Although growing Medicare Advantage enrollment helped fuel better-than-expected first-quarter 2021 earnings for some publicly traded insurers, they appear to be approaching the full year with caution, as earnings in 2021 could be dampened by a couple of factors. These include the unfavorable impact of the health insurer fee (HIF) repeal for 2021 and lower Medicare risk-adjusted revenue — a recurring and expected theme during insurers’ recent quarterly earnings calls.

Risk scores that determine MA organizations’ risk adjustment payments for the current year are based on diagnoses gathered during the previous year to determine the relative health of an insurer’s MA enrollees and predict costs. But because the pandemic led many seniors to delay or forgo care, insurers’ ability to collect diagnoses last year was limited, despite the temporary authorization to use telehealth to gather diagnoses for MA risk adjustment.

Humana Risks Disproportionate Impact

For MA-focused Humana Inc., the disproportionate impact of COVID-19 on Medicare risk adjustment has created extra uncertainty as the insurer projects earnings for the full year. For the three months ending March 31, Humana on April 28 reported adjusted earnings per share (EPS) of $7.67, compared with $5.40 in the first quarter of 2020, and an overall revenue lift of 9% to $20.67 billion, thanks in large part to growth in its individual MA and state-based contracts. Consolidated medical loss ratio (MLR) for the quarter increased by 80 basis points year over year to 85.9%, which was in line with analysts’ expectations.

Unlock the full version of this article by subscribing.

Log in | Learn More