Member: Health Plan Weekly

Blues Plans Dominate Marketplaces; Medicaid Plans Increase Presence

July 6, 2020

by Jinghong Chen Between 2016 and 2018, Medicaid-focused insurers expanded their footprint into the Affordable Care Act (ACA) marketplaces by offering lower premiums for silver plans, according to a recent analysis by the Robert Wood Johnson Foundation. Blue Cross Blue Shield plans remained the dominant players, accounting for almost half of marketplace enrollment nationally in […]

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News Briefs

July 6, 2020

✦ Employer health care spending could grow anywhere from 4% to 10% in 2021 as costs rebound from a dip in utilization tied to the COVID-19 pandemic, according to a new report from PwC’s Health Research Institute. The two main factors that PwC expects to inflate spending in 2021 are increased mental health services utilization and new and previously approved specialty drugs. Two major potential offsetting factors include the rapid adoption of telehealth and employers increasing their use of narrow networks.

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Payers Partner With Communities of Color to Battle Racism

June 29, 2020

COVID-19 has disproportionately infected and killed people of color, causing many health care leaders to renew their focus on racism’s role in social determinants of health (SDOH). Since George Floyd was killed by Minneapolis police and Black Lives Matter protests took over America’s streets, the conversation about racism in health care has become even more urgent. Experts and policymakers say payers can help battle racism and SDOH by partnering with organizations rooted in communities of color — and improve insurance business outcomes by doing so.

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Insurers Must Cover Only ‘Medically Necessary’ COVID Tests

June 29, 2020

As more employers turn to COVID-19 testing to see if employees are safe to return to the workplace, the Trump administration has clarified that insurers must cover only physician-ordered “medically necessary” diagnostic and antibody tests.

The guidance, released jointly on June 23 by the Department of Health and Human Services, the Department of Labor and the Department of the Treasury, also says self-funded employer plans must pay for COVID-19 testing that’s medically appropriate, and that providers of tests must publicly post retail prices for those tests.

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Reports: Medicaid MCOs Are ‘Dominant,’ Offer Quality Care

June 29, 2020

Two recent reports found that Medicaid managed care plans now enroll most Medicaid members, help keep costs and premiums low in the markets where they participate, and are competitive with commercial plans at the low end of the individual market in areas including network quality and benefit design.

One white paper was prepared by consultancy The Menges Group for America’s Health Insurance Plans (AHIP) and released on June 23, and the other was authored by researchers at the Robert Wood Johnson Foundation (RWJF) and Urban Institute and released on June 17. The Menges Group-AHIP study focused primarily on measuring the scale of Medicaid MCO market share nationally, while the RWJF-Urban Institute report surveyed Medicaid stakeholders about MCO quality and effectiveness.

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