Key Takeaways
- Policy changes in the health insurance industry can be the result of new legislation, new offerings from insurance companies, the market, and more.
- In 2024, expected policy changes include increased transparency surrounding healthcare plans, rising prices, and changes to Medicare.
- Today’s market also features diverse coverage options and varying innovative healthcare plans, providing more options than ever before.
- To navigate the changing landscape, brokers must remain up to date with industry news and consider choosing healthcare solutions that provide the right support to consumers.
Navigating health insurance is difficult enough, but it doesn’t get any easier when health insurance policies and the regulations surrounding them are constantly changing. Whether it’s big insurers shifting their approach, new laws being passed, or the market skyrocketing rates, change seems to be inevitable in the industry.
Along the way, healthcare brokers are at a disadvantage, forced to navigate the waves of changing policies. Not only must they stay on top of fluctuating regulations, but they must also understand the changes well enough to relay them to their clients in an easy-to-grasp way.
In 2024, some of the changes include rising rates, regulations on increased transparency, and policies on making healthcare plans more accessible. To stay on top of the changing landscape, brokers must remain informed on industry news and offer products that patients can trust and rely on—having the right support in the process can make a significant difference.
Understanding Regulatory Changes
Regulatory and policy changes happen frequently in the health insurance industry due to the ever-changing nature of healthcare requirements and decisions from plan providers. The following regulatory changes taking place in 2024 center around improving equity and access to healthcare.
1. Transparency in Coverage
Put into practice in 2020, the Transparency in Coverage Act set standards for insurance and healthcare plan providers to increase pricing transparency for consumers. The act aims to minimize surprises between patients obtaining medical services and receiving a bill.
The act specifies that providers are required to disclose information about in-network negotiated rates, billed charges, and rates for prescription drugs through a self-service tool on a public website. This act allows consumers to get accurate estimates of their cost-sharing liability and personalized out-of-pocket costs for healthcare items and services from different providers in real time.
As of January 1, 2024, self-service tools must include all items and services offered. These requirements will make it easier for consumers to compare and shop for health insurance plans.
2. Rising Prices
Inflation has reached its way into almost every area of the economy, and health insurance is no different. With rising prices everywhere, healthcare plans in 2024 may also jump as much as 6.6%.
To some industry experts, it is a surprise that the prices are not even higher, given the current state of the economy and the increase in prices in other industries. Still, this rise in rates will affect small and medium businesses and large enterprises alike.
On the bright side, the same survey highlighted that many employers stated that they would not transfer the burden to their employees, absorbing these additional costs on their own. That said, employees must still be aware of the risk of rising premiums, copays, and other out-of-pocket costs.
3. Changes to Medicare
2024 brings several changes to Medicare, some of which will provide financial relief for members. Starting in 2024, the Health and Human Services (HHS) Inflation Reduction Act of 2022 will work to lower prices for prescription drugs under Medicare Part D. The plan will involve pricing negotiations for lower prices, with the first round of negotiations set to begin in 2024 and maximum fair prices to go into effect by 2026.
Other systems are in place to make care more accessible to Medicare members. In 2024, Medicare will also begin reimbursing providers who help patients navigate their health care, improving their ability to access care. The agency will also start paying providers to train family caregivers to help provide care to sick family members.
That said, Medicare will also see higher premiums and deductibles, with increases to both across different plans. These changes may balance out to provide relief for recipients.
Exploring Diverse Coverage Options
The one silver lining of a constantly changing health insurance environment is that the market is constantly seeing new coverage options and innovative solutions. These diverse coverage options have allowed the idea of healthcare plans to extend well beyond the traditional model of health insurance.
Today, members can seek comprehensive health coverage or find a healthcare plan that meets their specific needs at a lower cost. For example, a healthy individual may only require preventive care and access to supplemental services like mental health and choose an appropriate plan. Meanwhile, an individual in need of more extensive care may pursue a plan with more advanced coverage at a greater premium.
It’s important to note that plan seekers should consider their unique needs. If you end up needing a specialist visit and don’t have coverage for it, it could be a significant out-of-pocket cost.
Brokers should be on top of the many different coverage options that exist in today’s market so they can expand their product offerings. Expanding these offerings increases the chances of meeting client demands and positioning themselves as a valuable resource for consumers.
Pricing Models in the Health Insurance Market
Pricing models in the healthcare industry have also become more diverse, changing the way that providers structure their plan offerings. Of course, specific pricing depends on the plan and the provider, but there are several models that providers may use.
Some of the most common pricing models include:
- Community rating – A community rating model sets premium prices for all members of a specific community and prevents health insurers from varying premiums within a certain geographic area based on age, gender, health status, or other factors.
- Market-based pricing – Market-based pricing encompasses data from multiple sources around the industry, using both historical claims and provider insights to determine reasonable rates for healthcare services.
- Risk rating – Risk rating pricing adapts premiums based on a given individual’s health conditions and risk, often involving medical underwriting. This model offers pricing more applicable to a person’s situation but can put healthcare coverage prices out of reach for people who are most vulnerable.
- Experience rating – Experience rating sets premiums based on the claims experience of a specific group or employer, so prices reflect the actual usage by the plan members but may result in higher costs for those who seek care more often.
The rise of available data through new technology has greatly impacted the way healthcare plans are priced. Healthcare plan providers now have more information than ever to use as a reference for determining fair and reasonable pricing.
For example, at Redirect Health, we use a combination of data-driven insights and industry expertise to support brokers and connect our members to affordable care. By reaching out to us when you need care, you can get connected with the most affordable care options without sacrificing any of the quality of the service you receive.
Our member responsibility costs are also transparent and clearly outlined in each of our plans, involving no medical underwriting. As a result, members enjoy access to quality care with no guesswork.
How Healthcare Brokers Can Thrive in a Dynamic Market
In order to thrive in a dynamic market, healthcare brokers must be able to stay on their toes and be flexible in the face of constant change. Navigating change is part of the job itself and is crucial to success.
Some ways that brokers can stay ahead of the game include:
- Staying informed – Keeping up with the latest news and information surrounding the healthcare industry will allow brokers time and capability to adapt and adjust to upcoming regulatory changes.
- Choosing the right healthcare solution – A healthcare solution like Redirect Health offers support and guidance for brokers, informed by data and industry experts, relieving some of the burden.
- Staying open-minded – Brokers should remain open-minded and willing to learn more about new innovative approaches to healthcare so that they can expand their service offerings.
- Embrace technology – Advancements in technology have allowed brokers to streamline processes and enhance the client experience with resources like broker dashboards and renewal tools.
In addition to these strategies, working with a healthcare solution that supports brokers can go a long way. Working with a solution that offers broker tools can make sign-ups and renewals more efficient, allowing brokers to focus more time and energy on adapting to the changing market.
Turn to Redirect Health in the Evolving Landscape
The landscape of health insurance policies is constantly changing. Changes in government policies surrounding health insurance, innovative plan offerings, and a fluctuating economy can all impact the world of healthcare coverage and require brokers to adapt.
Redirect Health is here to support brokers and members in navigating a changing landscape. Our unique model is designed to make the healthcare process as smooth and transparent as possible, offering clear rates for each of our plans and the services they include.
At the same time, we maintain a close relationship with our members, employers, and brokers, and we believe in strong communication, especially when change does happen—that’s why we communicate any rate or policy changes in advance of every year so that there are no surprises when renewing. We also support brokers with a suite of broker tools, high-quality plan offerings, and our industry expertise.
Contact us today to learn more about our healthcare plans and how we support brokers in connecting their clients with products that fulfill their unique needs.