Health plans provide for readjustment greater than 15%

In anticipation of the disclosure of the readjustment index of individual and family health plans by the National Supplementary Health Agency (ANS), operators predict readjustment above 15% after reporting record medical-hospital expenses. When applying the same calculation formula used by ANS, entities representing the companies reached similar values.

The National Federation of Supplementary Health (FenaSaúde) estimates that the agency authorizes a readjustment of 15.7%. The Brazilian Association of Health Plans (Abramge) reached the rate of 15.8%. One of the main reasons for the forecast is the increase in medical and hospital costs, reported by operators. In total, Brazil has approximately 49 million health plan beneficiaries.

According to the most recent study by the Institute of Supplementary Health Studies (IESS), obtained exclusively by Estadão, the variation in medical-hospital costs (VCMH) of operators was 27.7% in the 12 months ended in September 2021. This is a record in the historical series started in 2007. Before that, the biggest increase (20.4%) had occurred between 2015 and 2016, when Brazil plunged into an economic crisis.

At the beginning of the covid-19 pandemic and social isolation, people stopped going to doctors and hospitals and postponed more expensive exams and elective (non-urgent) surgeries. As a result, health insurance expenses plummeted. In September 2020, the VCMH calculated by the IESS was negative for the first time (-3.6%).

“Many people postponed things that should not have been postponed, such as the diagnosis and treatment of cancer. With the progression of the disease, the costs increased”, says José Cechin, executive superintendent of the IESS. Operators’ expenses grew again in March 2021. With the advancement of vaccination and the increased sense of security, people stopped avoiding doctors’ offices and hospitals. “The variation in expenses was fast and intense, especially between June and September 2021”, he says.

In the composition of health care costs, hospitalizations had the greatest weight (63%). Then came therapies (13%), exams (11%), other outpatient services (7%) and consultations (6%). In all items, there was an increase in per capita expenses between September 2020 and September 2021. It was more pronounced in the category of other outpatient services, which recorded a 38% growth in expenses. “One of the chances of an increase in this item was the great demand for services such as physiotherapy, speech therapy, psychotherapy by people who had long covid”, says Cechin.

How does the ANS calculation work?

In the IESS study, only the expenses of a sample of 688,900 beneficiaries were analyzed, most of them (36.9%) aged 59 years or older. To define the adjustment of monthly fees, ANS also considers other factors.

The calculation combines the value of care expenses index (IVDA) with inflation by the broad consumer price index (IPCA), removing the health plan sub-item from the latter. In the formula, the IVDA has a weight of 80% and the IPCA, of 20%.

In a note, the ANS reported that the maximum percentage of adjustment to be authorized for individual or family plans is being calculated and will be released after completion of the calculations and manifestation of the Ministry of Economy. According to the agency, there is no set date for the release. In previous years, the definition took place in May. Last year, the index was only announced in July.

“We hope that the ANS will follow the formula that it invented. There will be complaints because people’s incomes have not grown according to inflation, but the readjustment of health plans will be high because the health care expenses of operators have grown”, says Cechin.

According to Mario Scheffer, professor at the Faculty of Medicine of the University of São Paulo (USP) and blogger Estadão, a high increase in individual plans would be totally incompatible with the current economic and health crisis. “It’s absurd, even more so after a period in which operators profited a lot, with an increase in customers, and low usage during the pandemic”, says Scheffer.

“ANS allows adjustments based on data overestimated by operators, without transparent technical justification. There are inconsistencies in the way operators justify the adjustment and the agency is conniving with this”, he says. “It (the agency) accepts what will be the biggest increase in monthly fees for individual plans in more than 20 years. Furthermore, it continues not to control or inspect the readjustments of collective plans”, adds the USP professor.

ANS had another calculation formula before 2019

In a context of high inflation and a general increase in the price of products and services, consumers fear that they will not be able to afford more health insurance expenses. “The possibility of a high readjustment has worried consumers because it comes at this very bad time, with high gas, energy and the supermarket”, says Ana Carolina Navarette, coordinator of the Health Program of the Brazilian Institute for Consumer Protection (Idec) .

“It is necessary to remember that the estimates of companies in the sector usually exceed the readjustment authorized by the ANS”, she says. “Last year, the operators’ calculations were around 2% and the agency’s index was negative (-8.19%)”.

According to Ana Carolina, the current calculation formula is more favorable to clients than the one adopted by the agency before 2019. “It is more transparent, adopts auditable data and has historically produced lower readjustments”, she says. “The first adjustment with the new methodology was 7.35%. The increases authorized in previous years were 10% (2018) and 13.55% (2017),” she points out.

Checking migration possibilities is an alternative for customers

If the ANS defines a high percentage and the customer can no longer afford this expense, Ana Carolina recommends that the consumer try to change plans within the same operator. In this way, it is possible to take with him the needs that have already been fulfilled.

The operator is required to provide a list of plans to which migration is possible. Another possibility is to try to change the plan and operator by making portability. For this, the beneficiary must access the ANS guide on the agency’s website.

By entering your health plan details, the service provides a list of others that you can switch to. Portability is only allowed if the customer has been in the original plan for at least two years and is up to date with the monthly payment. The plan to which the person intends to migrate must be of the same value or cheaper.

About Jenni Smith

She's our PC girl, so anything is up to her. She is also responsible for the videos of Play Crazy Game, as well as giving a leg in the news.

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