AIS’s Directory of Health Plans

Datapoint: Centene Expanding 2020 Exchange Offerings in 10 States

August 15, 2019

Centene Corp. this week said it will expand its 2020 exchange offerings in ten of its state markets; Arizona, Florida, Georgia, Kansas, North Carolina, Ohio, South Carolina, Tennessee, Texas and Washington. Centene is currently the Affordable Care Act exchange market leader, with 1,968,416 enrollees nationwide. Its three largest state markets are Florida (520,104 lives), New York (264,853 lives) and Georgia (205,967 lives).

Centene Corp. this week said it will expand its 2020 exchange offerings in ten of its state markets; Arizona, Florida, Georgia, Kansas, North Carolina, Ohio, South Carolina, Tennessee, Texas and Washington. Centene is currently the Affordable Care Act exchange market leader, with 1,968,416 enrollees nationwide. Its three largest state markets are Florida (520,104 lives), New York (264,853 lives) and Georgia (205,967 lives).

Source: AIS’s Directory of Health Plans

Datapoint: Illinois Gov. Revamps Medicaid Program With New Reforms

August 14, 2019

Illinois Gov. J.B. Pritzker (D) last week signed a bill that will improve administrative problems in the state’s Medicaid managed care program, including a more streamlined eligibility process and automatic renewal for members. The new legislation requires contracted payers to pay claims within 30 days, and prioritize payments to providers that serve large numbers of Medicaid beneficiaries. Illinois currently serves 2,097,951 people in its Medicaid managed care program, with WellCare Health Plans, Inc. as the market leader, enrolling 37.9% of the managed care population.

Illinois Gov. J.B. Pritzker (D) last week signed a bill that will improve administrative problems in the state’s Medicaid managed care program, including a more streamlined eligibility process and automatic renewal for members. The new legislation requires contracted payers to pay claims within 30 days, and prioritize payments to providers that serve large numbers of Medicaid beneficiaries. Illinois currently serves 2,097,951 people in its Medicaid managed care program, with WellCare Health Plans, Inc. as the market leader, enrolling 37.9% of the managed care population.

Source: AIS’s Directory of Health Plans

Datapoint: Nearly 40% of All Covered Lives Are Enrolled in Medicare or Medicaid

August 13, 2019

More than 130 million people, or 39.8% of all covered lives in the United States, are served by a public-sector health program (or Medicare and Medicaid).

More than 130 million people, or 39.8% of all covered lives in the United States, are served by a public-sector health program (or Medicare and Medicaid).

Source: AIS’s Directory of Health Plans

Datapoint: Medicare Will Cover Costly CAR-T Therapies

August 12, 2019

CMS last week finalized its decision to cover CAR-T cell treatments, as well as all services related to administration of the costly therapy. Available CAR-T therapies have been slow to pick up coverage due to their high list prices, with Gilead’s Yescarta priced at $373,000 and Novartis’ Kymriah at $475,000. CMS currently facilitates coverage for 33,301,406 people through Medicare fee-for-service.

CMS last week finalized its decision to cover CAR-T cell treatments, as well as all services related to administration of the costly therapies. Available CAR-T therapies have been slow to pick up coverage due to their high list prices, with Gilead’s Yescarta priced at $373,000 and Novartis’ Kymriah at $475,000. CMS currently facilitates coverage for 33,301,406 people through Medicare fee-for-service.

Source: AIS’s Directory of Health Plans

Datapoint: Humana Picks Up Louisiana Medicaid Contract, Centene and Aetna Lose Out

August 8, 2019

The Louisiana Department of Health this week awarded new managed care contracts to serve its Medicaid program, slated to begin in 2020. The state awarded four contracts to AmeriHealth Caritas, Anthem, Inc., UnitedHealthcare and new entrant Humana Inc., compared to its previous five. Centene Corp., which currently enrolls 475,914 managed Medicaid members in Louisiana, and Aetna, which serves 122,518, were not selected to renew. Louisiana currently serves 1,682,121 Medicaid eligibles, with 91.1% enrolled in managed care plans.

The Louisiana Department of Health this week awarded new managed care contracts to serve its Medicaid program, slated to begin in 2020. The state awarded four contracts to AmeriHealth Caritas, Anthem, Inc., UnitedHealthcare and new entrant Humana Inc., compared to its previous five. Centene Corp., which currently enrolls 475,914 managed Medicaid members in Louisiana, and Aetna, which serves 122,518, were not selected to renew. Louisiana currently serves 1,682,121 Medicaid eligibles, with 91.1% enrolled in managed care plans.

Source: AIS’s Directory of Health Plans