AIS’s Directory of Health Plans

Gold Kidney Health Plan last week said it is undertaking a significant expansion of its Medicare Advantage offerings in Florida and Arizona for 2025. The company will increase its presence from 9 to 22 counties in Florida and from 4 to 8 markets in Arizona, aiming to provide more Medicare-eligible residents with access to high-quality, affordable health coverage. This expansion includes services for individuals with chronic conditions such as end-stage renal disease, diabetes and heart failure. The insurer currently serves 1,067 members in its specialized MA products.

Priority Health this week unveiled a partnership with Carrot Fertility to provide comprehensive reproductive health support to its Michigan members. This collaboration will offer two tailored solutions, Carrot Core and Carrot Pro, addressing a wide range of needs from fertility treatments to menopause and hormonal health. The initiative aims to deliver personalized care and expert guidance, enhancing access to reproductive health services and supporting various family-planning journeys. The new offerings will be available to both fully funded and self-funded employer groups starting January 1, 2025. Priority Health currently serves 418,909 risk-based employer group members and 90,339 self-funded members.

Cigna Healthcare has plans to reduce its Medicare Advantage offerings in eight states starting in 2025, impacting approximately 5,400 members, primarily in Florida. The insurer will cut 36 plans and exit at least three counties entirely, citing the need to maintain profitability amid rising healthcare costs and regulatory changes, according to an announcement posted on Pinnacle Financial Services’ website. Despite these reductions, most affected members will still have access to other Cigna MA plans in their areas. Cigna is in the process of selling its MA business to Blues giant Health Care Service Corp. Cigna currently serves 577,930 MA and dual eligible members nationwide.

Highmark Blue Shield is poised to expand its Medicare Advantage footprint in Pennsylvania with the launch of plans in the greater Philadelphia area, reports the Philadelphia Business Journal. Highmark Health, the Pittsburgh-based not-for-profit parent company of Highmark Blue Shield and other Blue Cross Blue Shield plans, on Aug. 29 reported an 8% year-over-year increase in revenue that it largely attributed to the Highmark Health Plans business. For the first half of 2024, that segment posted operating revenue of $11.1 billion and an operating gain of $304 million, “driven by steady membership in both government and commercial business,” the insurer said. Highmark is the second-largest MA insurer in Pennsylvania, behind CVS Health Corp.’s Aetna, with 283,134 members.

Cigna Healthcare is launching a new “E-Treatment” option through MDLIVE by Evernorth, making virtual care more accessible and convenient for customers who have coverage through the individual marketplace or via their employer. The service allows users to receive diagnoses and treatment plans for common, lower-risk conditions such as allergies, infections, and respiratory illnesses without direct interaction via phone or video.

Elevance Health, Inc. has agreed to acquire Indiana University Health Plans, according to a Sept. 10 press release. IU Health Plans, a subsidiary of Indiana University Health, has 19,245 Medicare Advantage members and 10,868 fully insured commercial beneficiaries. It will become a part of Anthem Blue Cross and Blue Shield in Indiana, which is Elevance’s insurance affiliate in the state. The deal is subject to customary closing conditions and is expected to close by the end of the year.

Iowa on Sept. 4 awarded Centene’s subsidiary, Iowa Total Care, a new Medicaid managed care contract, extending its participation in the state’s Medicaid program for another six years. This contract, part of the Iowa Health Link program, ensures that Centene’s Iowa Total Care will continue to provide coordinated physical, behavioral, and long-term care services to its 224,492 members across the state.

Humana Inc. announced on Aug. 29 a value-based kidney care program with Evergreen Nephrology, which has nephrology practice partnerships in 17 states. Eligible Humana Medicare Advantage members with chronic or end-stage kidney disease will gain access to Evergreen professionals, who will collaborate with the members’ existing nephrologists. Todd DeYoung, associate vice president of Humana’s specialty and value-based partnerships, said in a press release that the program will “help improve both [members’] quality of care and quality of life.” Humana currently enrolls 1,132,350 MA and dual eligible members.

Elevance Health, Inc. will offer Affordable Care Act exchange plans in three new states next year. The insurer’s Wellpoint-branded plans will expand into Florida, Maryland and Texas — all states where it has a managed Medicaid presence. According to AIS’s Directory of Health Plans, Elevance Health has 1,074,000 members enrolled in ACA exchange plans, making it the insurer’s smallest market segment. As of 2024, the insurer offered exchange plans in 10 states, with California, Virginia and New York representing its three largest markets.

A federal judge has ruled that Tennessee wrongly removed thousands of individuals from its Medicaid program, TennCare, without proper notice or the opportunity for a fair hearing, according to an Aug. 27 report in Reuters. The initial lawsuit, brought in 2019, highlighted that the state failed to comply with federal redeterminations requirements, leading to many low-income residents losing their health care coverage while still eligible for Medicaid. The case now includes disenrollments from both before and after the COVID-19 pandemic. The ruling mandates that Tennessee must reinstate coverage for those affected and ensure compliance with federal Medicaid regulations moving forward. TennCare currently serves 484,544 beneficiaries via plans offered by BlueCross BlueShield of Tennessee, UnitedHealthcare and Elevance Health.