Rising Uninsured: Why Boosting your Eligibility and Enrollment Services is Critical

The number of Americans without health coverage continues to escalate. The rise in the uninsured has been attributed to several factors, including rising health care costs, the economic downturn and erosion of employer-based insurance. Your organization can effectively find third-party coverage for your uninsured patients through an advanced eligibility and enrollment program. For health systems, a strong program can improve the patient experience while reducing uncompensated care, alleviating bad debt and optimizing reimbursement risk.

The rise in uninsured patients makes optimizing reimbursement and managing financial risk critical to a hospital’s sustainable financial health.

Approximately 28 million people, or 8.6 percent of all Americans, did not have health insurance at any point in 2020, according to the U.S. Census Bureau’s annual report on the uninsured. In addition, the rate of private health insurance coverage decreased to 66.5 percent between 2018 and 2020, driven by a decline in employment-based coverage, which reached a low of 54.4 percent. Children were especially hard hit, according to the report. Uninsured rates for children under the age of 19 in poverty rose 1.6 percentage points to 9.3 percent.

Further studies support this alarming trend. A survey by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention, revealed troubling estimates of health insurance coverage for the civilian non-institutionalized U.S. population. Highlights include:

  • Number of persons under age 65 uninsured: 31.2 million
  • Percent of persons under age 65 uninsured: 11.5%
  • Percent of children under age 18 uninsured: 5.1%
  • Percent of adults aged 18-64 uninsured: 13.9%

Cost is frequently cited as a primary reason for being uninsured. A 2021 American Medical Association (AMA) paper cited that while 74% of nonelderly adults in 2019 said they were uninsured because coverage was not affordable, one third of insured adults reported difficulty affording to pay their deductible. Overall, approximately half of U.S. adults reported they or a family member delayed or skipped needed health care or dental care in the past year due to cost.

The rise in uninsured patients makes optimizing reimbursement and managing financial risk critical to a hospital’s sustainable financial health. Beyond the bottom line, optimizing your eligibility and enrollment services can significantly enhance the patient experience by helping the uninsured obtain health benefits and providing peace of mind throughout the care continuum.

Three ways to boost your Eligibility and Enrollment program

Two women wearing face masks reviewing information on a laptop

With the number of uninsured rising since the beginning of the pandemic, it is imperative that your organization work diligently to secure third-party coverage for them.




TAKEAWAY

The number of Americans without health coverage has exploded over the past two years. To prevent those newly uninsured patients from increasing your bad debt costs, you need to optimize your eligibility and enrollment services. Those services may include enrolling patients in public insurance programs, determining patients’ eligibility for community and financial assistance programs, identifying low-cost health insurance options and educating patients on health insurance benefits, and helping them with enrollment processes.

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