that require states to ensure continuous coverage to current Medicaid and CHIP enrollees to access a temporary increase in the Medicaid/CHIP match rates,” the brief said. Read more at https://bit.ly/39Lg97F.

     Making the expanded Affordable Care Act (ACA) marketplace tax credits included in the American Rescue Plan permanent would lower the national uninsured rate by 4.2 million, according to an analysis by the Robert Wood Johnson Foundation (RWJF) and Urban Institute. Individuals who already qualified for premium tax credits under the ACA will see more generous financial aid, including expanded access to zero- premium plans for lower-income people. In addition, people whose incomes were too high to qualify for subsidies will be eligible for reduced premiums for the first time thanks to a provision that caps marketplace premiums at 8.5% of all enrollees’ income. The subsidies are currently set to expire after 2022. Read more at https://rwjf.ws/3docTB4.

  • MedSupp Presents Disruption Opportunity for MA Plans

    Medicare beneficiaries who shopped and made a coverage change during this last Annual Election Period (AEP) were more likely to stick with their current insurer than in years past, illustrating the dual need for insurers to engage with consumers throughout the year and to innovate with benefits that will attract and retain satisfied members, according to experts speaking at a recent webinar co-hosted by Deft Research and GHG Advisors. At the same time, Medicare Supplemental (MedSupp) customers are showing increased interest in Medicare Advantage, presenting more opportunities to disrupt that market.

    Outside of a few dozen rural counties where it’s hard to create an attractive plan network, MA insurers across the country are seeing solid growth, with close to 43% of Medicare eligibles enrolling in the individual and group MA market — moving ever closer to CMS’s estimate that MA penetration will reach 50% by 2025, observed Deft Executive Vice President George Dippel during the April 8 webinar, “2021 AEP: How the Results Will Drive Plan Decisions for 2022 and Beyond.”

  • UnitedHealth Expects Pent-Up Care to Return Later in ’21

    UnitedHealth Group began the first quarter of 2021 on a high note, reporting earnings per share (EPS) and a medical loss ratio (MLR) that both beat the Wall Street consensus estimate and saying it expects to achieve greater full-year earnings than it previously estimated. However — mirroring much of the messaging last year when the COVID-19 pandemic was massively depressing routine and elective care — executives warned that the majority of the unfavorable COVID impact they’re expecting will transpire in the second half of the year.

    In fact, UnitedHealth expects roughly 70% of the predicted COVID-related $1.80 EPS hit to occur in the back half of the year, Chief Financial Officer John Rex said during an April 15 conference call to discuss the company’s financial results. He said that projection is based on UnitedHealth’s prediction that as the year wears on and vaccination rates rise, people will increasingly be able to access higher-acuity, previously deferred care.

  • With IPO Talk, Telehealth Buy, Startup’s Future May Be Bright

    After 2020 proved to be a banner year for initial public offerings, three separate startup health insurers — Alignment Healthcare, Clover Health and Oscar Health — rode the wave and launched IPOs in the early months of 2021. Now, Bright Health Inc. is reportedly poised to become the fourth insurer to do so, and in the meantime has picked up a telehealth asset for good measure.

    Industry experts tell AIS Health that while many aspects of Bright Health’s business will become clearer if it does end up trading publicly, the company so far looks more likely than some of its fellow startups to succeed.

  • Hospitals Are Slow to Make Negotiated Prices Transparent

    Several recent studies indicate that providers have been slow to fully comply with a 2019 Trump administration final rule requiring hospitals to disclose pricing information to consumers. The hospital price transparency regulation, which met stiff legal opposition from industry groups including the American Hospital Association, has not been enforced with gusto by the Biden administration, but experts say that might change — and that the rule isn’t going anywhere.

    The price transparency rule requires hospitals to release “a machine-readable file containing a list of all standard charges for all items and services” to the public. The rule was part of the Trump administration’s larger push to make cost of care and medical data more transparent for consumers, a strategy that also includes a price transparency mandate for insurers (HPW 11/6/20, p. 1). Because of the pandemic, the hospital rule’s effective date was pushed back from November 2019 to January 2021. Hospitals that are not compliant can be assessed a penalty of up to $300 per day by CMS, a fine that would amount to $109,500 over a full year.

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