Medicare and Medicaid

Datapoint: Centene to Expand Texas Medicare Presence

December 9, 2020

Centene Corp. last week said it is undertaking a significant Medicare Advantage expansion in Texas, offering coverage in 84 new counties in 2021. The move will launch the MA arm of Superior HealthPlan, Centene’s Texas subsidiary. Centene currently ranks fifth in overall Texas MA lives, serving 91,319 members through its WellCare of Texas subsidiary.

Centene Corp. last week said it is undertaking a significant Medicare Advantage expansion in Texas, offering coverage in 84 new counties in 2021. The move will launch the MA arm of Superior HealthPlan, Centene’s Texas subsidiary. Centene currently ranks fifth in overall Texas MA lives, serving 91,319 members through its WellCare of Texas subsidiary.

Source: AIS’s Directory of Health Plans

More Medicare Advantage Insurers Expand Supplemental Benefits for 2021

December 9, 2020

Although Medicare Advantage insurers were somewhat slow to adopt newly expanded supplemental benefits in 2019, recent analyses of 2021 benefit offerings indicate large jumps in the uptake of certain offerings while others remain stagnant.

According to an analysis of available plan benefit package (PBP) data from CMS, Milliman estimates that 575 unique plans in 2021 are offering at least one of the following benefits: adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, and therapeutic massage. That’s compared with just 102 plans offering a benefit in one of these categories in 2019, Milliman observes.

By Lauren Flynn Kelly

Although Medicare Advantage insurers were somewhat slow to adopt newly expanded supplemental benefits in 2019, recent analyses of 2021 benefit offerings indicate large jumps in the uptake of certain offerings while others remain stagnant.

According to an analysis of available plan benefit package (PBP) data from CMS, Milliman estimates that 575 unique plans in 2021 are offering at least one of the following benefits: adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, and therapeutic massage. That’s compared with just 102 plans offering a benefit in one of these categories in 2019, Milliman observes.

Looking at a wider array of benefits that include acupuncture, dental and hearing, Avalere Health’s analysis of CMS data estimates that 4,494 PBPs in 2021 are offering supplemental benefits at the contract-plan-segment level, up from 2,888 PBPs in 2018 and 3,440 in 2019. Tom Kornfield, a senior consultant with Avalere, saysone of the most telling findings from the analysis is that meal delivery benefits have consistently grown, rising from 23% of 2018 PBPs to 57% of PBPs next year, while nutrition/wellness offerings have stayed relatively stagnant and are offered by just 19% of PBPs for 2021.

Meanwhile, “the big 3 supplemental benefits (vision, hearing, and dental) are now almost universally available (98%, 94%, and 91%, respectively),” writes Avalere. And while telehealth as a supplemental benefit has remained at a low 7% since 2018, now that MA plans are able to include additional telehealth services as a basic Medicare benefit in their bid submissions to be paid for by Medicare, 59% of plans this year have additional telehealth benefits available for Medicare-covered Part B services. In 2021 this number will jump to 94%, according to Avalere’s analysis.

The analysis also observes that one-third of MA plans (34%) will offer a variety of supplemental benefits related to the COVID-19 pandemic next year. The most popular version of these benefits includes “care/relief packages.”

To the extent that those benefits attract new enrollees, “it certainly could help, but I don’t know that it’s going to be the overarching decision” point, says Kornfield. It’s more likely that drug coverage, physician networks and projected out-of-pocket costs will remain top factors for consumers, he suggests.

Top Medicare Advantage Payers Enroll More Than Two-Thirds of U.S. Market, Eye Further Growth in 2021

December 4, 2020

The top five Medicare Advantage insurers enroll 67.4% of the national market, according to the latest update to AIS’s Directory of Health Plans. Over the past several years, large insurers have rapidly expanded their MA footprints as baby boomers continue to age into Medicare. And most of these payers are focusing on further expansion as the 2021 plan year approaches. Notably, UnitedHealthcare is plotting its largest expansion since 2015, adding 291 counties to its roster. United is currently the top MA insurer in 25 states (see map below). CVS Health Corp.’s Aetna is adding 115 new counties to its MA service area for the 2021 plan year, while Humana Inc. will offer HMO products in 125 new counties. Kaiser Permanente’s growth has been more restrained, as the company concentrates on its existing regional markets rather than expanding. On average, the top five insurers’ MA enrollment increased 11.3% from 2019 to 2020.

by Carina Belles

The top five Medicare Advantage insurers enroll 67.4% of the national market, according to the latest update to AIS’s Directory of Health Plans. Over the past several years, large insurers have rapidly expanded their MA footprints as baby boomers continue to age into Medicare. And most of these payers are focusing on further expansion as the 2021 plan year approaches. Notably, UnitedHealthcare is plotting its largest expansion since 2015, adding 291 counties to its roster. United is currently the top MA insurer in 25 states (see map below). CVS Health Corp.’s Aetna is adding 115 new counties to its MA service area for the 2021 plan year, while Humana Inc. will offer HMO products in 125 new counties. Kaiser Permanente’s growth has been more restrained, as the company concentrates on its existing regional markets rather than expanding. On average, the top five insurers’ MA enrollment increased 11.3% from 2019 to 2020.

