Member: RADAR on Medicare Advantage

CMS Eases Up on MA Data Collection, But Unknowns Remain

April 2, 2020

As efforts to contain the outbreak of COVID-19 continue to evolve, the Trump administration on March 30 issued a series of new flexibilities aimed at increasing hospital and provider capacity. At the same time, CMS provided some respite to Medicare Advantage and Part D plans dealing with the crisis by suspending audit and quality reporting activities so that plans and states can focus on providing care to the increasing number of beneficiaries affected by the new coronavirus. While those changes will enable CMS to issue star quality ratings for 2021, the potential impact of COVID-19 on payment rates for next year remained unclear.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

MAOs Hope for More Clarity on Quota Share Reinsurance

April 2, 2020

Under Medicare law, Medicare Advantage organizations must assume full financial risk on a prospective basis for the provision of basic benefits provided to enrollees. But certain exceptions exist that allow MAOs to purchase reinsurance, such as excess of loss reinsurance limiting the primary carrier’s liability in excess of a specified dollar “attachment point.” As MAOs seek permissible reinsurance arrangements to manage new risk associated with the coronavirus (see story, above), plans and their actuaries are hopeful that CMS will provide much-needed clarity around the use of quota share reinsurance in a soon-to-be finalized rule, one industry expert tells AIS Health.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

Success of PPOs, OTC Coverage May Drive 2021 MA Offerings

With Chart: Enrollment in Individual MA PPOs Outpaced Growth of HMOs in 2020 AEP

April 2, 2020

Although individual HMO plans continued to capture the bulk of enrollment in Medicare Advantage plans during the 2020 Annual Election Period (AEP), overall gains by individual PPO plans were not far behind those of the historically popular HMOs, according to a recent analysis from Pareto Intelligence, a Convey Health Solutions company. Based on CMS’s February data release (which reflects enrollments accepted through Jan. 1 and is regarded as demonstrating the final AEP figures), Pareto estimates that enrollment in individual PPOs climbed 10.25% during the AEP to more than 4.8 million enrollees, outpacing individual HMO growth of 5.43% to nearly 11.3 million members.

These and other granular insights from the AEP can help MA plan sponsors quickly turn around lessons learned from 2020 and incorporate them into benefit designs before bids are due for the 2021 plan year, suggests Jason Montrie, president of Pareto Intelligence. In an interview with AIS Health, Montrie reflects on some of Pareto’s key observations.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

GAO to CMS: Get More Data on Default Enrollment of Duals

April 2, 2020

As states consider new standards for Dual Eligible Special Needs Plans (D-SNPs) that will satisfy statutory requirements beginning in calendar year 2021, the enrollment of dual- eligible beneficiaries in Medicare and Medicaid plans that are offered by the same entity has been discussed as a way to promote better coordination of care. A new Government Accountability Office (GAO) report highlights the various approaches some states have taken to encourage the concept of aligned enrollment and recommends that CMS gather more information on one method in particular — the auto- assignment, or default enrollment, of newly eligible duals into an aligned D-SNP.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

Medicare Advantage Penetration Reaches 36% in 2020

April 2, 2020

by Carina Belles Medicare Advantage penetration continued to grow following the 2020 Medicare Annual Election Period, reaching 36.0% in 2020, according to CMS’s March data release. Thirteen states and territories have MA penetration rates of greater than 40%, with the Commonwealth of Puerto Rico leading the pack at a whopping 69.1% penetration. Just two states, […]

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.