Payers are expecting healthcare utilization to return to pre-pandemic levels, and as a result, are not factoring in additional costs or savings into their 2022 premiums, according to a report by the Kaiser Family Foundation.

For the report, authors reviewed the initial 2022 premium rate filings for insurers participating in the Affordable Care Act exchanges’ individual market in 13 states and the District of Columbia. The ACA individual market represents a small share of the privately insured population, but the “rate filings for this market are detailed and publicly accessible, making them a useful source of information on how health insurers are thinking about their likely costs for the next year,” the authors wrote.

Of the 75 insurers that filed their 2022 premium rates in the states and districts studied, only 13 said the Covid-19 pandemic will have an upward effect on their costs. These include seven plans in New York, three in Connecticut and one each in Tennessee, Michigan and Vermont. A majority of insurers stated that the impact would be less than 1%.

Three insurers said that the pandemic would have a downward impact on their 2022 costs, and about half (37 insurers) said the pandemic would have no net impact. The remaining insurers did not specify their thoughts on the potential impact of the pandemic.

The 2022 rate filings also provide insight into other considerations on insurers’ minds.

Seventeen of the insurers mentioned telehealth in their filings. But most of those that mentioned virtual care said that they did not expect it to have an upward or downward net effect on their costs next year.

While very few insurers mentioned the No Surprises Act, which bans surprise billing for out-of-network services in most cases starting in 2022, potential effects of the American Rescue Plan Act did figure in payers’ filings. Some insurers believe that increased federal premium subsidies through the act will drive enrollment in marketplace plans next year.

A handful of payers further expect the increased enrollment will lower average morbidity as healthier individuals will enroll in the market. This could have a small downward effect on insurers’ premiums — less than 5%.

But it is important to note that these are just predictions. With new Covid-19 variants, the slowdown of vaccinations and a potential rise in demand due to delayed care, uncertainties regarding utilization remain, the authors wrote.

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