Infographic

HealthCare.gov Sign-Ups Fell 3.8%

February 8, 2019

Approximately 8.4 million people selected or were automatically re-enrolled in health plans for 2019 through HealthCare.gov by the Dec. 15 deadline, a decline of 3.8% year over year, according to the Centers for Medicare & Medicaid Services. Of the 39 states using HealthCare.gov, only six states saw an enrollment increase.

by Jinghong Chen

Approximately 8.4 million people selected or were automatically re-enrolled in health plans for 2019 through HealthCare.gov by the Dec. 15 deadline, a decline of 3.8% year over year, according to the Centers for Medicare & Medicaid Services. Of the 39 states using HealthCare.gov, only six states saw an enrollment increase. According to a new Kaiser Family Foundation report, “The Uninsured and the ACA: A Primer,” the uninsured rate among the nonelderly population declined to a historic low of 10.0% in 2016. Eighteen states had more than 10% of their nonelderly population uninsured in 2017, while 13 of them have not expanded their Medicaid program.

NOTE: States with no data are those that operate their own ACA exchanges rather than using HealthCare.gov.

SOURCES: Centers for Medicare & Medicaid Services. Kaiser Family Foundation analysis of 2008-2017 American Community Survey, 1-Year Estimates.

Medicare Advantage Membership Grew 4.8% Nationwide From 2017 to 2018

February 1, 2019

While insurers are offering more affordable health plans to stand out in the competitive Medicare Advantage market, the number of people enrolled in MA plans increased by 4.8% nationwide from December 2017 to December 2018. The top three MA plans — UnitedHealthcare, Humana Inc. and Aetna Inc. — all saw membership growth in 2018.

by Jinghong Chen

While insurers are offering more affordable health plans to stand out in the competitive Medicare Advantage market, the number of people enrolled in MA plans increased by 4.8% nationwide from December 2017 to December 2018. The top three MA plans — UnitedHealthcare, Humana Inc. and Aetna Inc. — all saw membership growth in 2018. UnitedHealthcare, the largest MA plan, gained more than 20,000 lives in 10 states year over year. It currently is the top MA plan in 26 states. From 2017 to 2018, Aetna Inc. (now owned by CVS Health Corp.) increased its MA membership by 19.0%, and the trend will likely continue into 2019, as the insurer takes on its largest-ever MA expansion.

SOURCE: AIS’s Medicare and Medicaid Market Data, as of December 2017 and December 2018.

California Medicaid Could Shift to Fee-for-Service Drug Benefit

January 25, 2019

by Carina Belles

California’s new governor, Gavin Newsom (D), on Jan. 7 signed an executive order directing the Dept. of Health Care Services to transform the state’s Medicaid pharmacy benefit to an entirely fee-for-service system by January 2021. Medi-Cal, California’s Medicaid program, is served by more than 20 managed care organizations. MCOs are currently able to contract with a pharmacy benefits manager (see a full breakdown of the state’s Medicaid PBM relationships below),

by Carina Belles

California’s new governor, Gavin Newsom (D), on Jan. 7 signed an executive order directing the Dept. of Health Care Services to transform the state’s Medicaid pharmacy benefit to an entirely fee-for-service system by January 2021. Medi-Cal, California’s Medicaid program, is served by more than 20 managed care organizations. MCOs are currently able to contract with a pharmacy benefits manager (see a full breakdown of the state’s Medicaid PBM relationships below), but the new plan would allow the state to directly negotiate drug prices, purchase drugs in bulk and develop transparency on drug cost reimbursement.

With nearly 90% of the state’s 12.1 million Medicaid beneficiaries enrolled in managed care, a shift to fee-for-service would entirely upend existing PBM relationships in Medi-Cal, the largest managed Medicaid program in the U.S. “We suspect that the fee-for-service aspect may have an adverse impact on PBMs and potentially MCOs that provide managed Medicaid services in the state,” wrote securities analyst George Hill, in a Jan 8. research note from RBC Capital Markets, LLC. “Given the size of California, its actions draw significant investor attention.”

SOURCE: AIS’s Directory of Health Plans (DHP). Visit https://aishealthdata.com/dhp for more information.

Medicaid HMO Market Sees Potential Expansion in 2019

January 18, 2019

The number of people enrolled in Medicaid HMO plans decreased by 1.6% nationwide from December 2017 to December 2018. Of the 22 states that saw a decrease in Medicaid HMO membership, Indiana experienced the biggest drop, with 17.2% lower enrollment year over year. Looking ahead, voters in Idaho, Utah and Nebraska passed ballot initiatives in the 2018 midterm elections to expand Medicaid to residents living at less than 133% of the federal poverty level.

by Jinghong Chen & Carina Belles

The number of people enrolled in Medicaid HMO plans decreased by 1.6% nationwide from December 2017 to December 2018. Of the 22 states that saw a decrease in Medicaid HMO membership, Indiana experienced the biggest drop, with 17.2% lower enrollment year over year. Looking ahead, voters in Idaho, Utah and Nebraska passed ballot initiatives in the 2018 midterm elections to expand Medicaid to residents living at less than 133% of the federal poverty level. This move could bring coverage to more than 300,000 people in the three new states combined. Meanwhile, newly elected Maine Gov. Janet Mills (D) signed an executive order to begin implementation of the expansion that had been passed in 2017 but was delayed by the outgoing governor. See below for Medicaid HMO enrollment changes in 2018 and an overview of several key states whose November 2018 midterm results might result in major changes to their Medicaid programs in 2019.

SOURCES: AIS’s Medicare and Medicaid Market Data, as of December 2017 and December 2018. 2018 Midterm Election results as of Nov. 8, 2018; 2017 Maine referendum results as of Dec. 20, 2017. Expansion eligibility figures sourced from ballot initiative materials, local and national news reports and state Medicaid documents where available.

Aetna Takes On Largest-Ever Medicare Advantage Expansion for 2019

January 11, 2019

From 2017 to 2018, Aetna Inc. increased its Medicare Advantage membership by 18.9%, to 1.76 million lives. This trend will likely continue into 2019, as the insurer undertakes its largest-ever expansion into the market, adding 358 new counties. Aetna is currently ranked No. 3 in national MA market share, behind UnitedHealthcare and Humana Inc.

by Carina Belles

From 2017 to 2018, Aetna Inc. increased its Medicare Advantage membership by 18.9%, to 1.76 million lives. This trend will likely continue into 2019, as the insurer undertakes its largest-ever expansion into the market, adding 358 new counties. Aetna is currently ranked No. 3 in national MA market share, behind UnitedHealthcare and Humana Inc.

NOTE: Aetna did not experience membership gains between 15,000 and 20,000 lives in any state from 2017 to 2018.

SOURCE: DHP, AIS’s Directory of Health Plans