A.M. Best Special Report: Health Care Industry Evolves; New Markets and Prospects Emerge

A.M. Best Special Report: Health Care Industry Evolves; New Markets and Prospects Emerge


The Patient Protection and Affordable Care Act (PPACA), commonly referred to as health care reform, was on everyone’s mind in 2013, according to a special report by . Insurance companies continued to make preparations for changes that were about to become effective, January 1, 2014, many of which began in prior years. In planning for open enrollment, which began October 1, 2013, insurers redesigned products to be offered on the exchanges, implemented benefit changes to comply with essential health benefits, filed new rates with regulators and made modifications to their information technology systems. Throughout all of this, health insurers appeared to have adequately adapted, even with the issues that occurred during the initial rollout of the federal exchange and some of the state-based exchanges.

To operate in a post-PPACA environment, insurers also needed to adjust some of the business models from which they had previously operated. There are a number of macro-factors at play, including regulatory, demographic and economic factors. Health insurance is now moving more toward a retail environment with the federal and state-based exchanges and with more focus on direct-to-consumer marketing. Many employer groups are considering/electing to offer a private exchange model for some or all of their employees’ various health product needs. The aging of the U.S. population has led to increased interest in Medicare—both Medicare Advantage (MA)and Medicare supplement—among health insurers. In addition, Medicaid is being expanded to account for the growing number of unemployed who need health care coverage.

To access a copy of this special report, please visit .