Almost all major US payers hiked forecasts following Q1, hinting at 2021 optimism despite COVID-19

Analysts were worried about U.S. payers’ financial performances coming into 2021, as service utilization is expected to resurge this year following months of care delays during the pandemic. An acute rally in deferred care could depress earnings, following a year of historic profits in the sector.

But almost all major payers hiked their full-year guidance following a strong first quarter, with Humana being the only private insurer to not increase its 2021 outlook, signaling widespread optimism despite ongoing uncertainty due to the COVID-19 pandemic.

Payer executives said patient demand for care was generally back to normal levels or almost nearly there in the first quarter. But despite mounting utilization, all insurers reported notable profit growth in the first quarter.

UnitedHealth, parent company of the biggest private payer in the country, reported the largest profit in the quarter with $4.9 billion, up almost 44% year over year. That was followed by CVS Health, owner of Aetna, which reported profit of $2.2 billion, up about 10%.

However, Centene boasted the biggest year-over-year profit jump. The St. Louis-based insurer brought in net income of $699 million, more than 15 times its earnings compared with the same time last year.

Centene and other insurers that lean heavily on government products for revenue benefited from acute growth in Medicare and Medicaid membership and in the Affordable Care Act exchanges, as the COVID-19 recession caused some millions to lose job-based insurance last year. That went hand in hand with a decline in commercial membership, as the pandemic continues to reshape the U.S. insurance coverage landscape.

Another tailwind for payers active in the ACA marketplace was the Biden administration’s creation of a special enrollment period, allowing consumers more time to sign up for plans. On Tuesday, President Joe Biden said in a statement that 1 million Americans had signed up for coverage during the SEP so far, which began in the middle of the first quarter and closes mid-August.

The across-the-board increases in 2021 guidance could be an overly rosy forecast from payer management, as COVID-19 will likely continue to depress earnings, analysts have pointed out. But the higher guidance bodes well for an eventual return to normalcy over the course of the year. And most payers say they don’t anticipate drastic levels of pent-up demand in 2021.

“People were still able to largely get care in 2020 after the stay-at-home mandates were eased, so the giant backlog we don’t think is there,” Anthem CFO John Gallina told investors in April.