Annual Election Period/AEP

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.

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.

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.

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.

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.

Individual Medicare Advantage enrollment this month surpassed 24.7 million lives, reflecting 9.3% membership growth since last August, according to a Barclays analysis of CMS’s latest monthly enrollment report. The publicly traded MCOs saw year-over-year individual MA membership grow by 10.5%, with Centene Corp. and CVS Health Corp.’s Aetna delivering double-digit enrollment gains, according to the analysis. Cigna Corp., however, underperformed with a year-over-year membership decline of 5.5%, observed Barclays. CMS’s August data release reflects enrollments accepted through July 8.

Highmark Wholecare has partnered with Posit Science to incorporate “brain fitness” into a program aimed at reducing vulnerable members’ risk of falling and improving balance. Highmark Wholecare, formerly Gateway Health, will offer BrainHQ exercises and services to approximately 7,000 qualifying members who are dually eligible for Medicare and Medicaid and identified as a high risk for falls. BrainHQ’s evidence-based brain fitness program is available via web or mobile phone and is supported by more than 200 peer-reviewed studies, according to an Aug. 15 press release from the partners.

After seeing improved medical cost trends and, in some cases, lower administrative costs, select insurers serving the Medicare Advantage space recently lifted their earnings projections for the full year. Conference calls to discuss second-quarter 2022 earnings were full of questions about pricing and changes related to their MA products as the 2023 Annual Election Period (AEP) approaches, but executives were more focused on touting efforts to serve members holistically, including through rebranding strategies as companies attempt to align their various business segments.

Medicare Advantage enrollment reached nearly 28.8 million as of May, reflecting an overall increase of about 1% during the three-month Open Enrollment Period (OEP) that ended on March 31, according to the latest update to AIS’s Directory of Health Plans (DHP). That’s compared with growth of 5.3% from October 2021 to February, reflecting results from the Annual Election Period (AEP) that ran from Oct. 15 through Dec. 7. Beneficiaries who enrolled in an MA plan during the AEP have a one-time opportunity to change their coverage selection during the OEP, and insurers that made above-average membership gains during both periods attributed their successes to product enhancements, geographic expansions and strong distribution partnerships.

As CMS continues to seek ways to improve its consumer-facing tools for comparing Medicare coverage options, the agency last month unveiled a series of tweaks to the Medicare.gov website and Medicare Plan Finder (MPF). The MPF in 2019 underwent a major makeover that reportedly cost the Trump administration $11 million but critics say fell short of fixing many of the issues highlighted in a July 2019 report from the Government Accountability Office. CMS has continued to make updates based on consumer feedback, but some industry experts suggest more detail around the supplemental benefits offered by Medicare Advantage plans would be useful.

“CMS is making Medicare.gov easier to use and more helpful for people seeking to understand their Medicare coverage, which is an essential part of staying healthy,” said CMS Administrator Chiquita Brooks-LaSure in a May 18 press release. “We are committed to listening to the people we serve as we design and deliver new, personalized online resources and expanded customer support options for people with Medicare coverage and those who support them.”

Medicare consumers are facing an overwhelming variety of resources and plan choices and are showing signs of increased movement during the Open Enrollment Period (OEP). As a result, effective member engagement during the OEP and throughout the year is becoming increasingly important and can be achieved through using data to segment membership and deliver targeted, personalized messaging to ensure that a member is in the right plan from the start, industry experts advised during the 13th Annual Medicare Market Innovations Forum, hosted by Strategic Solutions Network, LLC (SSN).

After the Medicare Annual Election Period (AEP) that typically runs from Oct. 15 through Dec. 7, the three-month Medicare OEP starts on Jan. 1 and allows beneficiaries who selected a Medicare Advantage plan to make a onetime coverage change. This year was the fourth OEP since it was reinstated by the Trump administration after a hiatus, and seniors’ utilization of the renewed opportunity is growing.