As the COVID-19 crisis escalates, stakeholders across the health care industry are working to keep consumers healthy, treat those who need care, and provide financial assistance and flexibility to those who have lost their job or health insurance due to economic constraints. While providers work tirelessly to guide those who are sick back to good health, health insurers are also doing their part to alleviate consumers’ concerns. Prior to enactment of the federal stimulus bills, insurers like Aetna/CVS, Centene, Cigna, Harvard Pilgrim, Molina, UnitedHealth Group, and others, announced they would waive consumers’ deductibles and cost sharing for COVID-19 testing. The federal stimulus bills, enacted March 18 and March 26, subsequently required such coverage of all carriers. Then, although not required by federal law, several insurers also announced they would waive all cost sharing for COVID-19-related treatment. These actions (and others taken by states) are designed to help consumers who otherwise might have delayed or foregone testing and care due to cost barriers.
Beyond waiving the up-front costs, health insurers have also announced efforts to: promote insurance coverage; ease access to and improve efficiency of care; innovate in care delivery; and support the economic stability of providers, their communities, and themselves. Insurers say that these efforts will help to provide relief to the communities they serve, ensure that providers have sufficient financial resources to maintain adequate staffing, and reduce the likelihood of members’ care disruption. While insurers hope that these steps will promote members’ “peace of mind,” these efforts also make good business sense. For example:
- Efforts to lower cost-sharing, improve access to services, and provide premium payment flexibility can help sustain customer loyalty at a time of significant economic upheaval, when many employers are making painful decisions about maintaining health benefits.
- Supporting the financial stability of providers will redound to many insurers’ benefit, as the fates of insurance companies and providers have become increasingly intertwined. Many insurers have invested heavily to acquire provider groups, and many provider systems have their own health plans.
- Voluntary initiatives to improve coverage could lessen public demand for new regulatory mandates or, over the longer term, the expansion of government coverage programs.
Promoting Health Insurance Coverage
Experts estimate that up to 35 million consumers could lose insurance coverage through their job as a result of the economic downturn brought on by the COVID-19 crisis. Other consumers who have gone uninsured are now seeking coverage for the first time. To help consumers gain access to insurance, health insurers have advocated for a one-time special enrollment period (SEP) to allow consumers in states that rely on the federally facilitated marketplace to sign up for a plan. To date, twelve of the thirteen state-based marketplaces have opened a similar SEP in light of the outbreak, but the Trump Administration has refused to do the same for the federal enrollment site. Insurers are also offering their own SEPs to employees who previously declined group coverage through their employer. For example, in the five states it operates (Illinois, Montana, New Mexico, Oklahoma, and Texas) Health Care Service Corp., a Blue Cross Blue Shield company, has opened an enrollment period through April 30 to allow individuals who declined employer-based group insurance to gain coverage, including adding a spouse or dependent to their plan. UnitedHealth Group has done the same.
Many states have also required or encouraged their insurers to help those that have coverage to stay covered. With both employers and individual consumers now struggling to pay their monthly premiums, seventeen states have required and twenty-two states have recommended that insurers extend the grace period for consumers to pay their premiums. While it is unclear whether insurers would have made this move on their own, at least some, like Florida Blue (Florida) and CareFirst BlueCross BlueShield (Maryland, D.C.*, Virginia), have extended the grace period even though they are not required to.
America’s Health Insurance Plans (AHIP) and the BlueCross BlueShield Association (BCBSA) have written to Congress advocating for additional steps to promote coverage, including that Congress provide: direct financial assistance to employers who want to maintain coverage for employees; and temporary subsidization of COBRA premiums for employees who have been terminated or furloughed, among other recommendations.
Easing Access and Improving Efficiency of Care
Several insurers are working to make it easier for providers to stay focused on patient care. For example, several insurers, like Cigna, have reduced their prior authorization requirements so that patients can be transferred out of hospitals and into long-term acute care hospitals and subacute facilities faster. The insurer has done so even though only one of the ten states that it participates in – Utah – has requested that it waive prior authorization. As Cigna’s Chief Clinical Officer explained, “By accelerating the transfer of non-COVID patients out of hospitals and into long term acute care hospitals, we can free up space and beds, preserve supplies and ensure medical staff are available to treat COVID-19 patients [.]” Similarly, Humana has suspended all prior authorization and regular referral requirements for COVID-19-related care, regardless of what network providers are affiliated with. It has done so for all of its products, even though only three of the twenty states in which it participates – Kentucky, Louisiana, New Mexico – currently require such action. These steps help to reduce the amount of administrative work on providers’ plates, while also moving patients out of the costliest care settings as quickly as possible.
Some insurers and health systems who are currently in negotiations to resolve contract disputes are putting those differences aside. UnitedHealthcare and Houston Methodist have extended their contract for an additional two months, while Anthem Blue Cross and Blue Shield and Parkview Health have extended their contract for three additional months. These extensions ensure that consumers continue to have in-network access to services and allow provider entities to redirect their efforts to manage the crisis.
