Membership Growth

More than 20 million people lost their Medicaid or Children’s Health Insurance Program (CHIP) coverage as of April 11, 2024, according to data released by states and CMS on the Medicaid eligibility redetermination process. Medicaid enrollment peaked at 94.5 million in April 2023, when states were permitted to resume disenrolling people from Medicaid who no longer qualify after a multiyear pause during the COVID-19 public health emergency.

States have reported Medicaid renewal outcomes for two-thirds of Medicaid/CHIP enrollees, as of April 2024, according to KFF’s Medicaid Enrollment and Unwinding Tracker. Overall, about one-third of enrollees with a completed renewal lost their Medicaid coverage, and 69% of those coverage losses were due to procedural reasons — meaning individuals didn’t return their renewal form within a specific time frame or the state was unable to reach them. Disenrollment rates varied significantly across states, ranging from 57% in Utah to 12% in Maine.

Nearly 33 million individuals were enrolled in Medicare Advantage as of February, demonstrating a year-over-year increase of 7.1% and Annual Election Period growth of 4.0%, according to AIS Health’s analysis of the latest AEP data. Those figures reflect a continued slowdown in MA growth as fewer baby boomers age into Medicare. At the same time, switching among MA consumers continues to rise, and with less rebate and risk adjustment revenue expected this year, insurers had tough decisions to make to stay competitive.

According to the latest Medicare Shopping and Switching Study from Deft Research, MA switching during the 2024 AEP reached a “multiyear high” of 16%, compared with 15% in the 2023 AEP and 12% in the prior two periods. While previous Deft studies identified increasing levels of frustration with supplemental benefits as a top driver of switching, this year’s changes were “more so due to reductions in benefits and added cost,” says George Dippel, president of Deft Research.

Medicare Advantage growth is slowing down after a pandemic-era windfall, according to AIS Health’s analysis of the 2024 Annual Election Period (AEP). As of February — when then the final AEP data is reported — total MA enrollment was approaching 33 million lives (AIS’s collection of AEP data excludes some Medicare-Medicaid dual eligibles; see note below). That’s a 4.0% increase from October 2023, when the AEP began, and down from 4.6% during the same time period last year and a high of 6.8% in 2021. CMS previously projected that MA enrollment would increase by roughly 7% to 33.8 million this year; the AIS Health analysis shows that MA enrollment grew 7.1% from a year ago.

Each year, AIS Health does a deep dive into the enrollment shifts that took place regionally and nationally over the Medicare Annual Election Period (AEP) and explores the myriad drivers of growth (or attrition). From benefit enhancements to creative new partnerships, three AEP leaders disclose details of their winning strategies to AIS Health, a division of MMIT.

From October 2023 to February 2024 — which reflects the full capture of lives enrolled during the AEP, which ran from Oct. 15 through Dec. 7 — CVS Health Corp.’s Aetna increased its MA enrollment by 18.9% and grabbed roughly half of all new enrollment in individual plans, including Dual Eligible Special Needs Plans (D-SNPs). Aetna significantly grew its geographic footprint in both segments, maintained stable provider networks, and on average, featured lower premiums, maximum out-of-pocket costs and drug deductibles in its non-SNP plans.

Change Healthcare, which UnitedHealth Group acquired in October 2022, has been targeted by a cyberattack. UnitedHealth said in a regulatory filing that on Feb. 21 it discovered “a suspected nation-state associated cyber security threat actor” had gained access to some of Change Healthcare’s information technology systems, and the firm reacted by isolating the affected systems. According to the latest update on a website dedicated to information about the incident, as of Feb. 23 “the disruption is expected to last at least through the day.” All other systems across UnitedHealth Group’s enterprise are operational, and the company said in the filing that it’s working with security experts and law enforcement to address the incident. “The cyberattack against UnitedHealth Group, one of the largest U.S. commercial prescription processors, is credit negative for the company, as financial and reputational impacts may ensue,” Moody’s Investors Service Vice President and Senior Credit Officer Dean Ungar said in a statement emailed to reporters about the incident.

Like its competitors, Humana Inc.’s evolution from a pure-play health insurer to a highly diversified health care firm came with a rebranding. To that end, Humana Pharmacy — the company’s mail-order and retail pharmacy brand — in 2022 became CenterWell Pharmacy, nestled under the company’s CenterWell health services subsidiary. Now, that division not only has a new name, but also a new app.