*Enrollment figures represent the sum of Kaiser’s seven regional managed care organizations.

SOURCE: DHP, AIS’s Directory of Health Plans, as of Oct. 2020.

MA Insurers Report Strong Performance, Predict Enrollment Growth

November 30, 2020

Select publicly traded insurers reporting third-quarter 2020 earnings this past month predicted big gains in Medicare Advantage enrollment during the current Annual Election Period (AEP), and noted that growth in government products helped offset the impact of commercial losses and COVID-19 costs in the recent quarter.

Reporting third-quarter 2020 earnings on Nov. 6, CVS Health Corp. said a 3.5% year-over-year increase in overall revenues was due in part to growth in its Health Care Benefits segment, which includes Aetna. Revenues in that segment rose 8.8% from the prior-year quarter to $18.7 billion, primarily driven by membership increases in Aetna’s government products and the favorable impact of the return of the Affordable Care Act health insurer fee for 2020.

By Lauren Flynn Kelly

Select publicly traded insurers reporting third-quarter 2020 earnings this past month predicted big gains in Medicare Advantage enrollment during the current Annual Election Period (AEP), and noted that growth in government products helped offset the impact of commercial losses and COVID-19 costs in the recent quarter.

Reporting third-quarter 2020 earnings on Nov. 6, CVS Health Corp. said a 3.5% year-over-year increase in overall revenues was due in part to growth in its Health Care Benefits segment, which includes Aetna. Revenues in that segment rose 8.8% from the prior-year quarter to $18.7 billion, primarily driven by membership increases in Aetna’s government products and the favorable impact of the return of the Affordable Care Act health insurer fee for 2020.

Although earnings for the quarter dropped slightly from adjusted earnings per share of $1.84 a year ago to $1.66 (mostly due to COVID-related expenses), CVS raised its full-year adjusted EPS guidance to a range of $7.35 to $7.45.

Aetna President Karen Lynch, who will take over for CVS Health President and CEO Larry Merlo when he retires in February, said the insurer believes it is poised for “above-market growth” in MA in 2021 and beyond.

For the quarter ending Sept. 30, Humana Inc. reported adjusted EPS of $3.08, down from $5.03 in the year-ago quarter as a result of COVID- related expenses, as the company experienced lower-than-usual utilization that was largely offset by higher COVID testing and treatment costs, said Chief Financial Officer Brian Kane. “Accordingly, in the fourth quarter, we expect to record a loss of approximately $2.40 on an adjusted EPS basis, and are tightening our full-year 2020 EPS guidance to a range of $18.50 to $18.75, still within our initial guidance expectations prior to COVID,” he stated, as per a transcript of the call from The Motley Fool.

Humana for the year expects its individual MA membership to grow by approximately 375,000 lives, representing year-over-year growth of approximately 10%.

Pointing to continued expansion of its MA business as a growth driver, Cigna Corp. President and CEO David Cordani during a Nov. 5 earnings call said the company is on track to achieve a strategic EPS goal of $20 to $21 next year. Cigna reported adjusted EPS of $4.41 for the third quarter and anticipates full-year consolidated adjusted EPS of $18.30 to $18.60.

Biden is More Likely to Maintain Stability in MA Than Make Major Change

November 23, 2020

From strengthening the Affordable Care Act to addressing the COVID-19 pandemic, President-elect Joe Biden will have plenty of health care-related items on his plate when he moves into the White House. Part of Biden’s campaign pledge to improve health care coverage included lowering the Medicare eligibility age to 60, but his ability to enact any kind of sweeping health care reform will be severely limited by a likely divided Congress.

If Biden were to succeed with his Medicare-at-60 plan, “it would probably be a very big boon for Medicare Advantage,” given that a younger aging population might not use as many services as an older population and since MA is now a popular alternative to traditional Medicare, observes Stephanie Kennan at McGuireWoods Consulting. Passing such a change, however, depends on several key factors, says Kennan.

