Health plans for R$ 100? Understanding the ANS proposal

Brazil’s National Supplementary Health Agency (ANS) has presented a proposal to create more affordable health plans, with a projected price of R$ 100 or less, covering elective visits and medical tests, but not hospital stays, emergency care or therapies.

In this article, learn about the new ANS project, its feasibility and its possible impacts on both the private healthcare sector and the public health system.

What does the new plan include?

The proposed plan will cover visits in all medical care specialties, as well as tests defined in the ANS list of covered procedures, including CT scans, MRIs, ultrasounds and biopsies, with no limit on quantity. The focus is on Brazilians who currently use discount cards for low‑cost clinics.

The ANS Director of Standards and Authorization of New Products, Alexandre Fioranelli, explains: “It is a regulated option, superior to these discount cards, because it will guarantee these Brazilians, for a much more affordable monthly fee, coverage of visits and all medical care specialties.”

Oversight

The ANS will be responsible for overseeing and monitoring compliance with the clauses and the protection of the members who join this new product. The planned contract type is collective membership, with flexible rules, and it can be purchased by both companies and individuals.

What about price adjustments?

As for adjustments, Fioranelli said they will be based on the total cost of the payer’s portfolio, with the same percentage applied to all members of the product within the same payer.

Goal: broader access to medical care and relief for SUS

According to Fioranelli, only 25% of Brazilians have a health plan today, which overloads SUS (Brazil’s public health system) and creates large pent-up demand for health plans. According to him, the new affordable plan project will be an option aimed at individuals, focused on primary and secondary care, with the security the regulator provides.

According to data from the Ministry of Health and the Pan American Health Organization, primary care can resolve 80 to 90% of a person’s health needs over their lifetime.

Therefore, the intention is that, by increasing the number of people with access to primary and secondary care, bringing 10 million Brazilians into private healthcare, it will be possible to shorten the SUS waiting list for tests and speed up patient diagnosis, preventing diseases from worsening and reducing treatment costs

The other side of the coin: litigation

The rising litigation against health plans is a growing problem in Brazil. According to a survey by Abramge (Brazilian Association of Health Plans), the cost to payers of lawsuits reached R$ 17 billion between 2019 and 2023, reaching a total of R$ 6.8 billion in 2024.

Silvio Guidi, a health law attorney and professor of medical law at USP and PUC-PR, analyzes the high level of litigation in Brazilian private healthcare, arguing that once a health plan is purchased, consumers come to believe that all their health needs will be met in any and every circumstance.

“But a product like that, with this universal and infinite profile, simply does not exist [...] But consumers will only face this reality when the health need actually arrives. So, at a very sensitive moment in their lives, consumers will have their expectations frustrated. This enormous frustration is traditionally directed at the courts,” he says.

From this perspective, the big question about creating a new, more affordable health plan with less coverage is: how will members react when they discover, in emergency situations, that certain procedures are not included in the plan?

They are likely to go to court to demand coverage and, as is common in life-threatening cases, the ruling tends to favor the patient. Given this, whether this new model will bring real benefits to payers without leading to a significant increase in litigation expenses is a question that remains open.