Infographic

Health Insurers Owe $2.5 Billion in MLR Rebates This Year

November 20, 2020

Insurers that participate in the individual, small-group and large-group markets will issue a record high $2.5 billion in medical loss ratio (MLR) rebates to more than 11.2 million customers this year, an increase of almost $1.1 billion from rebates issued last year, according to CMS. Because health care utilization remains depressed, many health insurers are thriving amid the coronavirus pandemic. Several insurers have waived costs for COVID-19 treatments and offered up premium credits to lower the MLR rebates they could owe over the next couple of years (HPW 10/30/20, p. 1), as MLR rebate amounts are calculated on a rolling three-year average.

by Jinghong Chen

Insurers that participate in the individual, small-group and large-group markets will issue a record high $2.5 billion in medical loss ratio (MLR) rebates to more than 11.2 million customers this year, an increase of almost $1.1 billion from rebates issued last year, according to CMS. Because health care utilization remains depressed, many health insurers are thriving amid the coronavirus pandemic. Several insurers have waived costs for COVID-19 treatments and offered up premium credits to lower the MLR rebates they could owe over the next couple of years (HPW 10/30/20, p. 1), as MLR rebate amounts are calculated on a rolling three-year average.

NOTE: Rebates for 2019 are based on MLR reports filed through Oct. 16, 2020.

SOURCES: “2020 Medical Loss Ratio Rebates,” Kaiser Family Foundation. Visit https://bit.ly/2zosGOH. CMS, visit https://go.cms.gov/38B1bky, https://go.cms.gov/36suLWz and https://go.cms.gov/3loeY1n.

Study Finds Duals, Racial Minorities Are More Likely to Choose MA Plans

November 13, 2020

From 2013 to 2019, the number of Medicare-Medicaid dual eligibles enrolled in Medicare Advantage increased by 125% to 5.4 million lives, according to a new Milliman report commissioned by the Better Medicare Alliance. Meanwhile, the number of duals enrolled in traditional, fee-for-service (FFS) Medicare decreased by 5% to 6.9 million lives. Researchers found that by 2019, 42.2% of the duals population was enrolled in MA, compared to 25.0% of the same group in 2013 (see bar chart below). Members of the duals group switched from FFS to MA 2.3 million times over the six-year time period. Milliman said this flock to MA could be partially driven by the introduction of CMS’s duals demonstration projects, which are currently active in 11 states, but Dual Eligible Special Needs Plans (D-SNPs) are also an increasingly large part of the landscape, according to AIS’s Directory of Health Plans (see market breakdowns below). In addition to its findings on duals, the study showed that nonwhite Medicare beneficiaries were also more likely to choose MA (see bottom chart), with enrollment among racial minorities increasing by 111% over the six-year period.

by Carina Belles

From 2013 to 2019, the number of Medicare-Medicaid dual eligibles enrolled in Medicare Advantage increased by 125% to 5.4 million lives, according to a new Milliman report commissioned by the Better Medicare Alliance. Meanwhile, the number of duals enrolled in traditional, fee-for-service (FFS) Medicare decreased by 5% to 6.9 million lives. Researchers found that by 2019, 42.2% of the duals population was enrolled in MA, compared to 25.0% of the same group in 2013 (see bar chart below). Members of the duals group switched from FFS to MA 2.3 million times over the six-year time period. Milliman said this flock to MA could be partially driven by the introduction of CMS’s duals demonstration projects, which are currently active in 11 states, but Dual Eligible Special Needs Plans (D-SNPs) are also an increasingly large part of the landscape, according to AIS’s Directory of Health Plans (see market breakdowns below). In addition to its findings on duals, the study showed that nonwhite Medicare beneficiaries were also more likely to choose MA (see bottom chart), with enrollment among racial minorities increasing by 111% over the six-year period.

*In its analysis, Milliman identified 9.6 million full and partial dual beneficiaries from the March 2013 Medicare population and examined their enrollment behavior through April 2019.

SOURCES: “Comparing the Demographics of Enrollees in Medicare Advantage and Fee-For-Service,” Milliman report commissioned by the Better Medicare Alliance, Oct. 2020. View the full report here: https://bit.ly/2Tzu8EO. DHP, AIS’s Directory of Health Plans. Visit https://aishealthdata.com/dhp for more information.

Average Benchmark Premium Drops 2%; More Insurers Offer Plans on Federal ACA Marketplace

November 6, 2020

The average premium for the second-lowest-cost silver plan, or benchmark plan, sold through the Affordable Care Act’s federal marketplace will be $379 per month for a 27-year-old in 2021, a 2% decrease compared to 2020, according to CMS. Four states will see their average benchmark plan premiums decrease 10% or more year over year, and only North Dakota will see its average premium increase by 10% or more. Of the 36 states using HealthCare.gov, 16 have more insurers selling ACA plans in 2021 than they had in 2020. Only Delaware has just one insurer available to exchange enrollees this year.

by Jinghong Chen

The average premium for the second-lowest-cost silver plan, or benchmark plan, sold through the Affordable Care Act’s federal marketplace will be $379 per month for a 27-year-old in 2021, a 2% decrease compared to 2020, according to CMS. Four states will see their average benchmark plan premiums decrease 10% or more year over year, and only North Dakota will see its average premium increase by 10% or more. Of the 36 states using HealthCare.gov, 16 have more insurers selling ACA plans in 2021 than they had in 2020. Only Delaware has just one insurer available to exchange enrollees this year.

