Health Plan Weekly

✦ The annual estimated cost for COVID-19 diagnostic testing ranges from $6.0 billion to $25.1 billion, while the estimated cost for antibody testing ranges from $5.2 billion to $19.1 billion. That’s according to a new analysis from Wakely Consulting Group (prepared for America’s Health Insurance Plans), which separately updated its previous analysis estimating the cost of treating COVID-19 (see story, p. 1). The testing analysis examined potential costs associated with three types of COVID-19 tests: medically necessary ones used to treat or diagnose COVID-19; public health tests aimed at analyzing the prevalence of COVID-19 in the population on an ongoing basis; and occupational health tests meant to reduce employees’ risk of exposure to the coronavirus at their workplaces. Read more at https://bit.ly/2Yjwb1q.

✦ A new proposed rule from the Trump administration would let employers use health reimbursement arrangements (HRAs) to reimburse employees who opt for direct primary care arrangements or health care sharing ministry memberships. The proposed rule, published in the Federal Register on June 10, would also designate any funds employees spend on those two type of health insurance alternatives as deductible medical expenses. Last summer, the administration released a final rule that allowed companies to use HRAs to reimburse employees for purchasing individual health insurance policies (HPW 7/1/19, p. 1). View the proposed rule at https://bit.ly/3dTKSPn.

There are always uncertainties when it comes to projecting plan costs for the year ahead, but Medicare Advantage and Part D organizations in the most recent bid cycle faced a particularly unpredictable set of circumstances created by the COVID-19 pandemic.

“I think we will all look back on the 2021 bids as the year of COVID-19,” says Brad Piper, a principal and consulting actuary in Milliman’s Milwaukee office, who recently helped MA clients prepare bids that were due June 1. “That was a big challenge for the organizations that are in the Medicare Advantage program — [perhaps more so] than on the Part D side — and it impacted both sides of the coin: costs and revenue.”

Indiana on May 29 received CMS approval for a Section 1115 waiver demo that allows residents moving from Medicaid expansion to commercial plans to spend up to $1,000 of funds stored in quasi-HSA accounts on insurance premiums or cost-sharing expenses. State officials describe the plan as a way to help former Medicaid members whose income has grown stay insured. However, experts say that the program, which is related to Indiana’s push for Medicaid work requirements, isn’t likely to improve access to coverage for those eligible.

The program allows former members of the Medicaid expansion program, the Healthy Indiana Plan (HIP), who have joined an employer-backed or individual exchange commercial plan to spend up to $1,000 in Medicaid funds on expenses including premiums, copays, prescription drugs and other cost sharing for the 12 months after their transition from Medicaid.