Trends in Premiums, Claims, and Enrollment for Fully Insured Large Group, Small Group, and Individual Health Plans From 2011 to 2021.
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ABSTRACT:
SUBMITTER: Plummer E
PROVIDER: S-EPMC10114028 | biostudies-literature | 2023 Apr
REPOSITORIES: biostudies-literature
Publications
Trends in Premiums, Claims, and Enrollment for Fully Insured Large Group, Small Group, and Individual Health Plans From 2011 to 2021.
Plummer Elizabeth E Percy Allison A Bai Ge G
JAMA network open 20230403 4
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Project description:Using a representative longitudinal survey of Texas high school seniors who graduated in 2002, we investigate how college postponement is associated with four-year college expectations and attendance-focusing both on the length of delay and the pathway to the postsecondary system. Like prior studies, we show that family background and student academic achievement explains the negative association between delay and college expectations and that these factors, along with two-year college entry pathway, largely accounted for the negative association between postponement and enrollment at a four-year institution in 2006. Although delays of one year or longer are associated with significantly lower odds of attending a baccalaureate-granting institution four years after high school, the longest delays do not incur the most severe enrollment penalties.
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Project description:ObjectiveTo assess whether new premiums in SCHIP affect rates of disenrollment and reenrollment in SCHIP and whether they have spillover enrollment effects on Medicaid.Data sourceWe used SCHIP administrative enrollment data from Arizona and Kentucky. The enrollment data covered July 2001 to December 2005 in Arizona and November 2001 to August 2004 in Kentucky.Study designWe used administrative data from two states, Arizona and Kentucky, which introduced new premiums for certain income categories in their SCHIP programs in 2004 and 2003, respectively. We used multivariate hazard models to study rates of disenrollment and re-enrollment for the recipients who had been enrolled in the categories of SCHIP in which the new premiums were implemented. Competing hazard models were used to determine if recipients leaving SCHIP following the introduction of the premium were obtaining other public coverage or exiting public insurance entirely at higher rates. We also used time-series models to measure the effect of premiums on changes in caseloads in premium-paying SCHIP and other categories of public coverage and we assessed the budgetary implications of imposing premiums.Principal findingsIn both states, the new premiums increased the rate of disenrollment and decreased the rate of re-enrollment in premium-paying SCHIP among the children who were enrolled in those categories before the premiums were implemented. The competing hazard models indicated that almost all of the increased disenrollment is caused by recipients leaving public insurance entirely. The time-series models indicated that the new premium reduced caseloads in premium-paying SCHIP, but that it might have increased caseloads for other types of public coverage. The amount of premiums collected net of the costs associated with administering premiums is small in both states. Estimating the full budgetary effects with certainty was not possible given the imprecision of the key time-series estimates.ConclusionThese results suggest that the new premium reduced enrollment in the premium-paying group by 18 percent (over 3,000 children) in Kentucky and by 5 percent (over 1,000 children) in Arizona, with some of these children apparently leaving public coverage altogether. While most children enrolled in these categories did not appear to be directly affected by the imposition of $10-$20 monthly premiums, the premiums may have caused some children to go without health insurance coverage, which in turn could have adverse effects on their access to care. Imposing nominal premiums may reduce state spending, but projected savings appear to be small relative to total state SCHIP spending and resulting increases in enrollment in other public programs and in uninsurance rates could offset those savings.
| S-EPMC2151316 | biostudies-literature
Project description:Healthcare.gov was created to facilitate the market for non-group insurance in states that did not establish their own marketplaces. In Healthcare.gov, families are asked to report their tobacco use status, and tobacco use surcharges of up to 50% may result. We tabulate enrollment information for 35 states offering insurance plans through Healthcare.gov in both 2014 and 2016. The Centers for Medicare and Medicaid Services provided counts of enrollees indicating tobacco use, by state, year, and risk level. The number of enrollees increased from 5.0 million in 2014 to 9.4 million in 2016. From 2014 to 2016, the number of enrollees rose 39% for tobacco users and 90% for non-tobacco users. Reported non-tobacco user enrollment rose faster than reported tobacco user enrollment in 30 out of 35 states. Reported tobacco users are enrolling in marketplace plans at a lower rate and are more likely to enroll in less generous plans. The decline in smoking as reported when purchasing insurance on Healthcare.gov surpasses declines in smoking observed in other data sources, which suggests that tobacco users may be decreasingly likely to report their tobacco use status accurately to avoid surcharges. Finally, we find no evidence of the surcharges being associated with lower enrollment among self-reported tobacco users, or in rates of smoking.
