AIS’s Directory of Health Plans

Datapoint: Texas Cancels Recent Medicaid Contract Awards

April 8, 2020

Following months of uproar from insurers, the state of Texas recently canceled re-procurement contracts for its STAR+PLUS Medicaid program, which provides more highly coordinated care for seniors and people with disabilities. Hit particularly hard by the disputed awards was Molina Healthcare, which saw its STAR+PLUS contracts reduced from six service areas to two. Molina currently serves 195,168 Medicaid members in Texas, holding 5.1% of the state’s market share.

Following months of uproar from insurers, the state of Texas recently canceled re-procurement contracts for its STAR+PLUS Medicaid program, which provides more highly coordinated care for seniors and people with disabilities. Hit particularly hard by the disputed awards was Molina Healthcare, which saw its STAR+PLUS contracts reduced from six service areas to two. Molina currently serves 195,168 Medicaid members in Texas, holding 5.1% of the state’s market share.

Source: AIS’s Directory of Health Plans

Datapoint: DOJ Sues Anthem, Inc. for MA Billing Practices

April 7, 2020

The U.S. Dept. of Justice recently filed a lawsuit against Anthem, Inc., alleging that from 2014 to 2018, the company knowingly submitted inaccurate billing codes to obtain higher risk adjusted payments from the Medicare Advantage program. Anthem replied in a statement to news outlets that “the government is trying to hold Anthem and other Medicare Advantage plans to payment standards that CMS does not apply to original Medicare.” As of March 2020, the insurer currently serves 1,288,321 Medicare Advantage members.

The U.S. Dept. of Justice recently filed a lawsuit against Anthem, Inc., alleging that from 2014 to 2018, the company knowingly submitted inaccurate billing codes to obtain higher risk adjusted payments from the Medicare Advantage program. Anthem replied in a statement to news outlets that “the government is trying to hold Anthem and other Medicare Advantage plans to payment standards that CMS does not apply to original Medicare.” As of March 2020, the insurer currently serves 1,288,321 Medicare Advantage members.

Source: AIS’s Directory of Health Plans

Datapoint: BCBSOK Offers In-Home Care to Fight Coronavirus Overcrowding

April 2, 2020

Blue Cross and Blue Shield of Oklahoma has partnered with DispatchHealth to offer in-network in-home health services to its members in an effort to prevent overcrowded hospitals and emergency departments amid the coronavirus pandemic. While the mobile units cannot treat the coronavirus, medical teams will be able to perform some lab tests and offer IV medications, among other common services. BCBSOK is currently the largest insurer in the state, serving 755,454 members and holding 26.5% of Oklahoma’s overall market share.

Blue Cross and Blue Shield of Oklahoma has partnered with DispatchHealth to offer in-network in-home health services to its members in an effort to prevent overcrowded hospitals and emergency departments amid the coronavirus pandemic. While the mobile units cannot treat the coronavirus, medical teams will be able to perform some lab tests and offer IV medications, among other common services. BCBSOK is currently the largest insurer in the state, serving 755,454 members and holding 26.5% of Oklahoma’s overall market share.

Source: AIS’s Directory of Health Plans

Datapoint: Aetna Waives Cost Sharing for COVID-19 Treatment

March 31, 2020

CVS Health Corp.’s Aetna last week said it would waive all cost sharing and copayments for inpatient coronavirus treatment. Previously, the insurer has waived coinsurance fees for coronavirus testing, and stopped requiring pre-authorization for hospitalizations in states that have been hit hard by the pandemic, such as New York and Washington. Aetna currently serves 21,333,020 members nationwide, with 33.6% enrolled in risk-based commercial products.

CVS Health Corp.’s Aetna last week said it would waive all cost sharing and copayments for inpatient coronavirus treatment. Previously, the insurer has waived coinsurance fees for coronavirus testing, and stopped requiring pre-authorization for hospitalizations in states that have been hit hard by the pandemic, such as New York and Washington. Aetna currently serves 21,333,020 members nationwide, with 33.6% enrolled in risk-based commercial products.

Source: AIS’s Directory of Health Plans

Datapoint: Pandemic May Cause Large Premium Surges

March 26, 2020

A new analysis from Covered California warned that the costs associated with the coronavirus pandemic could cause premium rates to rise dramatically, as much as 40% for some plans, in 2021. The state-based exchange said the outbreak could particularly hurt exchange plans, which currently cover 10,919,681 lives, as premium surges may cause many unsubsidized enrollees to drop coverage altogether.

A new analysis from Covered California warned that the costs associated with the coronavirus pandemic could cause premium rates to rise dramatically, as much as 40% for some plans, in 2021. The state-based exchange said the outbreak could particularly hurt exchange plans, which currently cover 10,919,681 lives, as premium surges may cause many unsubsidized enrollees to drop coverage altogether.

Source: AIS’s Directory of Health Plans