What individual insurance market trends mean for providers

Health insurance, pen and stethoscope
The individual insurance marketplace can pose unique challenges for providers. (Getty/Minerva Studio)

Amid uncertainty about the future of healthcare reform, hospitals and health systems must be aware of and prepare for the potential challenges posed by the individual health insurance marketplaces.

Costs in the individual marketplaces have been volatile, so one way providers can support patients who have those plans is to understand the total costs associated with treating them, writes Paul Keckley, Ph.D., health policy analyst and editor of the Keckley Report, in an article for Hospitals & Health Networks.


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Until now, much of the discussion from the provider side on the future of healthcare reform has centered on proposed changes to Medicaid. States that expanded Medicaid saw uncompensated care costs drop significantly, and provider groups largely came out against Republican efforts to repeal and replace the Affordable Care Act as well as proposed sweeping cuts to Medicaid.

RELATED: Provider groups praise demise of AHCA, call for bipartisan action on future healthcare reform

But, Keckley writes, providers need to monitor trends in the individual market as well, which may result in more problems for them. For example, higher copays and deductibles may put preventive care, including key tests and screenings, out of reach for this patient population. Furthermore, the individual market is likely to grow as more employers push responsibility for insurance costs on employees, which in turn could push more costs of care onto providers.

“Hospitals must prepare for two realities: The individual market will grow, and the risks associated with its management will be challenging,” according to Keckley.

RELATED: S&P report: ACA individual market is fragile, but not in a 'death spiral'

One solution that some hospitals are considering is to offer sponsored health plans that target individual market enrollees. But this could backfire, Keckley writes, as premiums will likely increase significantly. Just because a big hospital name is on the plan, that doesn’t mean it will attract more enrollees if premiums are too high to draw interest. Instead, he suggests providers engage in greater advocacy on these issues with state and local leaders.

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