Altruista-Health-Open-Enrollment-2019
Medicare Advantage plans expand markets and adopt strategies to address social determinants of health.
Oct 4, 2019

Industry Gears Up for Open Enrollment

On the cusp of open enrollment season, several trends are coming into focus for 2020. How they play out in the lives of health plan members depends greatly on where they get their health insurance. Following are some topics making headlines.

Larger employers adding digital options

The cost increases for employer-based coverage at larger companies are moderate – about 5 percent – and some employers have built more choice into their offerings. They are adding digital and mental health options for their employees, and adding PPOs back into the mix, according to the National Business Group on Health. Employees who had been offered only high-deductible health plans told employers they wanted other options.

Employers have said recently that deductibles aren’t likely to go higher. The downfall of many high-deductible plans has been the inability of consumers to shop around for care as initially intended. A 2016 study showed that less than 7 percent of services are considered “shoppable,” that is, something that can be planned for and where prices can be obtained and compared. Such services as joint replacements, flu shots and blood tests are examples of services considered shoppable.

Medicare Advantage succeeds … and expands

Next year will unleash a new wave of options for Medicare Advantage members as insurers experiment with benefits that address social determinants of health. Although these were allowable in 2019, most plans needed more time to develop strategies around these offerings. So, 2020 will likely be rich in lessons about what works and what doesn’t. Medicare Advantage in itself continues to be popular and successful. A number of plans are expanding their markets.

Individual plans require attentive consumers

Experts say Americans who get their insurance through the Exchange will again have to work a little harder to enroll since funds to educate on the Affordable Care Act and navigate the system have been cut dramatically in recent years. Open enrollment dates will generally stay the same for Exchange and off-Exchange plans – Nov. 1 through Dec. 15. Much of the upheaval and uncertainty of the last several years has calmed and price hikes are generally very modest – about 1 percent in the 20 states that make their information available.

Paying more but still confused

Health insurance literacy remains strikingly low, even as many plan members are paying more for their care. The share of Americans who can correctly define basic health insurance terms – premium, deductible, copay, coinsurance and out-of-pocket maximums – hovers between 4 – 7 percent. To top it off, most overestimate how well they understand these terms. Unfortunately, research shows people with low health insurance literacy are more likely to avoid even no-cost preventive care. Recognizing the complexities of the healthcare system, 78 percent of large employers now offer some form of decision support to help employees navigate it for the best use of their benefits.

Of course, with the current turmoil in the nation’s capital, the future of healthcare legislation and regulations that have been front-burner items could easily be overshadowed in the national dialogue. But for 2020, health plans are in place and open enrollment should proceed as expected.