Health Plan Weekly

As the number of known COVID-19 cases continues to increase in the U.S., reaching over 1,600 on March 13, health insurers are taking action to help their enrollees access testing and treatments. A majority of reported cases are in Washington, New York and California, where state governments have issued guidance to health insurance providers regarding testing and treatment coverage. Below are some key measures taken by insurers, based on a roundup compiled by America’s Health Insurance Plans.

Health insurance stocks were not spared on March 12, the worst trading day on Wall Street since Black Monday in 1987. UnitedHealth Group, Cigna Corp., Anthem, Inc., and Humana Inc. all closed at least 9% down from the day before. Analysts say the gloomy view of payers is justified, despite carriers’ efforts to boost investor confidence.

In a March 9 note describing financial models of the COVID-19 pandemic based on the 2018 flu season, Credit Suisse analyst A.J. Rice projected “a negative EPS [earnings per share] impact relative to our 2020 EPS estimates ranging from 1.6% for Cigna to 14.4% for Humana” for the first quarter of 2020, adding that “for the full year, this results in negative EPS impact of 0.8% for Cigna to 3.7% for Humana.”

Individual marketplaces under the Affordable Care Act (ACA) have seen premiums stabilize, according to an analysis of 2020 open enrollment data performed by McKinsey & Co Inc. Health exchange experts tell AIS Health that increased payer participation and market maturity are responsible for the increased consistency in prices.

Notable insights from the report include:

✦ The number of counties with a single carrier on exchanges dropped 11% year over year to 25% in 2020.

✦ Approximately 9% of consumers could choose only one carrier in 2020, down from 16% in 2019.

✦ This year, 66% of consumers were able to choose between at least three carriers.

✦ Average premium prices went down by 1% year over year for all plan tiers except platinum, which increased by 3%.

Medicaid managed care organizations and states that are working to implement value-based payment within Medicaid must overcome challenges posed by provider consolidation and limited state resources, researchers from the Medicaid and CHIP Payment and Access Commission (MACPAC) reported recently.

MACPAC’s deep dive into value-based payment for Medicaid, highlighted at the commission’s February meeting, found that some states take a prescriptive approach, requiring MCOs to implement specific value-based programs, while others take a more flexible strategy.

As the new coronavirus continues to spread throughout the world, the U.S. federal government, states and private health insurers have responded with a flurry of actions aimed at lowering cost barriers that could discourage people from getting tested or treated. But health policy experts tell AIS Health that the sheer number of such announcements lays bare one of the U.S. health care system’s biggest flaws — its decentralized nature.

More than 40 different health insurers so far have stepped forward to unveil new coronavirus-related policies, according to a running list compiled by America’s Health Insurance Plans (AHIP). Many are waiving cost-sharing and prior-authorization requirements for members who need to get tested for the virus, and some of them are also waiving deductibles. Other measures include relaxing restrictions on telehealth and prescription refills, and opening emotional-support help lines. However, most of the new cost-sharing policies apply only to fully insured commercial plans, Medicaid managed care and/or Medicare Advantage (MA) plans, as employers have more discretion when it comes to self-insured health plans.