NOTES: CMS reported average benchmark plan premiums only in HealthCare.gov states, which include states with federally facilitated exchange and states with a state-based exchange on the federal platform.

SOURCE: CMS. Visit https://go.cms.gov/35Dfe5U.

Average PDP Star Rating Gets Minuscule Bump

October 30, 2020

Approximately 98% of Medicare beneficiaries who sign up for a stand-alone Prescription Drug Plan (PDP) in 2021 will be in contracts rated 3.5 stars or higher, compared to 70% in the 2020 plan year, CMS estimated recently based on current enrollment figures. The average star rating for stand-alone PDPs rose just slightly to 3.58 in 2021 from 3.5 in 2020. However, only five PDP contracts received a 5-star rating, covering 0.13% of the PDP enrollees. One of the top five PDP sponsors, Centene Corp.-owned WellCare Health Plans, had 59% of its members enrolled in a 4-star contract. CVS Health Corp.’s SilverScript Insurance Company, the largest PDP sponsor, had all of its enrollees in a plan with 3.5 stars.

by Jinghong Chen

Approximately 98% of Medicare beneficiaries who sign up for a stand-alone Prescription Drug Plan (PDP) in 2021 will be in contracts rated 3.5 stars or higher, compared to 70% in the 2020 plan year, CMS estimated recently based on current enrollment figures. The average star rating for stand-alone PDPs rose just slightly to 3.58 in 2021 from 3.5 in 2020. However, only five PDP contracts received a 5-star rating, covering 0.13% of the PDP enrollees. One of the top five PDP sponsors, Centene Corp.-owned WellCare Health Plans, had 59% of its members enrolled in a 4-star contract. CVS Health Corp.’s SilverScript Insurance Company, the largest PDP sponsor, had all of its enrollees in a plan with 3.5 stars.

Average PDP Star Rating Gets Minuscule Bump
NOTE: Map shows only non-employer-group health plan counties.

SOURCES: CMS. Visit https://go.cms.gov/35eLdsU. AIS’s Directory of Health Plans, as of September 2020.

United, Anthem Take a Hit in 2021 Star Ratings; Other Top Payers Hold Steady

October 23, 2020

Medicare Advantage Prescription Drug (MA-PD) plans saw somewhat of a reversal of fortune in their 2021 star ratings, according to CMS’s Oct. 8 data release. The agency reported that 77% of MA-PD members are enrolled in a plan rated at least 4 stars overall, compared to 81% in the 2020 plan year. Stand-alone Prescription Drug Plans (PDPs) saw a similar decline, with 17% of members enrolled in a PDP rated 4 stars or above, down from 28% this year. Among the top five MA-PD payers, UnitedHealthcare and Anthem, Inc. lost the most ground in the ratings. United’s share of members enrolled in plans rated 4 stars or above shrank from 84% to 74%, while Anthem’s dropped from 58% to 51%. Humana Inc. and CVS Health Corp.’s Aetna fared better, holding steady to 2020’s numbers at 92% and 83%, respectively, though Aetna did lose its only 5-star contract. Kaiser Permanente, meanwhile, repeated its stellar 2020 performance, with 94% of its MA-PD members enrolled in a 5-star contract.

by Carina Belles

Medicare Advantage Prescription Drug (MA-PD) plans saw somewhat of a reversal of fortune in their 2021 star ratings, according to CMS’s Oct. 8 data release. The agency reported that 77% of MA-PD members are enrolled in a plan rated at least 4 stars overall, compared to 81% in the 2020 plan year. Stand-alone Prescription Drug Plans (PDPs) saw a similar decline, with 17% of members enrolled in a PDP rated 4 stars or above, down from 28% this year. Among the top five MA-PD payers, UnitedHealthcare and Anthem, Inc. lost the most ground in the ratings. United’s share of members enrolled in plans rated 4 stars or above shrank from 84% to 74%, while Anthem’s dropped from 58% to 51%. Humana Inc. and CVS Health Corp.’s Aetna fared better, holding steady to 2020’s numbers at 92% and 83%, respectively, though Aetna did lose its only 5-star contract. Kaiser Permanente, meanwhile, repeated its stellar 2020 performance, with 94% of its MA-PD members enrolled in a 5-star contract. See the full ratings distribution for all contracts below, plus the ratings and enrollment distribution for the top five payers.

*Enrollment figures represent the sum of Kaiser’s seven regional managed care organizations.

NOTE: Analysis does not include enrollment data from contracts that were too new to be rated, or did not have enough data available to measure a star rating.

SOURCE: CMS; DHP, AIS’s Directory of Health Plans