| S-EPMC5447394 | biostudies-literature
Project description:ImportancePreventing diabetes complications requires monitoring and control of hyperglycemia and cardiovascular risk factors. Switching to high-deductible health plans (HDHPs) has been shown to hinder aspects of diabetes care; however, the association of HDHP enrollment with microvascular and macrovascular diabetes complications is unknown.ObjectiveTo examine the association between an employer-required switch to an HDHP and incident complications of diabetes.Design, setting, and participantsThis retrospective cohort study used deidentified administrative claims data for US adults with diabetes enrolled in employer-sponsored health plans between January 1, 2010, and December 31, 2019. Data analysis was performed from May 26, 2022, to January 2, 2024.ExposuresAdults with a baseline year of non-HDHP enrollment who had to switch to an HDHP because their employer offered no non-HDHP alternative in that year were compared with adults who were continuously enrolled in a non-HDHP.Main outcomes and measuresMixed-effects logistic regression models examined the association between switching to an HDHP and, individually, the odds of myocardial infarction, stroke, hospitalization for heart failure, lower-extremity complication, end-stage kidney disease, proliferative retinopathy, treatment for retinopathy, and blindness. Models were adjusted for demographics, comorbidities, and medications, with inverse propensity score weighting used to account for potential selection bias.ResultsThe study included 42 326 adults who switched to an HDHP (mean [SD] age, 52 [10] years; 19 752 [46.7%] female) and 202 729 adults who did not switch (mean [SD] age, 53 [10] years; 89 828 [44.3%] female). Those who switched to an HDHP had greater odds of experiencing all diabetes complications (odds ratio [OR], 1.11; 95% CI, 1.06-1.16 for myocardial infarction; OR, 1.15; 95% CI, 1.09-1.21 for stroke; OR, 1.35; 95% CI, 1.30-1.41 for hospitalization for heart failure; OR, 2.53; 95% CI, 2.38-2.70 for end-stage kidney disease; OR, 2.23; 95% CI, 2.17-2.29 for lower-extremity complication; OR, 1.17; 95% CI, 1.13-1.21 for proliferative retinopathy; OR, 2.35; 95% CI, 2.18-2.54 for blindness; and OR, 2.28; 95% CI, 2.15-2.41 for retinopathy treatment).Conclusions and relevanceThis study found that an employer-driven switch to an HDHP was associated with increased odds of experiencing all diabetes complications. These findings reinforce the potential harm associated with HDHPs for people with diabetes and the importance of affordable and accessible chronic disease management, which is hindered by high out-of-pocket costs incurred by HDHPs.
| S-EPMC10960199 | biostudies-literature
Project description: Not available
| S-EPMC10867677 | biostudies-literature
Project description:OBJECTIVE:To investigate whether enrollment in high-deductible health plans (HDHPs) led enrollees to choose lower-priced providers for office visits and laboratory tests. STUDY SETTING:Claims data from more than 40 large employers. STUDY DESIGN:We compared the change in price for office visits and laboratory tests for enrollees who switched to HDHPs versus enrollees who remained in traditional plans. We estimated separate models for enrollees who changed providers versus those who remained with the same provider to disentangle the effects of HDHPs on provider choice and negotiated prices. DATA COLLECTION:Claims data from 2004 to 2010 on 1.8 million enrollees. PRINCIPAL FINDINGS:After enrollment in HDHPs, 28 percent of enrollees changed physicians for office visits (compared to 19 percent in the Traditional Plan group, p < .01); however, this did not result in a statistically significant reduction in price for office visits. About 25 percent of enrollees changed providers for laboratory tests (compared to 23 percent in the Traditional Plan group, p < .01), resulting in savings of about $2.09 or a 12.8 percent reduction in price per laboratory test. We found that HDHPs had lower negotiated prices for office visits but not for laboratory tests. CONCLUSIONS:High-deductible health plan enrollment may shift enrollees to lower cost providers, resulting in modest savings.
