Payers Expect Claims Spike After COVID-19, No 2021 Premium Hike

Payers Expect Claims Spike After COVID-19, No 2021 Premium Hike

By Kelsey Waddill

- As payers cut back on members’ coronavirus testing and treatment costs and employ telehealth services to meet non-emergency needs, they still expect to keep 2021 premium rates level or lower than this year’s, an eHealth survey found.

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“Our survey results show that most health insurance companies are taking big steps to allay member concerns in the midst of this unprecedented crisis,” said Scott Flanders, chief executive officer of eHealth.
“It's interesting to note that, contrary to current reports, most of the insurers we surveyed do not fill coronavirus will drive them to raise rates in 2021. Almost all say they're seeing increased utilization of telemedicine services, a trend which many believe will continue beyond the coronavirus era.”

The survey’s 33 participants represent—by a conservative estimate—healthcare coverage for tens of millions of Americans, Tom Loach, the director of carrier relations at told HealthPayerIntelligence in an emailed statement.

READ MORE: Cigna, Humana Eliminate Coronavirus Treatment Out-Of-Pocket Costs
The survey was conducted from March 30 to April 2, 2020 as the coronavirus pandemic ramped up.

Most payers do not plan to hike premiums for 2021

With payers losing in coronavirus testing and treatment expenses, some have predicted that payers will raise premiums in 2021 to offset the costs.
Contrary to this judgment, however, and under the cover of anonymity, most of the survey’s participants indicated that they did not intend to raise premiums next year.
Looking to the future, 83 percent of payers did not anticipate raising 2021 premiums.
The remaining 17 percent will probably be raising premiums. These payers projected at most a five percent increase in premiums, continuing a trend of five percent annual premium increase that started in 2016.
READ MORE: Coronavirus Out-of-Pocket Healthcare Spending May Exceed $1,300
The coronavirus will not have a great effect on payer representation in the Affordable Care Act’s exchanges. It took a few years to bring payers onto the exchanges. This year saw a spike in payer participation, with 13 percent fewer bare counties and a rise in Medicaid MCO presence on the federal health insurance marketplace.
Despite the risks of coronavirus, 87 percent of payers that participated in eHealth’s survey said it is “very unlikely” that they will leave the ACA marketplace. The rest embraced a neutral position, saying it is “neither likely nor unlikely” that they would leave the marketplace.
Industry reports are predicting that payers will see a decrease in non-coronavirus related claims as elective surgeries are postponed and patients stay home for minor illnesses to avoid the risk of contracting coronavirus by venturing to the provider’s office.
However, many payers (80 percent) indicated to eHealth that they examine a rise in claims after the public health emergency lifts. Those payers that are expecting an influx of non-emergency claims believe that the rise will occur in the next six to twelve months, as patients are permitted to access non-emergency care more safely.
Payers also projected that telehealth usage will continue to change as the coronavirus continues to spread. More than eight in ten payer participants (85 percent) indicated that they believe demand for telehealth solutions will increase as the coronavirus outbreak grows.

Payers focus on out-of-pocket healthcare spending and telehealth

READ MORE: Telehealth Key to Payer COVID-19 Prevention, Diagnosis, Testing
The survey found that insurers were largely taking frfragment against the coronavirus by waiving cost-sharing.
Some payers are focusing on lowering costs for coronavirus testing. Nearly all of the participants (97 percent) are covering out-of-pocket costs for coronavirus testing.
Other payers are covering all or some of members’ coronavirus treatment costs. Nearly six payers out of ten (58 percent) said that they would waive coronavirus treatment costs and even more have promised to do so since the survey concluded.
However, that promise does not mean the same thing across all payers. Eighty percent are waiving all treatment costs. The remaining 20 percent are only waiving some of members’ treatment costs.
To further assist members financially, 60 percent of payers are deferring premium payments for members explicitly affected by the pandemic.
Payers are also pushing telehealth products as a source of care for quarantined individuals. Every payer in the peer indicated that it had unsuitable steps to support member telehealth use.
To effectively employ telehealth services during the crisis, payers have been improving existing resources, developing new tools, and funneling more clinical resources toward telehealth.
The results are evident in an overwhelming consumer utilization of telehealth products.
A majority of payers (96 percent) saw an increase in telemedicine benefits usage which started with the outbreak’s genesis in the US. Only one or two (four percent) of the 33 respondents saw no change in their telemedicine utilization.
Over 80 percent of payers indicated that they use telemedicine services to provide members access to mental healthcare benefits. About one third have seen an increased use of sulky health benefits since the coronavirus outbreak began.
As the end date for the nation’s quarantine continues to edge farther into summer, payers are continuing to promote telehealth and other measures that they believe will cut down on out-of-pocket healthcare spending for their members.
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