The app — which is available to CenterWell Pharmacy members covered by Humana’s Medicare Advantage and Part D plans — represents a “total redesign,” with increased personalization capabilities and a streamlined approach to prescription management, the firm said in a Feb. 20 press release.

As the second batch of publicly traded insurers posted fourth-quarter and full-year 2023 financial results, continued utilization pressures in Medicare Advantage remained a prominent theme during earnings calls held in the first two weeks of February. Such pressures prompted Humana Inc. to slash its outlook for 2024, but this month only CVS Health Corp.’s Aetna lowered its adjusted earnings per share (EPS) guidance, while The Cigna Group — which is planning to sell its relatively small MA business — raised its outlook.

CVS Health Corp. on Feb. 7 reported fourth-quarter adjusted EPS of $2.12 and full-year adjusted EPS of $8.74. Consolidated revenue grew 11.9% year over year to $93.8 billion, while revenue for the Health Care Benefits segment, which includes Aetna’s MA business, increased 16% to nearly $27 billion. CVS Health said it added 1.3 million members in 2023, which reflected growth across multiple product lines.

After reportedly vying with Elevance Health, Inc. for the purchase of The Cigna Group’s Medicare Advantage business, Health Care Service Corp. (HCSC) will buy Cigna’s MA, Medicare Supplemental, Medicare Part D and CareAllies assets for a total transaction value of $3.7 billion. HCSC has been aggressively growing its MA business through service area expansions; the addition of Cigna’s MA lives would boost its current share of the segment from 0.62% to 2.40%, according to AIS’s Directory of Health Plans.

In a press release unveiling the deal, the Chicago-based insurer said the acquisition will accelerate its growth in “an important market segment” and “bring many opportunities to HCSC and its members — including a wider range of product offerings, robust clinical programs and a larger geographic reach.” HCSC is customer-owned, meaning policyholders and not stockholders are the owners, and it is an independent licensee of the Blue Cross and Blue Shield Association. Its Blues plans currently enroll 204,638 members across five states: Illinois, Montana, New Mexico, Oklahoma and Texas.

As the first round of fourth-quarter and full-year 2023 financial results were reported by publicly traded insurers in January, modest enrollment growth during the recently concluded Annual Election Period (AEP) and continued utilization pressures were prominent Medicare Advantage themes during earnings calls. Although analysts were particularly concerned with results posted by Humana Inc., which notably moved up its earnings release date, some maintained that the MA-focused insurer remains poised for long-term growth in the sector.

Humana Inc. on Jan. 25 introduced 2024 adjusted earnings per share (EPS) guidance of “approximately $16” — compared with the Wall Street consensus of $29.14. But that was after a regulatory filing indicated that inpatient utilization was higher than expected in the fourth quarter of 2023, primarily during November and December, “as well as a further increase in non-inpatient trends, predominantly in the categories of physician, outpatient surgeries, and supplemental benefits, which emerged with the November and December paid claims data.” Humana’s stock plummeted after the disclosure, and the impact reverberated throughout the managed care sector, denting the share values of competitors including CVS Health Corp. and Elevance Health, Inc.

While publicly traded insurers’ fourth-quarter and full-year 2023 earnings reported thus far have highlighted concerning trends in Medicare Advantage, a new report from Moody’s Investors Services suggests that the MA market even prior to the current climate is showing “signs of weakening.” Nevertheless, with per-member earnings far greater than in other sectors, MA can still be profitable when properly managed and will stay competitive, suggests an analyst with the credit ratings firm.

Among the 10 insurers rated by Moody’s — which account for approximately two-thirds of all MA members — aggregate earnings stemming from MA decreased by 2% from $10.8 billion in 2019 to $10.6 billion in 2022, the most recent year available. During that same period, the aggregate MA earnings margin fell from 4.9% to 3.4% and earnings per member dropped by 28% ($732 to $526). While those earnings remain higher compared to other segments, earnings per member in the Medicaid and commercial segments increased, leading to an overall decline of 2.7% to $216 per member, according to the Jan. 23 Moody’s report.