Other insurers are acting to increase the number of providers available. CVS Health/Aetna, for instance, is simplifying its provider credentialing process and BlueCross BlueShield of North Carolina has committed to credentialing providers and physician assistants within 72 hours of receiving an application to treat COVID-19 needs. Insurers are even encouraging their own employees with medical backgrounds to join providers in their treatment efforts. For example, Blue Cross Blue Shield of Michigan will continue to pay salaries and benefits for employees who volunteer to care for COVID-19 patients. Centene has developed a Medical Reserve Leave policy that offers clinical employees paid leave and benefits for three months of volunteer services.
Innovating in Care Delivery
To encourage consumers to stay at home and out of public spaces and hospitals, insurers are turning to technology and other innovative means of delivering care. The majority of states have required or encouraged insurers to expand their use of telehealth and many are doing just that, including launching enhanced digital tools. Molina, for example, designed a “Coronavirus Chatbot,” which allows consumers to assess their own personal risk profile, receive live help, and gain instructions on what actions to take if symptoms are present. Other insurers, like Blue Cross and Blue Shield of Oklahoma, are partnering with organizations to deliver medical services through mobile units. These units aim to prevent members from overcrowding hospitals and emergency rooms when their symptoms are only mild or unrelated to COVID-19. Most insurers have also adopted flexible policies on prescription drug refills. Anthem is allowing members to receive early refills and encouraging members to speak with their physicians about moving to a 90-day supply, if appropriate. If so, members can take advantage of the insurer’s home delivery pharmacy services. EmblemHealth implemented a similar service weeks ago, partnering with a full-service digital pharmacy to offer same-day prescription home deliveries.
Supporting Economic Stability
Providers: From small rural hospitals to larger health systems, providers are facing financial pressure since they have largely canceled or postponed profitable elective procedures. The American Hospital Association sent a letter to insurers urging them to accelerate payments to providers during the crisis to “support stable cash flow” and ensure that operations can continue at the current capacity. Many insurers have responded to this call. UnitedHealth Group, whose subsidiary, OptumCare, is one of the largest owners of physician group practices in the country, announced that it would provide $2 billion in funding to providers. Blue Cross and Blue Shield of Minnesota will front providers $80 million in payments that were not scheduled to be dispersed until the fall. Premera Blue Cross will provide $100 million in advanced payments and delay its recoupment of overpayments for the duration of the emergency. Centene has developed a support program to help its providers with grant writing and business loan applications so that they can obtain new benefits available under Congress’s recent Coronavirus Aid, Relief, and Economic Security (CARES) Act.
Communities: Insurers are also making large donations to the communities they serve. Harvard Pilgrim Health Care, for instance, donated over $3 million to relief efforts in Connecticut, Maine, Massachusetts, and New Hampshire, including support for restaurants, meals for families in need, and transportation assistance. Blue Cross Blue Shield of Massachusetts contributed $250,000 to relief efforts in the state, in addition to expediting $1.75 million in investments and unrestricted cash for local nonprofits providing services like food for first responders and meals for students who are now at home. Horizon Blue Cross Blue Shield of New Jersey made its single largest donation in the company’s history by committing $2.5 million to local food banks, family services, and in donating 500,000 N95 respirator masks and 81,000 face shields. Cigna is donating medications to the Washington University School of Medicine to help advance research in finding a COVID-19 treatment.
Insurers: Amidst these efforts, insurers are keeping an eye on their own financial stability. Some insurers have started to warn investors of the impact COVID-19 will likely have on their year-end financials. Humana, for example, recently borrowed $1.1 billion from investors and updated its “Cautionary Statement” warnings to account for the potential negative effects of the virus. AHIP warned that many plans “are bracing for an extraordinary increase in costs related to treating patients . . . these costs could exceed $250 billion to more than $500 billion.” It is unclear how much of an impact the COVID-19 crisis is likely to have on insurers’ bottom line. Some insurers are starting to predict that these costs could lead to high premium increases next year, while others say that premiums are likely to remain stable or increase only slightly.
Take Away: In light of the COVID-19 outbreak, health insurers are taking several actions to reduce financial and other barriers to care and to support their provider and member communities. Some of these efforts were likely prompted by recent state actions requiring or encouraging insurers to implement stronger consumer protections during the crisis. Other efforts, however, just make good public health and business sense. These efforts will help:
- Lower barriers to widespread, accessible testing services,
- Allow employer customers to maintain their health benefit plans,
- Ensure that members who have symptoms of COVID-19 access needed care faster,
- Extend the viability of independent or affiliated provider groups needed to treat their members, and
- Encourage those who are healthy to stay at home and avoid unnecessary exposure, slowing the spread of the disease.
While the long-term financial impacts of COVID-19 are not yet known, these efforts demonstrate that insurers are doing their part to assist members and providers during the crisis. Whether these efforts are enough to blunt calls for additional coverage or payment mandates for insurers, or for more government involvement in coverage programs, remains to be seen.
*D.C. has prohibited insurers from terminating consumers’ coverage without the consent of the Insurance Commissioner.