Annual Election Period/AEP

2023 Stars Signal Return to Normal, With Some Caveats

A little over half of Medicare Advantage Prescription Drug (MA-PD) contracts that will be offered in 2023 received an overall rating of 4 stars or higher, according to Medicare Parts C and D Star Ratings data released by CMS on Oct. 6. As expected, the new ratings reflect a return to normal after adjustments made for the COVID-19 public health emergency (PHE) resulted in a staggering 70% of MA-PD plans earning 4 stars or higher for 2022, compared with 49% of plans in 2021. But as the market becomes more saturated across the country, industry experts are watching closely to see whether recent steps taken by CMS to penalize poor performers will really level-set the market or demonstrate that more changes are needed to ensure members enroll in high-quality plans.

0 Comments
© 2024 MMIT

As Expected, Top MA-PD Payers See Star Ratings Declines

The average star rating for Medicare Advantage Prescription Drug (MA-PD) plans declined following the phaseout of pandemic-related flexibilities, according to CMS. While 72% of MA-PD beneficiaries are enrolled in a contract that is rated at least 4 stars for 2023, that’s down from an all-time high of 90% in 2022. These drops were anticipated however, as CMS in 2022’s ratings qualified all contracts under an “extreme and uncontrollable circumstances” policy to account for the COVID-19 public health emergency (PHE), which allowed payers to pick “best of” scores on many measures. Also, for 2023, the agency assigned a greater weight to member experience measures based largely on contracts’ Consumer Assessment of Healthcare Providers and Systems, after CMS suspended the collection of CAHPS survey data during the PHE.

0 Comments
© 2024 MMIT

As E-Brokers Struggle, Elevance Extends Lifeline to GoHealth

Elevance Health, Inc. last month invested $35 million in GoHealth, an e-broker for Medicare Advantage plans that has struggled this year and seen its stock market value plummet. Michael Abrams, managing partner of Numerof & Associates, tells AIS Health that the investment was “equivalent to a life-saver” for GoHealth.

GoHealth received a total of $50 million, with the other $15 million coming from a company referred to as GH 22 Holdings, Inc. in an SEC filing. A GoHealth spokesperson writes in an email to AIS Health, a division of MMIT, that GH 22 is “a significant partner” of GoHealth.

0 Comments
© 2024 MMIT

2023 MA Landscape Features Geographic Expansions, Duals Offerings and Part B Givebacks

Medicare beneficiaries in nearly every state will have more Medicare Advantage plans to choose from and see lower premiums this fall when shopping for coverage, according to CMS’s recently released landscape files for the 2023 plan year. And both major insurers and regional plans at press time were touting new offerings such as Part B buyback plans, flexible spending features that include allowances for utilities, and enhanced dental coverage.

“What we’re seeing is kind of a continuation of what we’ve seen in the past several years, which is expanding of not only the big five but also of the smaller insurers as well, and then increased focus on supplemental benefits and the Special Supplemental Benefits for the Chronically Ill (SSBCI), and continued expansion into the D-SNP [Dual-Eligible Special Needs Plan] market,” observes Betsy Seals, co-founder and CEO of Rebellis Group, LLC.

0 Comments
© 2024 MMIT

New Third-Party Marketing Oversight Duties Have Industry Scrambling Before AEP

After observing a high volume of marketing-related complaints that the federal government believes are driven by the actions of third-party marketing organizations (TPMOs), CMS this month is implementing several new requirements aimed at protecting Medicare beneficiaries as they compare coverage options during the 2023 Annual Election Period (AEP) that starts on Oct. 15. And while one trade group is concerned that the changes may leave some independent agents and brokers out of the AEP, two marketing experts say they don’t anticipate a major shakeup and are hopeful that the changes will only weed out the bad actors.

