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Medicare Advantage Enrollment Soars Past 26 Million in Latest AEP

March 12, 2021

Approximately 2.4 million people enrolled in a Medicare Advantage plan from February 2020 to February 2021, bringing the total MA population to 26.3 million medical lives. That’s a 9.9% year-over-year increase, according to AIS Health’s analysis of data from the 2021 Medicare Annual Election Period (AEP). While the AEP was strong overall, the top 10 MA insurers continue to dominate the market, with 62.7% of all new enrollees selecting a plan from UnitedHealthcare, Humana Inc. or CVS Health Corp.’s Aetna. Meanwhile, Centene Corp.’s completed acquisition of WellCare Health Plans, Inc. allowed it to jump from No. 10 to No. 6, more than doubling its 2020 headcount. See a complete breakdown of the top 10 payers’ results below. No state saw any MA losses from 2020 to 2021, with 10 seeing increases of more than 20%, including several states with historically low penetration rates, such as Delaware, Maryland and Vermont (see map below).

by Carina Belles

Approximately 2.4 million people enrolled in a Medicare Advantage plan from February 2020 to February 2021, bringing the total MA population to 26.3 million medical lives. That’s a 9.9% year-over-year increase, according to AIS Health’s analysis of data from the 2021 Medicare Annual Election Period (AEP). While the AEP was strong overall, the top 10 MA insurers continue to dominate the market, with 62.7% of all new enrollees selecting a plan from UnitedHealthcare, Humana Inc. or CVS Health Corp.’s Aetna. Meanwhile, Centene Corp.’s completed acquisition of WellCare Health Plans, Inc. allowed it to jump from No. 10 to No. 6, more than doubling its 2020 headcount. See a complete breakdown of the top 10 payers’ results below. No state saw any MA losses from 2020 to 2021, with 10 seeing increases of more than 20%, including several states with historically low penetration rates, such as Delaware, Maryland and Vermont (see map below).

NOTES: Per AIS’s research methodology, above analysis does not include about 430,000 lives enrolled in CMS’s Financial Alignment Initiative demonstration plans for Medicare-Medicaid Dual Eligibles.
*Enrollment figures represent the sum of Kaiser’s seven regional managed care organizations.
†Enrollment data includes Centene’s acquisition of WellCare, which closed in January 2020.
‡Anthem, Inc. entered an agreement to acquire InnovaCare Health’s Medicare and Medicaid assets in February 2021. The deal is expected to close in the second quarter of 2021.

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

Seven of 10 Drugs Saw Price Hikes Without Novel Clinical Evidence, ICER Reports

March 5, 2021

Out of 10 drugs with price increases that had a significant impact on national drug spending in 2019, seven of those increases were not supported by new clinical evidence that demonstrates substantial improvement in health, according to the drug price research organization Institute for Clinical and Economic Review. The price increases of these seven drugs alone cost U.S. consumers an additional $1.2 billion a year. The group also evaluated insulin products — whose skyrocketing costs are facing increasing public scrutiny — and found that five of the top 10 insulins had wholesale acquisition cost (WAC) increases from 2018 to 2019, while net price declined for nine of these products.

by Jinghong Chen

Out of 10 drugs with price increases that had a significant impact on national drug spending in 2019, seven of those increases were not supported by new clinical evidence that demonstrates substantial improvement in health, according to the drug price research organization Institute for Clinical and Economic Review. The price increases of these seven drugs alone cost U.S. consumers an additional $1.2 billion a year. The group also evaluated insulin products — whose skyrocketing costs are facing increasing public scrutiny — and found that five of the top 10 insulins had wholesale acquisition cost (WAC) increases from 2018 to 2019, while net price declined for nine of these products.

NOTE: Eli Lilly provided net pricing information based on price per vial rather than price per unit.

SOURCE: “Unsupported Price Increase Report: 2020 Assessment.” Institute for Clinical and Economic Review, January 12, 2021. Visit https://bit.ly/2ZIYh7z.

Flex Benefits Take Off Amid Pandemic, New Analysis Shows

February 26, 2021

Medicare Advantage organizations are continuing to embrace flexible benefits, with the number of plans offering Special Supplemental Benefits for the Chronically Ill (SSBCI) exploding from 245 in 2020 to 831 in 2021, according to a Jan. 27 analysis of CMS data from Faegre Drinker. While the pandemic is just one factor driving the increase, the prevalence of certain benefits points to more seniors seeking help from home. Of the new benefits approved for 2021, virtual companion visits are offered by 62 plans. There was also a sharp uptick in the number of plans offering pre-made meals (up 228% from 2020) and food and produce delivery (up 242%). While diabetes and congestive heart failure remain the most commonly targeted conditions, mental health disorders took the No. 3 spot in 2021, with 230 MA plans offering benefits related to anxiety, depression and substance use disorder, compared to zero plans in 2020. Faegre’s researchers tell AIS Health this is likely related to the surge in demand for behavioral health services amid the pandemic.

