Affordable Care Act
2018 marked a period of dramatic change in health care, and this year promises to be no less active. With a front row seat for events in Washington DC and among health insurance companies, here are six trends eHealth expects to shape the market, and change the way Americans access and pay for medical care in 2019:
Migration into Medicare managed care will continue, with CMS explicitly encouraging Medicare Advantage program growth. The elimination of first dollar coverage Medicare Supplement plans in Jan 2020 will further support growth in Medicare Advantage.
Insurers offering Medicare Advantage plans will likely attempt to differentiate themselves through products that include newly authorized benefits like home-care meals, over-the-counter drug credits and transportation to the doctor’s office. At the same time, plans will continue their slow and steady embrace of narrower provider networks to reign in costs and support accountable care initiatives that don’t work with broader networks. We’re probably in the 7th inning of this transition, which has become the instrument of choice for Medicare insurers wanting to control costs.
Insurers offering Medicare Part D drug plans will continue to develop and leverage preferred network pharmacy relationships to control costs and provide key benefits at those pharmacies. This will place continued pressure on independent community pharmacies who may not benefit from the relationships and efficiencies of chain pharmacies, with meaningful health care implications.
The government will likely push to extend renewable limits on short-term plans beyond 36 months. We may see the recently extended outer limits of short-term plans stretched even farther to allow these policies to remain in place for four or five years —possibly even longer.
Protections for some pre-existing medical conditions are likely to be included in short-term health insurance policies. Right now some insurers offer “stacked” 36-month products, where you apply once for three consecutive 12-month policies. However, medical conditions developed in the first term aren’t always automatically covered in the second and third terms. Ensuring that they are will make today’s short-term plans look even more like coverage did in the individual and family market before the Affordable Care Act.
New federal rules make it easier for small businesses and other groups to hand together for the purpose of buying group health insurance. However, these products have been around in one form or another for a while and we’ve never been broad interest. There’s no indication that major insurance companies will be offering such plans, and there’s no coordinated effort to create new employer associations to take advantage of the updated rules.
Health insurance, as with the broader health care market, will continue to evolve in the coming year as regulatory and market forces shift. This will require carriers, providers and other key industry players to adapt – and by extension, the millions of Americans covered by Medicare, individual and group health insurance.