Health insurers benefited from the COVID-19 pandemic’s dampening of healthcare utilization. As hospitals deferred elective procedures and health plan members put off routine doctor’s appointments, health insurance claims plummeted and health insurer profits spiked, particularly in the second quarter. Many insurers waived copayments for coronavirus-related treatment and other care, but those actions did not offset the benefits of billions saved from getting fewer claims.
Insurers also continued to shift their coverage to push certain medical services out of the hospital and into to lower-cost settings. Taking cues from Anthem and UnitedHealthcare, Cigna implemented a policy in August that restricted coverage of MRIs and CT scans when performed in a hospital-based facility.
A windfall arrived in insurers' bank accounts after the U.S. Supreme Court ruled in April that the federal government owed health insurers more than $12 billion under the now-expired Affordable Care Act risk-corridor program. The court ruled 8-1 that the ACA imposed an obligation on the government to pay, and congressional appropriations riders passed later did not repeal that obligation. “These holdings reflect a principle as old as the nation itself: The government should honor its obligations,” Justice Sonia Sotomayor wrote in the majority opinion.