Membership Growth

Public Coverage Is Up, Private Coverage Is Down — Yet Likely Not for Long

The uninsured rate dipped slightly between 2020 and 2021, and while private insurance continued to be the most common type of coverage, it decreased in prevalence while government coverage increased, according to new data from the U.S. Census Bureau. One Wall Street analyst suggests that the findings are unsurprising given the current policy and demographic landscape, but he notes that trends are poised to change considerably when millions cease to qualify for Medicaid.

The Census Bureau’s survey, conducted between February and April, asked individuals whether they had any type of health coverage in the past calendar year. In 2021, 8.3% of the U.S. population lacked health insurance, compared to 8.6% in 2020. Put another way, 27.2 million Americans did not have coverage last year, down from 28.3 million the year prior. The 2021 uninsured rate of 8.3% represented a small uptick compared to 2019, however, when it reached a low of 8.0%.

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Three Major Insurers Will Expand ACA Exchange Footprints in 2023

Galvanized by a growing, stable Affordable Care Act exchange market and a looming dropoff in Medicaid membership, some of the country’s largest health insurers in 2023 are once again expanding their ACA marketplace footprints. At the same time, two startup insurers are pulling out of select markets — although one policy expert tells AIS Health that those moves mainly reflect how difficult it is to compete against companies with dominant market shares.

Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, says significant enrollment growth in Southern states appears to be driving some insurers’ expansion moves this year.

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Major National Health Insurers Expand ACA Presence in 2023

Cigna Corp. will expand its Affordable Care Act exchange offerings in 2023 by 50 new counties in Georgia, Mississippi and North Carolina and add three new states — Texas, Indiana and South Carolina — the insurer said in August. If approved by the state regulators, Cigna’s market expansion has the potential to reach roughly 730,000 additional enrollees. The carrier has been expanding its footprint over the past few years, currently ranking 11th in national ACA enrollment with 340,000 members. Its major state markets are Tennessee (85,000 members), Virginia (62,000) and Missouri (49,000).

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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.

Medi-Cal Awards Diss Centene With Reduced Service Area

As part of a Medicaid managed care revamp and its first statewide competitive procurement for the Medi-Cal program, the California Dept. of Health Care Services (DHCS) on Aug. 25 named the three insurers that will serve as commercial managed care plans (MCPs) in 2024. Elevance Health’s Anthem Blue Cross Partnership Plan, Centene Corp.’s Health Net and Molina Health Care were selected to participate in varying service areas across 21 counties. Health Net’s loss of three counties, however, spooked investors as Centene already faces declining Medicaid enrollment and continues to settle allegations of mishandling Medicaid pharmacy benefits in multiple states, the latest being Washington.

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.

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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.

News Briefs: Individual Medicare Advantage Enrollment Surpasses 24.7 million, Up 9% Year Over Year

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.

In 2Q, Some PBMs Report Dampened Margins, Customer Pipelines

Unlike in recent periods, PBMs were not necessarily stars of the show as the country’s largest publicly traded managed care organizations reported their second-quarter 2022 earnings. However, executives across the board still touted PBMs as a key component of their growth and diversification strategies.

At UnitedHealth Group, the first major MCO to report its quarterly results, one equities analyst queried the health care giant’s leaders about why OptumRx’s “strong” revenue and membership growth haven’t translated into larger margins.

Humana, Elevance Realign Business Segments, Anticipate Strong 2023 AEP

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.