Medicare and Medicaid

Datapoint: Biden Admin Nixes Work Requirements in Two States

March 24, 2021

The Biden administration last week quietly rescinded Medicaid work requirement approvals in Arkansas and New Hampshire, according to letters sent by CMS to the states. The U.S. Supreme Court was supposed to hear oral arguments related to the controversial reforms touted by the Trump administration next week, but recently removed the hearing from its docket, suggesting that previous rulings striking down work requirements could stand. Arkansas, which currently serves 853,216 Medicaid beneficiaries, was the only state to ever fully implement a work requirement. About 18,000 people lost coverage over a six-month period before a D.C. district court judge blocked the rule in March 2019.

The Biden administration last week quietly rescinded Medicaid work requirement approvals in Arkansas and New Hampshire, according to letters sent by CMS to the states. The U.S. Supreme Court was supposed to hear oral arguments related to the controversial reforms touted by the Trump administration next week, but recently removed the hearing from its docket, suggesting that previous rulings striking down work requirements could stand. Arkansas, which currently serves 853,216 Medicaid beneficiaries, was the only state to ever fully implement a work requirement. About 18,000 people lost coverage over a six-month period before a D.C. district court judge blocked the rule in March 2019.

Source: AIS’s Directory of Health Plans

MA Insurers Deploy New Benefit Flexibilities in Diabetes Management

March 22, 2021

From lowering cost sharing on select services to participating in the new Part D insulin model, Medicare Advantage insurers are incorporating new benefit flexibilities into their overall management of diabetes, which impacts one in every three Medicare beneficiaries.

Diabetes accounts for more than $300 billion in U.S. health care spending, including $17 billion spent on insulin in the Part D program. According to a Faegre Drinker analysis, 23.7% of plans offering condition-specific benefits this year are targeting diabetes. The most popular benefits include reduced cost sharing on podiatry, physician specialist and primary care physician services, and additional supplemental benefits related to podiatry, meals and worldwide urgent coverage.

NOTE: The abstract below is a shortened version of the RADAR on Medicare Advantage article “MA Plans Test New Flexibilities Targeted to Diabetic Members.”

By Lauren Flynn Kelly

From lowering cost sharing on select services to participating in the new Part D insulin model, Medicare Advantage insurers are incorporating new benefit flexibilities into their overall management of diabetes, which impacts one in every three Medicare beneficiaries.

Diabetes accounts for more than $300 billion in U.S. health care spending, including $17 billion spent on insulin in the Part D program. According to a Faegre Drinker analysis, 23.7% of plans offering condition-specific benefits this year are targeting diabetes. The most popular benefits include reduced cost sharing on podiatry, physician specialist and primary care physician services, and additional supplemental benefits related to podiatry, meals and worldwide urgent coverage.

And the fact that more than 1,600 MA and Part D plans this year are participating in the CMS Part D Senior Savings Model — which aims to lower out-of-pocket costs for diabetic seniors by featuring predictable copayments of no more than $35 for a broad set of insulins — speaks to plan sponsors’ confidence in serving the diabetes population effectively, suggests Tim Murray, director and senior consulting actuary with Wakely Consulting.

SelectHealth says many of its MA members in Idaho, Nevada and Utah already have $0 cost sharing on several services, but it has incrementally enhanced its diabetes-specific benefits in select markets and observed a “small, yet positive increase in these benefit utilizations.” The insurer focuses on reducing costs associated with essential services that are key to diabetes management, and says it targets behaviors as opposed to looking at the severity of the disease or risk scores when considering benefit design.

Blue Cross & Blue Shield of Rhode Island (BCBSRI) offers multiple flex benefits for members with diabetes, including routine foot care and additional dental services. That’s all part of a whole-person approach that includes education and ongoing clinical coaching and management, explains Michael Menard, managing director of Medicare strategy, product and business operations. New for 2021, BCBSRI is also participating in the Part D insulin model.

MVP Health Care, which sells MA plans in New York and Vermont, says it has offered many low- and no-cost services related to diabetes for several years, and for 2021 has removed the cost of routine podiatry care.

Independence Blue Cross has also made incremental adjustments to its diabetes-specific programs, including the expansion of a post-discharge meal benefit, the addition of a medical nutrition therapy benefit, and a dedicated diabetes case and condition management program to improve utilization and reduce gaps in care.

Medicare Advantage Enrollment Soars Past 26 Million in Latest AEP

March 12, 2021

Approximately 2.4 million people enrolled in a Medicare Advantage plan from February 2020 to February 2021, bringing the total MA population to 26.3 million medical lives. That’s a 9.9% year-over-year increase, according to AIS Health’s analysis of data from the 2021 Medicare Annual Election Period (AEP). While the AEP was strong overall, the top 10 MA insurers continue to dominate the market, with 62.7% of all new enrollees selecting a plan from UnitedHealthcare, Humana Inc. or CVS Health Corp.’s Aetna. Meanwhile, Centene Corp.’s completed acquisition of WellCare Health Plans, Inc. allowed it to jump from No. 10 to No. 6, more than doubling its 2020 headcount. See a complete breakdown of the top 10 payers’ results below. No state saw any MA losses from 2020 to 2021, with 10 seeing increases of more than 20%, including several states with historically low penetration rates, such as Delaware, Maryland and Vermont (see map below).

by Carina Belles

Approximately 2.4 million people enrolled in a Medicare Advantage plan from February 2020 to February 2021, bringing the total MA population to 26.3 million medical lives. That’s a 9.9% year-over-year increase, according to AIS Health’s analysis of data from the 2021 Medicare Annual Election Period (AEP). While the AEP was strong overall, the top 10 MA insurers continue to dominate the market, with 62.7% of all new enrollees selecting a plan from UnitedHealthcare, Humana Inc. or CVS Health Corp.’s Aetna. Meanwhile, Centene Corp.’s completed acquisition of WellCare Health Plans, Inc. allowed it to jump from No. 10 to No. 6, more than doubling its 2020 headcount. See a complete breakdown of the top 10 payers’ results below. No state saw any MA losses from 2020 to 2021, with 10 seeing increases of more than 20%, including several states with historically low penetration rates, such as Delaware, Maryland and Vermont (see map below).

