By Leslie Small

With open enrollment for the Affordable Care Act (ACA) exchanges set to begin on Nov. 1 in most states — as is the case with nearly everything in 2020 — the COVID-19 pandemic is expected to play a role. Health insurers had to decide when setting 2021 premiums whether to factor in a “COVID load,” while rising unemployment driven by the pandemic has the potential to boost sign-ups after two years of flat enrollment totals.

Meanwhile, a report released by the Trump administration on Oct. 19, which analyzed rates in the 36 states that use HealthCare.gov, found that the average premium paid by a 27-year-old for the second-lowest-cost silver plan will decline 2% for 2021, and 22 more plan issuers will offer coverage.

“The rates that we reviewed are pretty much the lowest increases we’ve seen in a long time,” says Donna Novak, a member of the American Academy of Actuaries’ Individual and Small Group Markets Committee. “I think [the] experience in 2019, which 2021 rates are based on, for many of the carriers turned out better than they expected it to be,” she adds.

Nisha Kurani, a senior policy analyst for the Kaiser Family Foundation’s Program on the ACA, said during a recent KFF webinar that when she helped analyze insurers’ 2021 rate filings to gauge how they were accounting for the impact of COVID-19, “the term uncertainty came up a lot.” Some insurers simply refrained from projecting a “COVID load” onto their premiums, she explained, while in some cases, state regulators directed insurers not to apply any COVID-related adjustments to their rates. Among the insurers that did account for a COVID-19 impact, KFF researchers observed a variation of strategies, such as factoring in the cost of a vaccine or adjusting morbidity/mortality assumptions.

Rosemarie Day, founder and president of Day Health Strategies LLC., says she anticipates that the rising unemployment rate during the pandemic could contribute to enrollment growth in the individual market. Because people who are generally healthy may be “paying more attention to health care messaging” due to concerns about contracting the novel coronavirus, they “could be coming in and helping to keep prices reasonable,” Day adds.