Member: RADAR on Medicare Advantage

Increased Weights, Cut Points Likely Led to Drop in 2021 Stars

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

October 15, 2020

Although more than three-quarters of Medicare Advantage beneficiaries remain in highly rated plans, the percentage of MA Prescription Drug (MA-PD) plan enrollees estimated to be in contracts receiving 4 or more stars in 2021 fell by approximately 4 percentage points from 2020. That overall takeaway from the Oct. 8 release of the 2021 star quality ratings was somewhat surprising, given that there were no new measures for 2021 and CMS used some of the same data to ease reporting burden during the pandemic, but a deeper look at the results reveals several factors at play, industry experts tell AIS Health.

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MAOs Appeal to Seniors’ Home Needs With 2021 Benefits

October 15, 2020

Major geographic expansions, increased interest in Special Needs Plans (SNPs), and $0 telehealth visits and other benefits aimed at keeping seniors healthy at home are just a few of the 2021 Medicare Advantage trends that can be gleaned from recent press releases and CMS’s so-called landscape files. And while many plans already offered at-home benefits and other extras to address social determinants of health (SDOH), they appear to be emphasizing the usefulness of such tools as the COVID-19 pandemic wears on, especially for dual-eligible enrollees.

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Once-Sanctioned Plan Seeks Damages From Enrollment Processor

October 15, 2020

The Medicare Annual Election Period (AEP) began on Oct. 15, but at least three Medicare Advantage and Part D sponsors will be sitting it out due to CMS sanctions. One of those is Delaware Life Insurance Co. (DLIC), which had to immediately cease enrollment and marketing activities more than eight months ago after its members faced numerous difficulties upon joining the plan. Now, in a lawsuit filed in the Cook County Circuit Court of Illinois, Clear Spring Health says vendor TMG Health and its allegedly faulty technology platform are to blame for the onboarding issues.

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Walmart Dives Deeper Into Medicare Waters With Brokerage, Clover Plan

October 15, 2020

Through its longstanding Medicare Part D partnership with Humana Inc., Walmart has always had its toe in the insurance market. But two moves unveiled this month indicate the retail giant is digging deeper into the health care space: (1) the launch of its own Medicare insurance brokerage, and (2) a new co-branded Medicare Advantage offering with tech-focused insurer Clover Health, which is planning to go public (see brief, p. 8).

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News Briefs

October 15, 2020

✦ Despite care utilization patterns rising closer to normal levels in the third quarter of 2020, adjusted earnings per share (EPS) for UnitedHealth Group fell 10% year-over-year to $3.51 as the company undertook “extensive consumer and customer financial assistance measures,” the insurer reported on Oct. 14. Medical loss ratio for the quarter was 81.9%, compared with 82.4% a year ago, driven by “modestly lower care patterns and the return of the health insurance tax,” and offset by COVID-19 assistance measures that included support of state testing and contact tracing efforts. For the quarter ending Sept. 30, the UnitedHealthcare segment recorded $50.4 billion in revenue, compared with $48.1 billion in the third quarter of 2019. That increase was fueled by growth in the firm’s public-sector and senior programs, which served 935,000 additional people year to date, and was partially offset by declining commercial enrollment. As of Sept. 30, UnitedHealthcare served 5.67 million Medicare Advantage lives (up from 5.6 million in the second quarter) and 6.4 million Medicaid enrollees (compared with 6.2 million in the previous quarter). UnitedHealth raised its full-year adjusted EPS outlook to a range of $16.50 to $16.75, from an earlier range of $16.25 to $16.55. Visit www.unitedhealthgroup.com/investors.

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