Datapoint: Oscar Outlines 2021 Expansion Plans

August 5, 2020

Oscar Health last week said it will expand its individual product offerings to 19 new markets in 2021, gaining a presence in four new states: Arkansas, Iowa, North Carolina and Oklahoma. The insurer will also launch a new virtual primary care benefit design, which offers $0 telehealth visits to in-network providers in 10 markets, as well as in-home labs and vital monitors for some members. Oscar currently enrolls 392,028 individual commercial members.

Oscar Health last week said it will expand its individual product offerings to 19 new markets in 2021, gaining a presence in four new states: Arkansas, Iowa, North Carolina and Oklahoma. The insurer will also launch a new virtual primary care benefit design, which offers $0 telehealth visits to in-network providers in 10 markets, as well as in-home labs and vital monitors for some members. Oscar currently enrolls 392,028 individual commercial members.

Source: AIS’s Directory of Health Plans

Centene Reports Lower Than Expected Enrollment Growth

August 5, 2020

Centene Corp. reported second-quarter earnings in line with its own projections and Wall Street consensus, but also enrolled fewer members than executives had expected. The firm touted revenue growth from its acquisition of WellCare Health Plans, Inc. and attributed strong revenues to decreased utilization related to COVID-19 shutdowns, though Centene said claims rebounded in June to more normal levels.

Centene’s adjusted earnings per share (EPS) was $2.40, which came close to what SVB Leerink analyst Stephen Tanal described as the Wall Street consensus of $2.42. The firm’s non-adjusted EPS increased by 79.5% compared with the second quarter of 2019, which is mainly attributable to the WellCare acquisition.

By Peter Johnson

Centene Corp. reported second-quarter earnings in line with its own projections and Wall Street consensus, but also enrolled fewer members than executives had expected. The firm touted revenue growth from its acquisition of WellCare Health Plans, Inc. and attributed strong revenues to decreased utilization related to COVID-19 shutdowns, though Centene said claims rebounded in June to more normal levels.

Centene’s adjusted earnings per share (EPS) was $2.40, which came close to what SVB Leerink analyst Stephen Tanal described as the Wall Street consensus of $2.42. The firm’s non-adjusted EPS increased by 79.5% compared with the second quarter of 2019, which is mainly attributable to the WellCare acquisition.

According to a transcript of the firm’s earnings call on July 28 prepared by the Motley Fool, Centene Chief Financial Officer Jeffrey Schwaneke reported a medical loss ratio of 82.1%, compared to 86.7% in the second quarter of 2019 and 88.0% in the first quarter of 2020.

“The HBR was low by historical measures and the decline was primarily driven by a reduction of medical utilization as a result of the COVID-19 pandemic, partially offset by increased costs associated with COVID-19 claims,” said Schwaneke. “In terms of monthly trends, utilization deferrals experienced during April and May largely reversed in the month of June.”

New enrollment so far this year has not met Centene’s internal expectations. As a result, Schwaneke expects peak membership growth to be 1.4 million in the fourth quarter, compared to a previous projection of 1.9 million new enrollees through August.

“We believe the temporary nature of some of the unemployment, enhanced unemployment benefits, and employers furloughing rather than terminating employees has all contributed to lower application rates than what is implied by overall unemployment levels,” Schwaneke explained.

Wall Street perception of the results was mostly positive. But Tanal said that Centene’s second-quarter results “demonstrate that the effects of the pandemic on Medicaid enrollment could be less helpful than initially anticipated, providing a smaller offset to Medicaid rate pressure that is likely to impact the business in the coming quarters.”

How Ballot Initiatives Changed the Game on Medicaid Expansion

August 4, 2020

It was the middle of 2016, and Obamacare supporters were stuck.

Nineteen states were refusing to participate in the health law’s Medicaid expansion, which provides health coverage to low-income Americans. States run by Democrats eagerly signed up for the program, lured in part by generous federal funding.

It was the middle of 2016, and Obamacare supporters were stuck.

Nineteen states were refusing to participate in the health law’s Medicaid expansion, which provides health coverage to low-income Americans. States run by Democrats eagerly signed up for the program, lured in part by generous federal funding.

Most Republican governors and legislatures had little interest in expanding the reach of the Affordable Care Act, and declined the money.

“People were frustrated,” said Chris Jennings, a longtime health care strategist who served in the Clinton and Obama administrations. “We were left with either doing nothing or finding a new solution. And then these guys came up with this referendum strategy….”

Read the full The New York Times article

Insurers Report Mixed Results From Covid-19

August 4, 2020

Two giant sellers of insurance to consumers—Allstate Corp. and Prudential Financial Inc.—reported second-quarter results that reflected the far-ranging impact of Covid-19. Allstate’s profit surged from fewer vehicle accidents on the road while ultralow interest rates weighed on Prudential.

The two insurers’ results show the first full quarter of the coronavirus’s unprecedented toll on the U.S. economy. Across all U.S. life and property-casualty insurers, analysts and investors’ focus has been on the costs that insurers are…

Two giant sellers of insurance to consumers—Allstate Corp. and Prudential Financial Inc.—reported second-quarter results that reflected the far-ranging impact of Covid-19. Allstate’s profit surged from fewer vehicle accidents on the road while ultralow interest rates weighed on Prudential.

The two insurers’ results show the first full quarter of the coronavirus’s unprecedented toll on the U.S. economy. Across all U.S. life and property-casualty insurers, analysts and investors’ focus has been on the costs that insurers are…

Read the full The Wall Street Journal article

Datapoint: Aetna to Debut Two New Benefit Designs for Employer Groups

August 4, 2020

CVS Health Corp.’s Aetna said it will launch two new benefit designs, Upfront Advantage and Flexible Five, for its high-deductible employer group plans. The move was precipitated by conversations with Aetna’s large group clients, who said they wanted to see expanded preventive coverage. Upfront Advantage will exempt some preventive services from deductibles, while Flexible Five will give members five coupons per beneficiary for services including primary and urgent care. Aetna currently enrolls 3,114,651 large group and 254,985 small group members.

CVS Health Corp.’s Aetna said it will launch two new benefit designs, Upfront Advantage and Flexible Five, for its high-deductible employer group plans. The move was precipitated by conversations with Aetna’s large group clients, who said they wanted to see expanded preventive coverage. Upfront Advantage will exempt some preventive services from deductibles, while Flexible Five will give members five coupons per beneficiary for services including primary and urgent care. Aetna currently enrolls 3,114,651 large group and 254,985 small group members.

Source: AIS’s Directory of Health Plans