Open Enrollment 2021 Primer: What to Expect and How to Navigate in the Wake of COVID-19

The US Open Enrollment Period (OEP) is that time of the year when potential members select or modify their health plans, and healthcare payers formulate strategies to invest in new areas to increase their market share. For payers, these investments depend on the changes that the US Centers for Medicaid and Medicare Services (CMS) proposes for the next enrollment year, as these changes impact payers in multiple ways. For instance, one of the CMS-proposed changes for OEP 2021, which allows Medicare beneficiaries with End-stage Renal Disease (ESRD) to enroll in Medicare Advantage (MA) plans, can reduce MA plan profits by about 2%. In fact, these changes not only impact healthcare payers operationally and financially, but also affect their strategic sourcing decisions.

In this viewpoint, we take a look at CMS’ key changes proposed for the 2021 OEP and the likely impact of those changes on the healthcare payer landscape. Further, we study in detail the sourcing implications associated with these regulatory changes.