NOTES: Per AIS’s research methodology, above analysis does not include about 430,000 lives enrolled in CMS’s Financial Alignment Initiative demonstration plans for Medicare-Medicaid Dual Eligibles.
*Enrollment figures represent the sum of Kaiser’s seven regional managed care organizations.
†Enrollment data includes Centene’s acquisition of WellCare, which closed in January 2020.
‡Anthem, Inc. entered an agreement to acquire InnovaCare Health’s Medicare and Medicaid assets in February 2021. The deal is expected to close in the second quarter of 2021.

SOURCE: DHP, AIS’s Directory of Health Plans. Visit https://aishealthdata.com/dhp for more information.

Datapoint: 2021 Medicare Advantage AEP Results

March 11, 2021

Medicare Advantage enrollment grew 9.9%, to 26.3 million lives, from February 2020 to February 2021, signs of another strong annual enrollment period. Market leader UnitedHealthcare saw a 13.5% increase, to 7.1 million lives.

Medicare Advantage enrollment grew 9.9%, to 26.3 million lives, from February 2020 to February 2021, signs of another strong annual enrollment period. Market leader UnitedHealthcare saw a 13.5% increase, to 7.1 million lives.

Source: AIS’s Directory of Health Plans

MA Insurers Use Direct Plan Comparisons, Digital Engagement to Compete During OEP

March 11, 2021

With reports of low Medicare Advantage switching during the recent Annual Election Period (AEP) and major national carriers capturing two-thirds of new enrollment, smaller regional players are looking at the current Open Enrollment Period (OEP) as an opportunity to foster satisfaction and retention and to promote their brand through multiple marketing channels.

“Even before the end of AEP, we were planning with our regional clients to ensure they had a strong presence in the marketplace during the OEP,” says Renee Mezzanotte, executive vice president of client engagement with Chesterbrook, Pa.-based DMW Direct. “A combination of media channels — digital, direct response TV and direct mail — are proving to keep our clients top of mind. As in years past, to make the most of limited budgets, DRTV schedules are flighted around direct mail drops to boost awareness and response. We can’t outspend national players, but we can outsmart them.”

NOTE: The abstract below is a shortened version of the RADAR on Medicare Advantage article “OEP Tactics Include COVID Comms, Direct Plan Comparisons.”

By Lauren Flynn Kelly

With reports of low Medicare Advantage switching during the recent Annual Election Period (AEP) and major national carriers capturing two-thirds of new enrollment, smaller regional players are looking at the current Open Enrollment Period (OEP) as an opportunity to foster satisfaction and retention and to promote their brand through multiple marketing channels.

“Even before the end of AEP, we were planning with our regional clients to ensure they had a strong presence in the marketplace during the OEP,” says Renee Mezzanotte, executive vice president of client engagement with Chesterbrook, Pa.-based DMW Direct. “A combination of media channels — digital, direct response TV and direct mail — are proving to keep our clients top of mind. As in years past, to make the most of limited budgets, DRTV schedules are flighted around direct mail drops to boost awareness and response. We can’t outspend national players, but we can outsmart them.”

The OEP, which runs from Jan. 1 to March 31 each year, allows beneficiaries who selected an MA plan during the AEP to make a one-time switch to another plan or change their coverage to Original Medicare.

“In addition to the emails and direct mail touches welcoming members and outlining specific benefits, member webinars have been an important part of our clients’ outreach,” adds Mezzanotte.

Getting in front of members with a strong onboarding strategy is critical, and that should start at the point of sale, says consultant Diane Hollie. It could be something simple that clearly describes the next steps. This should help avoid potential confusion or the feeling of buyer’s remorse, she suggests.

Another strategy Hollie is seeing clients explore is “understanding from the AEP where members have gone and how they can advertise against that.” This is the second OEP that CMS has allowed plans to make direct comparisons to other plans in their marketing, as long as the information is accurate and can be supported. Plans are also proactively using these direct plan comparisons in their age-in campaigns, she says.

“Member communication regarding COVID-19 has been an integral part of our clients’ plans over the last year and it continues in 2021 through email, mail, social media, and text,” Mezzanotte says. “While information is changing almost daily, it is crucial for plans not to shy away from speaking to their members even if it is to just to provide basic guidance.”

Datapoint: Centene Snags Hawaii Medicaid Contract Renewal

March 4, 2021

Centene Corp. last week said its Hawaii subsidiary, ‘Ohana Health Plan, was selected by the Hawaii Department of Human Services to continue proving behavioral health services to the state’s Medicaid managed care population. The statewide contract is set to begin in July 2021, and will last three years. Hawaii’s Medicaid managed care program, Med-QUEST, currently serves 378,100 people.

Centene Corp. last week said its Hawaii subsidiary, ‘Ohana Health Plan, was selected by the Hawaii Department of Human Services to continue proving behavioral health services to the state’s Medicaid managed care population. The statewide contract is set to begin in July 2021, and will last three years. Hawaii’s Medicaid managed care program, Med-QUEST, currently serves 378,100 people.

Source: AIS’s Directory of Health Plans