| S-EPMC6056587 | biostudies-literature
Project description:ImportanceSince 2019 and 2020, Medicare Advantage (MA) plans have been able to offer supplemental benefits that address long-term services and supports (LTSS) and social determinants of health (SDOH).ObjectiveTo examine the temporal trends and geographic variation in enrollment in MA plans offering LTSS and SDOH benefits.Design, setting, and participantsThis cross-sectional study used publicly available data to examine changes in beneficiary enrollment and plan offerings of LTSS and SDOH benefits from the benefits data from the second quarter of each year and other data from April of each year except 2024, for which the first quarter was the latest for benefits data and January the latest for other data at the time of analysis. Multivariable linear regression models for each type of benefit were used to investigate associations between county characteristics and enrollment in 2024. Analyses were stratified for (1) Dual Eligible Special Needs Plans (D-SNPs) that exclusively enroll dual-eligible beneficiaries and (2) non-D-SNPs.Main outcomes and measuresThe percentage of MA enrollees in plans offering LTSS or SDOH benefits at the county level.ResultsThis study included 2 631 697 D-SNP and 20 114 506 non-D-SNP enrollees in 2020, which increased to 5 494 426 and 25 561 455, respectively, in 2024. From 2020 to 2024, the percentage of D-SNP enrollees in plans offering SDOH benefits increased from 9% to 46%, whereas the percentage fluctuated between 23% and 39% for LTSS benefits. There was an increase in non-D-SNP enrollees with LTSS (from 9% to 22%) and SDOH (from 4% to 20%) benefits from 2020 to 2023, which decreased in 2024. In 2024, the most offered LTSS benefit was in-home support services, and the most offered SDOH benefit was food and produce. The percentage of enrollees with these benefits varied across counties in 2024. In multivariable linear regression models, among D-SNPs, enrollment in plans offering any SDOH benefits was higher in counties with greater MA penetration (coefficient, 5.0 percentage points [pp] per 10-pp change; 95% CI, 2.1-7.9 pp), in urban counties (coefficient, 7.2 pp vs rural counties; 95% CI, 3.8-10.6 pp), in counties with greater enrollment in fully integrated D-SNPs (coefficient, 3.0 pp per 10-pp change; 95% CI, 2.2-3.9 pp), and in counties in states with approved Medicaid home- and community-based services waivers for individuals 65 years or older or those with disabilities (coefficient, 10.8 pp; 95% CI, 4.0-17.6 pp). Enrollment in D-SNPs offering LTSS benefits was also higher in counties with greater MA penetration (coefficient, 5.9 pp per 10-pp change; 95% CI, 2.4-9.5 pp), urban vs rural counties (coefficient, 4.6 pp; 95% CI, 1.1-8.1 pp), and counties with greater enrollment in fully integrated D-SNPs (coefficient, 3.0 pp per 10-pp change; 95% CI, 2.1-3.9 pp) in addition to counties with greater social vulnerability scores (coefficient, 1.4 pp per 10-pp change; 95% CI, 0.3-2.5 pp).Conclusions and relevanceIn this cross-sectional study of MA plans and enrollees, an increase in enrollment was most consistent in D-SNPs offering SDOH benefits compared with LTSS benefits and in D-SNPs compared with non-D-SNPs. Geographic variation in enrollment patterns highlights potential gaps in access to LTSS and SDOH benefits for rural MA beneficiaries and dual-eligible enrollees living in counties with lower enrollment in fully integrated D-SNPs and states with more limited Medicaid home- and community-based services coverage.
