Health Plans Under Pressure | Predictions for 2025

Health plans will need to navigate a difficult financial environment caused by increased healthcare costs and potential membership losses while engaging with and reacting to policy changes with a new administration. The amount of change they will be exposed to in the government programs (Medicare, Medicaid and the ACA [Affordable Care Act] Exchanges) will depend on the speed with which any policy changes impact government programs.

In the employer-sponsored insurance market, they will face pressure to reduce premiums or risk potential enrollment decreases if the financial markets turn sour. To navigate, plans will be assessing their current and planned markets, benefits designs and staffing models. They will deploy more technology that will allow them to better utilize their clinical data to develop more targeted care approaches in a way that is flexible, cost-efficient and can be modified to adjust to any program changes that result from new policy shifts. They may also have the opportunity and challenges of offering new plan types and program flexibilities.