December

Wall Street Is Optimistic About Health Insurers’ Fortunes in 2021

December 30, 2020

Equities analysts are bullish on the health insurance industry in 2021, despite the challenges caused by the COVID-19 pandemic. Wall Street also expects more mergers and acquisitions will take place in 2021 than the previous year, particularly vertical deals and national carriers buying up regional health plans. However, analysts also emphasized that the uncertainty of care utilization patterns tied the pandemic continues to inject risk into their projections.

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2020 Year in Review: In Hindsight, It Was a Time Like No Other for Payers

December 30, 2020

For the health insurance industry — alongside the rest of the health care sector, and even the world — the COVID-19 pandemic was undeniably the event that dominated 2020. However, other issues also captured headlines and had major implications for the sector, including the U.S. election, various court cases, a slew of regulatory moves from the Trump administration, and some notable transactions.

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HealthCare.gov Sign-Ups Rise in Most States

December 30, 2020

Over 8.2 million people selected or were automatically reenrolled in health plans for 2021 on HealthCare.gov as of the Dec. 15 deadline, which was just shy of the 8.3 million sign-ups for the 2020 plan year, according to CMS. However, year-over-year comparisons are imperfect because Pennsylvania and New Jersey transitioned to their own state-based exchanges for the 2021 plan year, and their sign-ups accounted for 7% of all plan selections for 2020. Still, 25 of the 36 states using HealthCare.gov saw an enrollment increase for 2021 compared with 2020.

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Winners, Losers Remain Unclear With Surprise Billing Fix

December 23, 2020

After years of failed attempts, Congress has finally come to an agreement on a measure to end the practice of surprise medical billing — leaving experts debating whether the new policy can slow the growing cost of health care and the inflation of premiums. The legislation is part of the Dec. 21 Consolidated Appropriations Act, a coronavirus economic relief bill that was passed by Congress but at press time faced an uncertain future after President Donald Trump on Dec. 23 condemned the bill’s $600 direct payments to Americans as too low.

Surprise billing, also known as balance billing, is the practice of charging patients for out-of-network procedures that insurers refuse to pay for in whole or in part. Often, patients incur these balance bills without their knowledge: Some patients are incapacitated when treated by an out-of-network specialist like an anesthesiologist and cannot consent to the procedure they receive. The new legislation would ban providers from sending such a bill to patients, and would instead require providers to negotiate reimbursement with the patient’s insurer or submit the dispute to a binding arbitration process. The measure would not apply retroactively.

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By the Numbers: The National Health Insurance Market in 2020

December 23, 2020

The year 2020 has been filled with unpredictability amid all the changes ushered in by the COVID-19 pandemic. Because of the pandemic-driven economic crisis and ballooning unemployment, member enrollment has seen significant shifts from commercial health coverage toward managed Medicaid plans, according to AIS’s Directory of Health Plans. Though insurers are required to cover coronavirus testing and many chose to waive out-of-pocket costs for coronavirus treatment, their gross margins soared compared to 2019 as a result of significant drops in elective and routine care utilization.

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Payers See Value in Job Training for Medicaid Members

December 23, 2020

The University of Pittsburgh Medical Center is the largest employer in the Pittsburgh area, with hundreds of job openings on any given day. At the same time, the integrated network’s UPMC Health Plan covers nearly one in five Medicaid beneficiaries in the state of Pennsylvania.

So when the health plan launched its Pathways to Work program this July, it made sense for Medicaid members to be a focal point of the program’s workforce development efforts.

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