According to AHIP 88% of individual and fully insured group plans waived COVID-19 treatment costs during some point in the pandemic. (Photo: Shutterstock)
Many of cost-sharing waivers issued by health insurers have already expired or will lapse this month. But with the COVID pandemic still in full swing, what will that mean for Americans in need of health care?
As a result of many delaying non-essential medical treatments, health insurers are now seeing a rise in profits. But due the Affordable Care Act's (ACA) Medical Loss Ratio (MLR) rule, which dictates how much premium income must be spent on medical care, these companies are looking to return some of that capital back to consumers in the form of cost-sharing waivers.
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According to a new report by the Kaiser Family Foundation, many insurers are offering cost-sharing waivers for COVID-19 treatments, with a few are also offering additional measures like premium relief. In reviewing data compiled by America's Health Insurance Plans (AHIP), the report found that 88% of individual and fully insured group plans waived COVID-19 treatment costs during some point in the pandemic. At least five U.S. states and the District of Columbia require such waivers.
Still, how long such waivers last can depend on state law or an insurer's decision. The report found that 20% of individual and fully insured group plans had waivers that already expired, while 6% of plans have their waivers lapse in August 2020. While that number rose to 10% in September, it decreased to 6% again in October. Almost a third of these plans, however, will wait until in December to end their waivers, while 15% haven't specified an end date.
To be sure, the study noted that its finding may not show the full extent of these waivers given that it did not include those enrolled in self-insured plans through their employers, which do not always fall under federal regulation.
Less common than waivers, however, were insurers that offered consumers some form of relief for their premium payments. Almost a quarter of individual and fully insured group plans offered premium credits or reductions, while 7% provided grace periods where consumers would not be penalized for failing to pay their premiums on time. Only 2% also offered expedited rebates to consumers under the ACA's MLR rule after the Center for Medicare and Medicaid services (CMS) released guidance allowing health insurers to send rebates earlier than usual.
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Rhys Dipshan
CT-born, New York-based legal tech reporter covering everything from in-house technology disruption to privacy trends, blockchain, AI, cybersecurity, and ghosts-in-the-machine. Continually waiting for law to catch up with tech. (It's like waiting for Godot, but without the clowns)