| S-EPMC11409149 | biostudies-literature
Project description:ImportanceIn 2021, the Centers for Medicare & Medicaid Services designated a new category of dual-eligible special needs plans (D-SNPs) with exclusively aligned enrollment (receive Medicare and Medicaid benefits through the same plan or affiliated plans within the same organization).ObjectiveTo assess the availability of and enrollment in D-SNPs with exclusively aligned enrollment and to compare the characteristics of beneficiaries enrolled in D-SNPs with exclusively aligned enrollment available vs beneficiaries without such enrollment available.Design, setting, and participantsFull-benefit beneficiaries enrolled in D-SNPs for 6 months or longer in 2021 or 2022. Availability of and beneficiary enrollment in D-SNPs were assessed by year and county for D-SNPs with exclusively aligned enrollment available vs D-SNPs without exclusively aligned enrollment available. The D-SNP enrollees residing in counties with aligned plans available were compared based on demographic, social, health, and area characteristics vs D-SNP enrollees in counties without such plans available. Comparisons were also made based on beneficiaries who enrolled in the aligned D-SNPs vs those who did not enroll (were enrolled in unaligned D-SNPs). The data analyses were conducted from October 1, 2023, to August 2, 2024.Main outcomes and measuresAvailability of aligned D-SNPs and beneficiary residence by county; enrollment in exclusively aligned D-SNPs vs unaligned D-SNPs; and beneficiary demographic, social, health, and area characteristics.ResultsOf 2 197 732 beneficiaries enrolled in D-SNPs in 2021, 881 736 (40.1%) were living in counties with aligned enrollment available and 251 305 (11.4%) enrolled. Of 2 689 045 beneficiaries enrolled in D-SNPs in 2022, 1 047 223 (38.9%) were living in counties with aligned enrollment available and 318 906 (11.9%) enrolled. Beneficiaries enrolled in D-SNPs residing in counties without aligned enrollment available were more likely to live in rural or micropolitan areas (21.9%) vs beneficiaries in counties with aligned enrollment available (8.1%) (standardized mean difference [SMD], 0.38 [95% CI, 0.38-0.38]), be entitled to disability (44.4% vs 27.3%, respectively; SMD, 0.36 [95% CI, 0.36-0.36]), or be Black individuals (27.4% vs 21.4%; SMD, 0.14 [95% CI, 0.14-0.14]); were less likely to be Hispanic individuals (15.4% vs 33.7%; SMD, 0.45 [95% CI, 0.45-0.45]) or Asian or Pacific Islander individuals (6.1% vs 12.2%; SMD, 0.22 [95% CI, 0.22-0.22]); and lived in zip codes with a higher area deprivation index (mean, 66.8 [SD, 26.4] vs mean, 43.2 [SD, 29.0]; SMD, 0.86 [95% CI, 0.86-0.86]). Beneficiaries enrolled in aligned D-SNPs were more likely to be receiving long-term institutionalized care vs beneficiaries in nonaligned D-SNPs (4.3% vs 1.0%, respectively; SMD, 0.24 [95% CI, 0.24-0.25]) or have dementia or Alzheimer disease (9.2% vs 5.9%; SMD, 0.13 [95% CI, 0.13-0.13]).ConclusionsThis study found that availability of and enrollment in D-SNPs with exclusively aligned enrollment are increasing, but the overall proportion enrolled remains low. Further reforms are needed to promote aligned enrollment.
| S-EPMC11581671 | biostudies-literature
Project description: Not available
| S-EPMC1215580 | biostudies-literature
Project description:PurposeConsiderations for using administrative claims data in research have not been well-described. To increase awareness of how enrollment factors and insurance benefit use may contribute to prevalence estimates, we evaluated how differences in operational definitions of the cohort impact observed estimates.MethodsWe conducted a cross-sectional study estimating the prevalence of five gastrointestinal conditions using MarketScan claims data for 73.1 million enrollees. We extracted data obtained from 2009 to 2012 to identify cohorts meeting various enrollment, prescription drug benefit, or health care utilization characteristics. Next, we identified patients meeting the case definition for each of the diseases of interest. We compared the estimates obtained to evaluate the influence of enrollment period, drug benefit, and insurance usage.ResultsAs the criteria for inclusion in the cohort became increasingly restrictive the estimated prevalence increased, as much as 45% to 77% depending on the disease condition and the definition for inclusion. Requiring use of the insurance benefit and a longer period of enrollment had the greatest influence on the estimates observed.ConclusionsIndividuals meeting case definition were more likely to meet the more stringent definition for inclusion in the study cohort. This may be considered a form of selection bias, where overly restrictive inclusion criteria definitions may result in selection of a source population that may no longer represent the population from which cases arose.
| S-EPMC4599703 | biostudies-literature