Individual health plans can have readjustment above 40%, says study

The National Supplementary Health Agency (ANS) authorized the readjustment of individual and family health plans by up to 15.5%, a record rate since 2000. The increase in monthly fees, however, can exceed 40% for customers of medical plans. This is because, in addition to the annual adjustment, operators are authorized to raise monthly fees when there is a transition in age groups – the last possible increase is at age 59.

The calculation was made by the team of scientists led by Mario Scheffer, professor at the Faculty of Medicine of the University of São Paulo (USP) and blogger of the Estadão, and by Lígia Bahia, professor at the Federal University of Rio (UFRJ). The group was based on data from ANS, which for the first time released commercial values ​​of agreements and operators. The survey was published on the blog Política&Saúde.

The average calculated based on 3,500 plans, from 468 operators, points out that the rise in prices can reach 43.1% for those who “migrated” from the age group of 54 to 58 years old to that of 59 years old or more. – applicable for customers who turn 59 by April of the next year. According to ANS rules, there are ten age groups, whose transition entitles the operator to raise the price. For children and adolescents, the readjustment is 15.5%. For the other seven age groups, the rates range from 25.3% (34 to 38 years) and 43.1% (59 years and over).

For Scheffer, the rates are “unacceptable”, especially “at this time of economic recession and loss of purchasing power” of the population. “The elderly are being pecuniarily expelled from supplementary health. The person pays the plan for life and when they reach the age of 59, and need more, they can’t afford the costs anymore”, he says.

Individual plans correspond to approximately 20% of the total contracts signed with supplementary health operators. Collective plans – contracted by associations, unions, companies, among others – can be negotiated directly and are not under the control of ANS.

If all types of health plans are considered (individual, collective, etc.), Lígia Bahia’s group estimates around 6 million clients in transition ages, when the law authorizes an increase based on age. The Brazilian Association of Health Plans (Abramge), in turn, argues that most contracts for collective business plans do not provide for adjustment by this parameter.

The redistribution of values ​​for each age group, explains Scheffer, is done with “relative flexibility”, which allows the operators themselves to decide which groups receive a greater or lesser readjustment. The rule stipulates, however, that the last range (59 years old or older) cannot have a readjustment that is six times greater than the first one (0 to 18 years old). “Generally, the higher values ​​are for the higher ranges”, he points out.

After the announcement by the ANS, the Minister of Health, Marcelo Queiroga, expressed himself on social media. According to him, changes are needed in the sector, “such as greater transparency, more efficiency and increased competition”. He also said that “increases in monthly fees paid by Brazilians who hire health insurance are not necessarily associated with the quality of the service provided”. President Jair Bolsonaro, a candidate for reelection, said this week to presenter Sikera Júnior that the increase was not “fair”.

Companies

According to the National Federation of Supplementary Health (FenaSaúde), which represents 15 groups of operators and private insurance, the associates have had an increase of 2.4 million customers since June 2020 and each one “is free to offer differentiated conditions” to customers.

The entity also says that, in the case of collective plans, average readjustments last year were 9.84%, for plans of up to 29 lives; and 5.55% for those with 30 lives or more. Rates far above average, he says, “are the exception, not the rule”. And he argues that the readjustment “is indispensable to restore the variation in costs. It also highlights the 24% increase in expenses in 2021 – in the previous year there was a record drop in procedures with the pandemic.

For Marcos Louvais, executive superintendent of Abramge, the increase of 15.5% comes after the “negative” correction of the previous period and the real value would be 6% in two years. “In Brazil’s economic outlook, we would say that the plan has one of the lowest readjustments in history. When we discount the claims, the 14% that is left is barely enough to pay the taxes.”

The ANS says that “rapidly evolving factors”, such as the increase in life expectancy, “are urgent issues”. In this scenario, he says, the readjustment due to change in age group, provided for in the sector’s law, is justified. “The formation of age groups aims to spread the risk across a larger mass of users, providing a more balanced price for all beneficiaries.”

Estadão Content