By Lauren Flynn Kelly

From strengthening the Affordable Care Act to addressing the COVID-19 pandemic, President-elect Joe Biden will have plenty of health care-related items on his plate when he moves into the White House. Part of Biden’s campaign pledge to improve health care coverage included lowering the Medicare eligibility age to 60, but his ability to enact any kind of sweeping health care reform will be severely limited by a likely divided Congress.

If Biden were to succeed with his Medicare-at-60 plan, “it would probably be a very big boon for Medicare Advantage,” given that a younger aging population might not use as many services as an older population and since MA is now a popular alternative to traditional Medicare, observes Stephanie Kennan at McGuireWoods Consulting. Passing such a change, however, depends on several key factors, says Kennan.

One factor is the makeup of the Senate, which will be determined by runoff elections in Georgia that are scheduled for Jan. 5. If Republicans retain control of the Senate, some might interpret Medicare-at-60 as a progressive, public option-style plan, therefore making it harder to pass legislation enacting such a change, suggests Kennan. The other major issue is that the Medicare Hospital Insurance Trust Fund “really needs to be shored up,” she says.

Meanwhile, MA organizations under the current administration have enjoyed a fair degree of flexibility. Could a Biden administration rein in any of that?

“I think that when it comes to things like network adequacy and quality of care and making sure there’s enough access,” that’s where a Biden administration is more likely to focus rather than “trying to retract benefits,” says Kennan. “I think in general they’re going to be very concerned about access to services, affordability of services…and making sure that there’s information available to folks so they can make a good decision” and understand their health care choices.

During a Nov. 5 webinar hosted by Avalere Health, Avalere Founder Dan Mendelson suggested that regulatory changes aimed at maintaining stability and protecting consumers are far more likely than any major legislative change to MA.

“I think the opportunities arise in these more regulatory changes around the edges to shape the plans in a way that…protects the beneficiary, [helps] to close racial disparities, those kinds of things that are primary policy objectives of a new administration,” Mendelson said.

Study Finds Duals, Racial Minorities Are More Likely to Choose MA Plans

November 13, 2020

From 2013 to 2019, the number of Medicare-Medicaid dual eligibles enrolled in Medicare Advantage increased by 125% to 5.4 million lives, according to a new Milliman report commissioned by the Better Medicare Alliance. Meanwhile, the number of duals enrolled in traditional, fee-for-service (FFS) Medicare decreased by 5% to 6.9 million lives. Researchers found that by 2019, 42.2% of the duals population was enrolled in MA, compared to 25.0% of the same group in 2013 (see bar chart below). Members of the duals group switched from FFS to MA 2.3 million times over the six-year time period. Milliman said this flock to MA could be partially driven by the introduction of CMS’s duals demonstration projects, which are currently active in 11 states, but Dual Eligible Special Needs Plans (D-SNPs) are also an increasingly large part of the landscape, according to AIS’s Directory of Health Plans (see market breakdowns below). In addition to its findings on duals, the study showed that nonwhite Medicare beneficiaries were also more likely to choose MA (see bottom chart), with enrollment among racial minorities increasing by 111% over the six-year period.

by Carina Belles

From 2013 to 2019, the number of Medicare-Medicaid dual eligibles enrolled in Medicare Advantage increased by 125% to 5.4 million lives, according to a new Milliman report commissioned by the Better Medicare Alliance. Meanwhile, the number of duals enrolled in traditional, fee-for-service (FFS) Medicare decreased by 5% to 6.9 million lives. Researchers found that by 2019, 42.2% of the duals population was enrolled in MA, compared to 25.0% of the same group in 2013 (see bar chart below). Members of the duals group switched from FFS to MA 2.3 million times over the six-year time period. Milliman said this flock to MA could be partially driven by the introduction of CMS’s duals demonstration projects, which are currently active in 11 states, but Dual Eligible Special Needs Plans (D-SNPs) are also an increasingly large part of the landscape, according to AIS’s Directory of Health Plans (see market breakdowns below). In addition to its findings on duals, the study showed that nonwhite Medicare beneficiaries were also more likely to choose MA (see bottom chart), with enrollment among racial minorities increasing by 111% over the six-year period.

*In its analysis, Milliman identified 9.6 million full and partial dual beneficiaries from the March 2013 Medicare population and examined their enrollment behavior through April 2019.

SOURCES: “Comparing the Demographics of Enrollees in Medicare Advantage and Fee-For-Service,” Milliman report commissioned by the Better Medicare Alliance, Oct. 2020. View the full report here: https://bit.ly/2Tzu8EO. DHP, AIS’s Directory of Health Plans. Visit https://aishealthdata.com/dhp for more information.