by Carina Belles

Medicare Advantage organizations are continuing to embrace flexible benefits, with the number of plans offering Special Supplemental Benefits for the Chronically Ill (SSBCI) exploding from 245 in 2020 to 831 in 2021, according to a Jan. 27 analysis of CMS data from Faegre Drinker. While the pandemic is just one factor driving the increase, the prevalence of certain benefits points to more seniors seeking help from home. Of the new benefits approved for 2021, virtual companion visits are offered by 62 plans. There was also a sharp uptick in the number of plans offering pre-made meals (up 228% from 2020) and food and produce delivery (up 242%). While diabetes and congestive heart failure remain the most commonly targeted conditions, mental health disorders took the No. 3 spot in 2021, with 230 MA plans offering benefits related to anxiety, depression and substance use disorder, compared to zero plans in 2020. Faegre’s researchers tell AIS Health this is likely related to the surge in demand for behavioral health services amid the pandemic.

NOTES: CAD=Coronary Artery Disease; CHF=Congestive Heart Failure; COPD=Chronic Obstructive Pulmonary Disease; SUD=Substance Use Disorder.

SOURCE: An Early Look at 2021 Medicare Advantage Benefits: Part II, Faegre Drinker analysis of CMS data, Jan. 27, 2021. Visit https://bit.ly/3tQD9Kw.

Study Illustrates Demographics, Specialties That Used Telemedicine Most During Pandemic

February 19, 2021

As the COVID-19 pandemic spread in the U.S. from January to June 2020, 30.1% of all outpatient visits were delivered via telemedicine, but the growth of telemedicine use varied dramatically across patient demographics, clinical specialties and medical conditions, according to a recent study published in Health Affairs. Looking at data from 16.7 million people with commercial insurance or Medicare Advantage, researchers found that people in counties with lower poverty and higher percentages of racial and ethnic minorities tended to use telemedicine more heavily. Clinical specialties such as endocrinology, gastroenterology and neurology saw the greatest uptake of telemedicine.

by Jinghong Chen

As the COVID-19 pandemic spread in the U.S. from January to June 2020, 30.1% of all outpatient visits were delivered via telemedicine, but the growth of telemedicine use varied dramatically across patient demographics, clinical specialties and medical conditions, according to a recent study published in Health Affairs. Looking at data from 16.7 million people with commercial insurance or Medicare Advantage, researchers found that people in counties with lower poverty and higher percentages of racial and ethnic minorities tended to use telemedicine more heavily. Clinical specialties such as endocrinology, gastroenterology and neurology saw the greatest uptake of telemedicine.

SOURCE: “Variation In Telemedicine Use And Outpatient Care During The COVID-19 Pandemic In The United States,” Health Affairs 40, NO. 2 (2021): 349–358. Visit https://bit.ly/3tLiLdF.

Nearly 9 Million People Could Benefit From Broadened ACA Enrollment Period

February 12, 2021

President Joe Biden on Jan. 28 signed an executive order to reopen the federal health exchange from Feb.15 through May 15. During that special enrollment period, 4 million uninsured people will be eligible for a zero-premium bronze plan on HealthCare.gov, and another 4.9 million could get subsidies to cover part of a health plan, according to a recent analysis by the Kaiser Family Foundation. Compared to the general non-elderly population, these subsidy-eligible uninsured individuals are more likely to be young adults, high-school educated and working in industries such as construction, arts, entertainment and recreation. Approximately 8.3 million people selected or were automatically reenrolled in health plans for 2021 on HealthCare.gov as of the Dec. 15 deadline, according to CMS.

by Jinghong Chen

President Joe Biden on Jan. 28 signed an executive order to reopen the federal health exchange from Feb.15 through May 15. During that special enrollment period, 4 million uninsured people will be eligible for a zero-premium bronze plan on HealthCare.gov, and another 4.9 million could get subsidies to cover part of a health plan, according to a recent analysis by the Kaiser Family Foundation. Compared to the general non-elderly population, these subsidy-eligible uninsured individuals are more likely to be young adults, high-school educated and working in industries such as construction, arts, entertainment and recreation. Approximately 8.3 million people selected or were automatically reenrolled in health plans for 2021 on HealthCare.gov as of the Dec. 15 deadline, according to CMS.

NOTES: The uninsured marketplace-eligible population does not include people with incomes below the federal poverty level (FPL) who fall into the Medicaid coverage gap or those eligible for a Basic Health Plan in Minnesota or New York. The category of people who are ineligible for financial assistance includes people with incomes above 400% of FPL or who live in counties where the benchmark plan costs less than the applicable premium cap for their household income.

SOURCE: “Marketplace Eligibility Among the Uninsured: Implications for a Broadened Enrollment Period and ACA Outreach,” Kaiser Family Foundation. Visit https://bit.ly/2O4uVxW.