Friday, May 07, 2021

Predicting Enrollment Changes in the COVID Era

Today’s guest post comes from Jill Brown Kettler, Executive Editor at AIS Health, a division of MMIT.

Jill discusses MMIT's proprietary data on how the COVID-19 pandemic affected enrollment in commercial plans, Medicaid, and health insurance exchanges. 

To learn more about 2020 enrollment changes and the 2021 outlook, register for MMIT’s free webinar on May 18 at 1:00 pm ET: Meet the Expert: Predicting Enrollment Changes in the Covid Era.

Read on for Jill’s insights.
Predicting Enrollment Changes in the COVID Era
By Jill Brown Kettler, Executive Editor, AIS Health, a division of MMIT

When the COVID-19 pandemic reached the U.S. last year, the closures and disruptions that the virus brought to nearly every facet of life sparked considerable concern about the impact on market access. For example, would there be major shifts in medical and pharmacy coverage, with millions of lives moving from commercial coverage to the ranks of the uninsured and thus losing access to life-saving treatments?

The pandemic and the ensuing legislative, policy and economic response has made it more difficult than ever to predict enrollment across payers, geographies and channels, as I will discuss at an MMIT Meet the Expert webinar on May 18. 

As the leading provider of market access data, analytics and insights, MMIT’s expert teams of clinicians, data specialists and market researchers provide clarity and confidence on the “what and why” of market access, so that our clients can make better decisions.

(1) Commercial Enrollment: According to MMIT’s proprietary Payer Landscape enrollment data, the commercial sector was hardest hit by the pandemic, with commercial enrollment dropping by 8% or 13 million lives between January 2020 and April 2021. Most of the losses occurred between January and July 2020, and enrollment has held roughly steady since then.

The decline wasn’t as steep as some had feared, because of factors including the easier-than-expected transition to remote work and the Payroll Protection Program, which helped some employers maintain head counts and health insurance coverage. Of more concern is the fact that the travel, tourism and hospitality industries, which arguably suffered the most in the pandemic, already were less likely to offer health insurance to their workforces. And with layoffs and closures concentrated in industries with historically lower health insurance offer rates, there was less of an impact on overall commercial enrollment.

Looking ahead, we expect commercial enrollment to remain steady, with perhaps a slight drop-off in the fall. That’s partly the result of COVID relief legislation that will provide some protection for workers who lost job-based insurance. The American Rescue Plan, signed into law March 11, expands eligibility for premium subsidies for Affordable Care Act exchange plans and creates new temporary premium subsidies to cover the cost of COBRA continuation coverage.

(2) Managed Medicaid: The biggest enrollment gains over the past six quarters have been in the managed Medicaid segment, which saw an increase of about 8 million lives, almost a 17% uptick, while state Medicaid lives remained about flat between January 2020 and April 2021. After slow growth between January and July 2020, managed Medicaid has been adding roughly 2 million lives every quarter. We expect Medicaid enrollment to keep increasing because of national policy changes. States are receiving extra funding for Medicaid programs, but must comply with a maintenance of effort requirement that bars them from disenrolling most Medicaid recipients who no longer qualify.

(3) Health Insurance Exchanges: Meanwhile, health insurance exchange enrollment rose 15% or about 1.5 million lives to reach 11.7 million in April 2021. It could rise still further, with the Biden executive order that created a new special enrollment period for exchanges that runs through Aug. 15. This means that anyone can sign up for exchange coverage even without a qualifying life event. In addition, the executive order created more funding for navigators, who are tasked with helping people enroll in any eligible coverage — including Medicaid, possibly creating a lift in that program’s enrollment as well.

On May 18 at 1:00 pm ET, join me for a conversation about:
  • how enrollment gains and losses varied by geography and channel in 2020 — and what is likely to happen in 2021,
  • how unemployment levels as well as industry and policy actions have complicated the enrollment picture, and
  • case studies of three large payers showing how COVID affected enrollment during 2020 and where they are likely to see changes in 2021.
Click here to register for the free webinar: Meet the Expert: Predicting Enrollment Changes in the Covid Era.

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