Member: RADAR on Medicare Advantage

2020 Outlook: MA ‘Winners’ Must Focus on Differentiation, Integration

With Chart: MA, Cost, PACE, Demo and Prescription Drug Plan Contract Enrollment Report (December 2019)

January 3, 2020

With early signs of strong enrollment growth in 2020 and a healthy pay outlook in 2021 given the elimination of the Affordable Care Act health insurer fee and an anticipated rate increase, the sun continues to shine on Medicare Advantage. Even as momentum around Medicare for All and other universal health care proposals continues to build, industry experts say MA remains the safest game in town and will likely serve as a road map for any such health care reform. At the same time, insurers will continue to face program hurdles such as evolving audit practices, and they may want to consider strategic investments to boost their integrated care capabilities and remain competitive.

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2020 Outlook: SNPs Look to States, CMS for Direction on Duals Integration

January 3, 2020

For Medicare Advantage Special Needs Plans (SNPs) and other insurers serving individuals who are eligible for both Medicare and Medicaid, 2020 “will be the year of building momentum for integration of dual eligibles,” declares Cheryl Phillips, M.D., president and CEO of the SNP Alliance.

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CMS Releases Long-Awaited RFA on MA Hospice Model

January 3, 2020

Medicare Advantage organizations interested in testing the inclusion of a hospice benefit through their plans in 2021 will be tasked with ensuring timely and appropriate access to high-quality hospice care while also making sure that eligible beneficiaries receive palliative care. CMS unveiled the opportunity in January 2019, and in a request for applications (RFA) posted Dec. 19, it provided long-awaited details for how it expects MAOs and hospice providers to create a seamless care continuum for MA beneficiaries who elect hospice — a plan that one leading hospice organization found lacking.

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Kentucky Preps Medicaid Rebid, Giving Anthem, Passport Another Shot at Retaining Business

January 3, 2020

The five insurers that were selected for new statewide contracts with Kentucky’s managed Medicaid program will have to rebid now that the state’s new Democratic governor, Andy Beshear, has nullified the awards made under Republican predecessor Matt Bevin.

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Centene-WellCare Deal Is on Track for Approval; Combined Company Would Hold Nearly 20% of Medicaid Market

January 3, 2020

by Carina Belles Centene Corp.’s planned acquisition of WellCare Health Plans, Inc., a $17 billion move that would create a managed Medicaid behemoth and a serious contender in the Medicare Advantage ring, is close to being a done deal. In December, the insurers received regulatory approval from the final states needed to move forward, bringing […]

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