Health Plan Weekly

Here’s how major health insurers’ stock performed in January 2022. UnitedHealth Group had the highest closing stock price among major commercial insurers as of Jan. 31, 2022, at $472.57. Humana Inc. had the highest closing stock price among major Medicare insurers at $392.50.

Rhode Island Attorney General Peter Neronha, a Democrat, subpoenaed UnitedHealthcare over a recent data breach that saw the personal data of 22,000 plan beneficiaries get hacked by an unknown third party. The exposed beneficiaries were members of the health plan of the Rhode Island Public Transport Authority, which discovered the breach, Modern Healthcare reported.

The number of telehealth visits has declined as the pandemic has receded, according to analysis of Epic Systems Corp. data by the Kaiser Family Foundation. The research indicates telehealth visits accounted for 13% of outpatient visits between March and August 2020, but declined to 11% of outpatient visits between September 2020 and February 2021 and 8% of such visits from March to August.

In their public comments about a proposed rule that would bring back standardized plans to the Affordable Care Act exchanges, two health insurer trade groups make it clear that they believe such a move will “stifle innovation” in plan design. However, state-based marketplaces that already require plan standardization appear to have found a way to make that policy work for consumers and insurers alike, sources tell AIS Health.

“I’m not aware of anything to suggest that innovation — however one might define that — has been hampered to the detriment of consumers in the states where we see this policy in place,” says Justin Giovannelli, an associate research professor at Georgetown University’s Center on Health Insurance Reforms. Giovannelli co-authored a July 2021 piece for The Commonwealth Fund examining various states’ ACA plan standardization requirements.

Due to a Jan. 27 federal court order, CVS Health Corp.’s Aetna health insurance division could be the defendant in a class-action lawsuit regarding Aetna’s restrictive coverage decisions in breast and prostate cancer treatment. In a lawsuit filed in Florida district court, a federal judge found that Aetna improperly denied coverage of proton therapy to cancer patients who ultimately had to pay for the treatment out of pocket.

Proton beam radiation therapy (PBRT) is a type of cancer treatment “that uses high-powered energy to treat cancer and some noncancerous tumors,” according to the Mayo Clinic, which also notes that “studies have compared proton radiation and X-ray radiation, so it’s not clear whether proton therapy is more effective at prolonging lives.” The therapy isn’t widely available, although new proton therapy centers are being built in the U.S. and in other countries.

Despite Humana Inc.’s recently downgraded Medicare Advantage (MA) enrollment projections for 2022, Wall Street analysts praised the company’s high margins after the insurer reported fourth-quarter and full-year 2021 earnings on Feb. 2.

Humana posted earnings per share (EPS) of $1.24 for the quarter and $20.64 for the full year — both slightly above the company’s expectations — and reaffirmed its previously lowered projection of MA enrollment growth of 150,000 to 200,000 individuals in 2022.

Although Cigna Corp. ended 2021 with earnings that exceeded Wall Street expectations, the company also reported continued struggles with elevated medical costs last year. Further, the insurer disclosed that it expects less Medicare Advantage growth than it originally anticipated in 2022 and a decline in individual/family plan enrollment.

For the fourth quarter of 2021, Cigna reported adjusted earnings per share (EPS) of $4.77, beating the consensus estimate of $4.50. Cigna’s full-year adjusted EPS was $20.47, reflecting year-over-year growth of 11% that the company said was largely driven by the Evernorth health services segment.

A record 14.5 million people enrolled in Affordable Care Act marketplace coverage from Nov. 1, 2021, through Jan. 15, 2022, including 10.3 million people who live in states using HealthCare.gov and 4.2 million in states with their own marketplace, according to CMS. Three states — Kentucky, Maine and New Mexico — transitioned to their own state-based exchanges for the 2022 plan year. Among the 33 states using HealthCare.gov, all but Hawaii saw an enrollment increase for 2022 compared with 2021, with eight experiencing signup surges of more than 30%.

CMS on Feb. 2 released the 2023 preliminary rate notice for Medicare Advantage plans, giving plans an average pay boost of about 8%. To arrive at an expected average change in revenue of 7.98% for 2023, CMS factored in an effective growth rate of 4.75%, which is based largely on an anticipated rise in fee-for-service Medicare costs, according to a CMS fact sheet on the subject.

Medicare Part B beneficiaries will be able to acquire over-the-counter COVID-19 tests free of charge at participating pharmacies and retailers “starting in early spring,” according to CMS. Per a CMS fact sheet, beneficiaries will not need to apply for reimbursement to get the tests: “Eligible pharmacies and other entities that are participating in this initiative to allow Medicare beneficiaries to pick up tests at no cost at the point of sale and without needing to be reimbursed.” AHIP CEO Matt Eyles applauded the move. “This is a commendable model and the right path — for Medicare-eligible people and for all Americans — to ensure equitable access, swift treatment, and an effective response to the virus,” he said in a statement.

A new biannual report to Congress from HHS and the departments of Labor (DoL) and Treasury has found that carriers and plan sponsors are generally not in compliance with recent regulations requiring health plans to document the level of access plan members have to mental health care. Experts say that carriers are largely to blame, but plan sponsors also need to make a greater effort to hold insurers accountable and meet new federal reporting requirements.

Several federal laws mandate mental health care parity: Health plans are not allowed to impose benefit limitations on mental health care that are more severe than limits placed on medical and surgical benefits.

Since taking office, the Biden administration has taken a hard line on Section 1115 Medicaid waivers, rescinding multiple demonstrations that were approved by the Trump administration and subsequently becoming ensnared in legal fights with Republican-leaning states. Such disputes may wind up being detrimental to Medicaid managed care organizations, which in some cases spent considerable resources on implementing waiver demonstration programs that may never come to fruition.

The latest legal conflict is in Georgia, where the state is trying to preserve an 1115 waiver that the Trump administration approved. Georgia’s waiver would have imposed premiums and work requirements on Medicaid beneficiaries, with the added twist of expanding Medicaid eligibility just for the population earning up to 100% of the federal poverty level — rather than 138% like with regular Medicaid expansion — and therefore receiving a smaller federal funding match.