AIS’s Directory of Health Plans

Nearly 4.6 million have enrolled in Affordable Care Act exchange plans for 2024 since open enrollment began on Nov. 1, including 919,900 people who did not have exchange plans this year. The data captures sign-ups through Nov. 18 for people in the 32 states that use HealthCare.gov for enrollment and through Nov. 11 for people in the 17 states and Washington, D.C., that have state-based marketplaces. CMS Administrator Chiquita Brooks-LaSure said in a press release that “we have seen an increase in plan selections and a significant increase in the number of new enrollees year over year.” The three largest exchange insurers in the U.S. are Centene Corp. (3,258,194 members), Florida Blue (1,226,000 members) and Aetna (940,720 members), as of the latest update to AIS’s Directory of Health Plans.

Republicans in the Georgia House of Representatives are mulling the possibility of expanding Medicaid in the state, according to a Nov. 17 report in the Atlanta Journal-Constitution. Legislators held hearings earlier this month, listening to testimony about how Arkansas’ Medicaid expansion program cut its uninsured rate, as well as North Carolina’s upcoming expansion. About 2.91 million people currently receive Medicaid benefits in Georgia, and expansion could make an additional 450,000 people newly eligible for coverage.

Milwaukee-based integrated health system Froedtert Health on Nov. 1 finalized a plan to purchase Ascension Wisconsin’s interest in Network Health and fully acquire the commercial and Medicare Advantage insurer. Each organization previously held a 50% ownership interest in the insurer, which serves 23 Wisconsin counties and enrolls 116,756 members, according to AIS’s Directory of Health Plans. About 36% of its members are enrolled in commercial risk-based products, while 62% are enrolled in MA. Earning its third consecutive overall 5-star rating for 2024, Network Health was recently listed as one of 31 MA Prescription Drug contracts to earn 5 stars from CMS.

A KFF report released on Nov. 8 found that 3,959 Medicare Advantage plans are available for individual enrollment next year, the second-largest number of plans since 2010 and a 1% decrease from this year.  Meanwhile, the average beneficiary will be able to choose from 43 plans, the same as this year's record high. Eighty-nine percent of MA plans will offer prescription drug coverage in 2024; while 83% will offer telehealth benefits; and at least 97% will offer some dental, vision, fitness or hearing benefits. The three largest MA insurers by enrollment are UnitedHealthcare (9.21 million members), Humana Inc. (5.83 million members) and CVS Health’s Aetna (3.38 million members).

Blue Cross Blue Shield of Massachusetts on Nov. 6 announced it would remove prior authorization requirements for home care service for commercial beneficiaries starting on Jan. 1, 2024. The insurer noted the change would eliminate 14,000 authorizations for home care services, including physical and occupational therapy and visits from home health aides, nurses and social workers. BCBS of Massachusetts also recently removed prior authorization requirements for continuous glucose monitoring devices and type 1 diabetes. The Blues affiliate is the largest insurer in its home state, with 2,271,151 members. About 850,000 of its members are enrolled in commercial risk-based products, with 1.34 million enrolled in self-funded plans.

Cigna Healthcare may soon offload its Medicare Advantage business, according to a Nov. 6 report in Reuters. Despite annual MA service area expansions, the insurer is rumored to be exploring a sale, though it did not respond to Reuters’ request for comment. Cigna currently ranks No. 8 in national MA enrollment, serving 591,975 members. Its largest MA markets are Texas, Tennessee, Arizona and Florida.

The Georgia Pathways to Coverage program, which expands Medicaid eligibility but requires beneficiaries to meet a work requirement, has enrolled just 1,343 people three months after its launch, according to The Atlanta Journal-Constitution. The state’s Dept. of Community Health projected that the program could eventually enroll up to 100,000 people, but the administrative burden of proving that would-be Medicaid recipients are either working, volunteering, enrolled in school, or otherwise complying with the Pathways to Coverage requirements appear to be discouraging signups, the article noted. Georgia currently enrolls about 77% of its 2.91 million Medicaid members in managed care plans, offered by Centene Corp., Elevance Health and CareSource.

CVS Health Corp.’s Aetna on Oct. 30 unveiled expansion plans for its Affordable Care Act exchange products. For the 2024 plan year, the insurer will expand its offerings to Indiana, Kansas, Maryland, Ohio and Utah. Plan offerings include $0 preventive care and telehealth, as well as no-cost MinuteClinic visits at CVS locations. Aetna is currently the third-largest exchange insurer nationally, serving 940,720 members in 12 states.

Centene Corp.’s WellCare and Mutual of Omaha are partnering to offer co-branded Medicare Advantage products for the 2024 plan year. The plans offer zero and low premium options, and will be available throughout Georgia, Missouri, South Carolina and Washington, as well as the Dallas/Fort Worth and Houston metro areas in Texas. With 1,293,609 members, Centene is one of the largest MA insurers in the U.S., Mutual of Omaha has historically offered Medicare supplement products.

UnitedHealthcare will offer ACA exchange plans in four new states next year. With the addition of New Jersey, New Mexico, South Carolina and Wisconsin, the insurer said on Oct. 24, its total ACA marketplace footprint will comprise 26 states. UnitedHealthcare said its ACA exchange plans include features such as $0 virtual urgent care, prescriptions as low as $5 at over 40,000 in-network pharmacies, membership to a network of 17,000 gym locations, and an “opportunity to earn a $100 gift card in rewards benefits for completing health- and account-related tasks.” The insurer will also offer new plan options dubbed Copay Focus, which feature a $0 medical deductible and “a predictable copay for services.” United is currently the ninth-largest exchange insurer in the U.S., serving 572,148 members.