As the world emerges from COVID-19 lockdown and we return to more “normal” operations and matters, health insurance coverage is among those items seeing new focus and attention both regionally and nationally.

While the federal government, through various programs, made sure COVID testing, treatment and vaccinations were covered for most folks, people are now starting to return to their providers and seeking elective surgeries and other care they put off during the pandemic.

Knowing what has changed in the market since COVID began will undoubtedly help health care consumers. And as employers bring people back to work, it is important to understand what’s taking place in the health insurance market in order to make strategic plans for the next contractual period.

In April, Fallon Health announced that it would exit most of the commercial health insurance market and focus predominantly on public plans like MassHealth and Medicare. While members have 18 months to transition, Fallon’s decision has left many Massachusetts communities seeking a new provider. (Nearly 16,000 people in the Massachusetts Group Insurance Commission pool are with Fallon, as are 18 communities in Worcester County.)

Further, the merger of Tufts Health Plan and Harvard Pilgrim Health Care is creating some questions and tension in the marketplace, as employers and plan members question how it might affect their coverage benefits and costs. On the upside, the two health plans say that over time, more than $100 million in savings is anticipated through administrative synergies, which will go directly to mitigating premium increases and the out-of-pocket burden for members.

Some industry insiders warn that there is always the potential for other shake-ups as well.

Preparing for next year
While some communities may have fatigue from just finishing their fiscal 2022 health insurance purchasing, given the current market situation, insurance executives say it’s best to start planning now for fiscal 2023. (This is particularly true for those needing to make a change due to the Fallon Health exit.)

Communities are advised to seek the following from their health care provider:
1. Security. It’s important to know that your health plan will be around this year and next. Get assurances from potential providers that they don’t plan to exit the Massachusetts market.

2. Longevity. Most health insurance providers in Massachusetts have been around for a long time. While new players may have arrived, they come with experience from other areas. Still, it’s good to ask for a detailed corporate history from all potential providers. Make sure their experience in the health insurance market, and that of their leadership, is top-notch.

3. Stability. The pandemic upended a lot of things, and the health insurance industry was not spared. According to a Fitch Ratings report from May, health insurance providers had a relatively stable end to a turbulent year (2020), but uncertainty lies ahead. So it’s important to work with a provider whose outlook is stable. Check the insurer’s annual reports and quarterly statements. Look for those that have a better-than-average retention rate, ongoing relationships with health care providers and facilities, and high satisfaction ratings. The National Committee for Quality Assurance keeps ratings of each insurance provider on its website.

4. Innovation. According to an article in the May Harvard Business Review, people no longer accept “one-size-fits-all” solutions, including for health care. “Consumer needs and perspectives on health insurance coverage vary widely across many dimensions, including generational differences,” the article states. “It’s inevitable that demands for more personalization in health care will reach a tipping point.” Seek a provider that will look at your employees’ unique needs and craft plan solutions that encourage wellness and prevention and offer new and innovative benefits that can help them have the best quality of life.

MIIA believes in open and honest dialogue and listens closely to the needs of members when helping them craft insurance coverage for employees. Make sure to ask the same of your insurer or broker. Doing so can make the health insurance discussion productive and beneficial for you and your employees.

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