Health plans anticipate a greater than 15% increase after reporting record medical spending

In anticipation of the disclosure of the readjustment index for individual and family health plans by the National Supplementary Health Agency (ANS), operators expect a readjustment above 15% after reporting standard hospital medical expenses. When applying the same calculation formula used by the ANS, the entities representing companies reached similar values.

The National Federation of Complementary Health (FenaSaúde) estimates that the agency authorizes a readjustment of 15.7%. The Brazilian Association of Health Plans (Aprogramati) was 15.8%. One of the main reasons for the forecast is the increase in medical and hospital costs, reported by operators. In total, Brazil has nearly 49 million beneficiaries of the healthcare plan.

According to the latest study by the Institute for Complementary Health Studies (IESS), it was obtained exclusively by stadiumThe change in medical hospital costs (VCMH) for operators was 27.7% in the twelve months ending September 2021. This is a record in the historical series that started in 2007. Prior to that, the highest increase was (20, 4%) between 2015 and 2016 , when Brazil plunged into an economic crisis.

At the start of the COVID-19 pandemic and social isolation, people stopped going to doctors and hospitals and put off more expensive check-ups and elective (non-urgent) surgeries. As a result, health insurance expenses decreased. In September 2020, the VCMH calculated by IESS was negative for the first time (-3.6%).

“Many people put off things that shouldn’t be put off, such as cancer diagnosis and treatment. As the disease progresses, costs have increased,” says Jose Sechin, IESS executive supervisor. Operators’ expenses grew again in March 2021. As vaccination progressed and a sense of safety increased, people stopped avoiding doctors’ offices and hospitals. “The disparity in expenditures was rapid and intense, particularly between June and September 2021,” he says.

In the health care cost composition, hospital admissions had the largest weight (63%). Then came treatments (13%), exams (11%), other outpatient services (7%), and consultations (6%). Across all items, there was an increase in per capita expenditures between September 2020 and September 2021. It was most pronounced in the Other Outpatient Services category, which recorded a 38% growth in expenditures.. “One of the opportunities to increase this component was the high demand for services such as physical therapy, speech therapy, and psychotherapy by people with long-term COVID-19 disease,” Sechin says.

How does ANS calculation work?

In the IESS study, expenditures of a sample of only 688,900 beneficiaries were analyzed, the majority (36.9%) of whom were 59 years of age or older. To determine the monthly fee adjustment, the ANS also takes into account other factors.

The calculation combines the value of the Index of Care Expenditures (IVDA) and inflation through the broad consumer price index (IPCA), with the health plan sub-item removed from the latter. In the formula, IVDA is 80% and IPCA 20%.

In a memo, the NSA informed that the maximum readjustment percentage allowed for individual or family plans is calculated and will be issued after the Department of Economy’s calculations are completed and proven. According to the agency, there is no specific date for the release. In previous years, the definition was made in May. Last year, the index was announced only in July.

Hopefully ANS will follow the formula you invented. There will be complaints because people’s incomes have not grown in line with inflation, but readjustment of health plans will be high because operators’ healthcare expenditures have increased,” says Sechin.

According to Mario Schaefer, a professor at the University of São Paulo School of Medicine (USP) and blogger stadium, a significant increase in individual plans would be completely incompatible with the current economic and health crisis. “It’s ridiculous, and even more so after a period when operators made a lot of profit, with an increase in customers, and a decrease in usage during the pandemic,” Schaeffer says.

ANS allows adjustments based on overestimated data by operators, without transparent technical justification. He adds that there are inconsistencies in the way operators justify readjustment and the agency is colluding with this. “Is he there (an agency) It accepts the largest increase in monthly fees for individual plans in more than 20 years. In addition, it continues to have no control over or scrutiny of group plan modifications,” adds the USP professor.

The agency only sets the readjustment value for individual or family plans. There is no re-adjustment limit on corporate group plans or group membership plans. The value of the increase for these cases is negotiated between the companies and health workers.

ANS had another calculation formula before 2019

In the context of high inflation and a general increase in the prices of products and services, consumers fear that they will not be able to afford more expenses with the health plan. says Anna Carolina Navarrete, health program coordinator at the Brazilian Institute for Consumer Protection (Idec).

“It is essential to remember that estimates of companies in the sector usually exceed the adjustment authorized by the ANS,” she says. “Last year, the operators’ accounts were about 2% and the agency’s index was negative (-8.19%).”

According to Ana Carolina, the current account formula is more customer-friendly than the one the agency adopted prior to 2019. “It’s more transparent, it relies on auditable data, and has historically produced fewer adjustments,” she says. The first amendment rate with the new methodology was 7.35%. He noted that the authorized increases in previous years were 10% (2018) and 13.55% (2017).

Checking relay prospects is an alternative for customers

If the ANS determines a high rate and the customer can no longer afford these expenses, Anna Carolina recommends that the consumer try to change plans within the same operator. In this way, it is possible to take with him needs that have already been fulfilled.

The operator is asked to provide a list of plans that can be migrated to. Another possibility is to try to change the plan and operator through portability. For this, the beneficiary must access the ANS directory on the agency’s website.

By entering your health plan details, the service provides a list of others you can switch to. Portability is only allowed if the customer has been on the original plan for at least two years and is up to date with the monthly payment. The plan the person intends to immigrate to must be the same value or cheaper.