Payer outlook clouded by rising Medicare utilization: Fitch

A Medicare utilization surge in the fourth quarter of 2024 is clouding the health insurance industry's outlook in 2024, according to an April 8 report from Fitch Ratings shared with Becker's

Five things to know: 

1. The U.S. health insurance industry "continued to deliver relatively stable operating performance in 2023, despite moderately increased medical loss ratios for several companies," according to the report. 

2. The elevated medical loss ratios reflect increasing unit costs and higher utilization, particularly in the older adult market, Fitch said.   

3. Companies with higher proportional exposure to Medicare Advantage generally experience increases in their medical loss ratios, Fitch said. Those with less MA exposure had lower medical loss ratios. 

4. The consolidated operating EBITDA margin for the seven largest publicly held players was 6.8% in 2023, down from 7% in 2022, but the equivalent to the 8.6% seen in 2021, according to the report. Fitch said the stable operating results "reflect continued focus on premium rate adequacy among insurers in light of increased operating costs incurred within the provider community in recent years."

5. The report also touched on the Change Healthcare data breach. Fitch said that although its parent company, UnitedHealth Group, is likely to face elevated costs associated with the cyberattack, it does not expect the broader health insurance sector to be significantly affected.

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