0 Comments
© 2024 MMIT

2023 MA Landscape Features Geographic Expansions, Duals Offerings and Part B Givebacks

Medicare beneficiaries in nearly every state will have more Medicare Advantage plans to choose from and see lower premiums this fall when shopping for coverage, according to CMS’s recently released landscape files for the 2023 plan year. And both major insurers and regional plans at press time were touting new offerings such as Part B buyback plans, flexible spending features that include allowances for utilities, and enhanced dental coverage.

“What we’re seeing is kind of a continuation of what we’ve seen in the past several years, which is expanding of not only the big five but also of the smaller insurers as well, and then increased focus on supplemental benefits and the Special Supplemental Benefits for the Chronically Ill (SSBCI), and continued expansion into the D-SNP [Dual-Eligible Special Needs Plan] market,” observes Betsy Seals, co-founder and CEO of Rebellis Group, LLC.

0 Comments
© 2024 MMIT

In Member Satisfaction and Quality, Few Differences Exist Between Medicare Advantage and Traditional Medicare

There is limited evidence to suggest any major differences exist between Medicare Advantage and traditional, fee-for-service (FFS) Medicare when measuring beneficiary satisfaction, according to the Kaiser Family Foundation’s (KFF) recent literature review of 62 studies comparing the two programs. Nor did either program consistently stand out across quality measures. There were also few differences in length of hospital stays for common ailments or aggregate days spent in inpatient care between the two groups.

0 Comments
© 2024 MMIT

In ‘Early Innings’ of Major Retail Collabs, UnitedHealth-Walmart Make Medicare Play

With a focus on Medicare Advantage beneficiaries, UnitedHealth Group and Walmart Inc. have struck a 10-year “wide-ranging collaboration” with value-based care elements that could ultimately extend into Medicaid and commercial plans. In addition to launching a co-branded MA plan, the partnership will connect Walmart Health clinicians with Optum’s analytics and decision support tools for value-based care delivery, and it represents the latest example of a major retailer seeking out a partner to grow its health care business.

Walmart already has a Medicare Part D partnership with Humana Inc. and in October 2020 introduced a co-branded MA offering with Clover Health. The Bentonville, Ark.-based retail giant at the time also launched an insurance brokerage called Walmart Insurance Services. According to walmartinsurance.com, it sells plans from Anthem (Elevance Health), Arkansas Blue Cross Blue Shield, Humana, UnitedHealthcare and Centene Corp.’s WellCare. The site does not, however, list Clover Health, and a spokesperson for Walmart confirms that the collaboration ended in 2021.

0 Comments
© 2024 MMIT

News Briefs: HHS Predicts 15M Will Lose Coverage Once Medicaid/CHIP Redeterminations Resume

HHS is currently projecting that 17.4% of Medicaid and Children’s Health Insurance Program (CHIP) enrollees — or about 15 million people — will move out of those programs when the COVID-19 public health emergency (PHE) ends. States have been barred from conducting eligibility redeterminations for Medicaid and CHIP during the PHE, as a condition of receiving enhanced federal funding, but those eligibility checks will resume whenever the PHE ends. Of those expected to lose Medicaid/CHIP coverage, almost one third are expected to qualify for premium tax credits to help defray the cost of Affordable Care Act marketplace plans, and among those people, more than 60% can access a zero-premium plan.

0 Comments
© 2024 MMIT

Teasing 2023 Expansions, Regional MA Insurers Eye Competitive Texas Market

As Medicare Advantage insurers gear up to compete for enrollment during the 2023 Annual Election Period (AEP) that begins on Oct. 15, a handful of companies have already unveiled service area expansions that are pending CMS approval. Several of them named new territories in Texas, where some 4 million Medicare beneficiaries reside.

According to AIS's Directory of Health Plans (DHP), more than half of Medicare beneficiaries in Texas are enrolled in an MA plan. UnitedHealthcare has the biggest market share in the state, with 48.9% of enrollees, followed by Humana Inc., with 16.8%. And UnitedHealthcare has reportedly purchased the seventh-largest Texas MA plan, KelseyCare Advantage, which is operated by KS Plan Administrators and affiliated with medical group Kelsey-Seybold.

0 Comments
© 2024 MMIT