Addressing Health Insurance Consumer Behavior in 2020, Potential Trends to Watch in 2021

In 2020, health care and health care coverage dominated headlines amid the coronavirus disease 2019 (COVID-19) pandemic and debates surrounding the future of the Affordable Care Act (ACA) and Medicare program.

As one of the largest online health insurance exchanges in the United States, eHealth published 20 reports this past year assessing consumer costs and plan selection trends in the Medicare and ACA markets. Compiling notable takeaways from their respective surveys and index reports, eHealth sought to answer the question, “What did we learn in 2020 about US health insurance consumers and the Medicare and ACA markets?”

In the “eHealth Insights: 2020 Retrospective” report, researchers assessed several aspects prominent this year, including the impact that COVID-19 and subsequent restrictions had on social life and the response of insurers. Additionally, the current state and future of the ACA market was addressed, in which 64% of ACA plan enrollees feel the law needs to be reworked to better serve consumers like themselves.

Analyses on the average ACA plan premium found that an unsubsidized middle-income family of 4 pays, on average, $1437 per month or $17,244 per year, an extensive cost burden further added to by the average family deductible for a family of 4, $7767, totaling to approximately $25,000 in health insurance–related expenditures for the year.

In an email exchange with The American Journal of Managed Care^®, eHealth senior vice president of marketing, Andrew Shea, MBA, discusses report findings on potential cost savings for American families, as well as how the pandemic may cause significant lifestyle changes in the behavior of Medicare beneficiaries over the long term, including potential hesitancy against taking a COVID-19 vaccine.

AJMC^®: Your report touched on Medicare reforms, as well as noteworthy consumer behavior trends such as the popularity of Medicare Advantage plans. Based on potential savings, what factors should be top of mind for Medicare beneficiaries going into the new year?

Shea: Prescription drug costs and monthly plan premiums are the 2 most common concerns we hear about from Medicare recipients. We saw the same thing in a recent eHealth survey in which nearly two-thirds (63% of people with Medicare) said more should be done to make prescription medicines more affordable. They want to know how the Biden administration will address this important issue.

At the same time, too many Medicare beneficiaries are leaving potential drug savings on the table now. A lot of them are enrolled in Medicare plans that don’t properly match their needs.

To illustrate what I mean, on our website we invite beneficiaries to identify their current Medicare plan and their personal drug regimen, allowing us to show them which of the Medicare Part D or Medicare Advantage Prescription Drug plans we offer could save them money in combined premiums and co-pays, based on their personal drug needs. Last year we found that fewer than 1 in 10 (8%) Medicare beneficiaries were currently enrolled in the plan that covered their prescription drugs most affordably. We found that if they enrolled in the optimal plan they could have saved an average of $65.17 per month, or $782 per year.

AJMC^®: What consumer behavior trends noted in the report do you foresee continuing or further growing in influence in 2021?

Shea: The biggest wild card heading into 2021 is definitely the COVID-19 coronavirus. First of all, how willing are Medicare beneficiaries to be vaccinated? Nearly half (47%) of the Medicare beneficiaries we surveyed in the fall told us they were either “somewhat” or “very” uncomfortable getting a vaccine.

It will also be interesting to see how the coronavirus experience changes the behavior of Medicare beneficiaries over the long term. Some of the lifestyle changes they’ve adopted may continue for years after the virus is eradicated. For example, 68% of Medicare beneficiaries we surveyed told us that even after the coronavirus is gone they’ll be less likely to go on a cruise, 53% said they’ll be less likely to visit an amusement park, and nearly half (49%) said they’ll be less likely to fly on a plane again.

Another likely long-term change—many Medicare beneficiaries utilized telemedicine services for the first time during the COVID-19. Heavy use of telemedicine services is new for medical providers and insurers but it makes sense for seniors in a lot of cases. It’s convenient and less risky in terms of exposure to new viruses for a population that’s at greater risk from flu, for example. Most importantly, it helps rural Medicare recipients gain access to services that aren’t easy to obtain in their areas, like psychiatry. I think it’s a safe bet we’ll see demand for telemedicine services persist.

Beyond the coronavirus, it seems likely that we’ll see interest in Medicare Advantage plans continue. There’s been a lot of benefit innovation in that category over the past several years—home-delivered meals, over-the-counter drug stipends, medical alert pendants, and the $0 premium Medicare Advantage plans remain a big draw for many. Medicare recipients and their care providers will be watching to see if this popular Medicare program is changed or enhanced in the next few years.

AJMC^®: Any other thoughts or comments?

Shea: A few years ago, medical insurance companies began acquiring pharmaceutical benefit providers as a way to better coordinate care; the drugs you take are inextricably tied to the medical care you receive. More recently, managed care companies have either acquired retail pharmacies or expanded their relationships with them.

Expect to see these trends continue and for medical care and care management programs to be made more accessible by making them accessible in the health care setting most often visited by seniors. We used to think of coordinated care as a function of improved cooperation between ambulatory and inpatient providers. It’s become much bigger in recent years. Retail pharmacies and managed care companies are important for the most accountable care possible. There is a blurring of the old, outdated lines that distinguished payers from providers. This more modern form of care is good for everyone.