Membership Growth

Expanded Footprints, Enhanced Benefits Aided Plans’ OEP Gains

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.

UnitedHealth Dominates While Startups Make Gains in 2022 Medicare Open Enrollment Period

Medicare Advantage enrollment grew by about 232,000 lives during the 2022 Open Enrollment Period (OEP), according to CMS’s May data release and AIS’s Directory of Health Plans. As in the Annual Election Period (AEP), UnitedHealthcare dominated, holding 45.1% of the overall OEP gains, followed by CVS Health Corp.’s Aetna at 16.9% and Centene Corp at 13.5%. Among other large, publicly traded insurers, Cigna Corp. and Humana Inc. both flopped in the OEP, losing 12,600 and 4,200 members, respectively. Meanwhile, insurance startups Bright Health and Clover Health both made the top 20 despite recent financial challenges and questioned viability. See the top 25 OEP performers, plus their AEP results and current enrollment, in the chart below.

State Medicaid Agencies Grapple With Moving PHE End Date

With the COVID-19 public health emergency presumably continuing into October, state Medicaid agencies and their partners theoretically have more time to communicate with enrollees and prepare for the inevitable resumption of eligibility redeterminations once the PHE ends. But ongoing uncertainty over the PHE’s end date presents a host of challenges for states as they handle unprecedented numbers of Medicaid enrollees and attempt to conduct other program work unrelated to redeterminations, according to officials from California, Iowa and North Carolina who spoke during a May 24 webinar hosted by the National Association of Medicaid Directors (NAMD).

Throughout the PHE, which was declared in January 2020 and first renewed that April, states have received a temporary 6.2 percentage-point increase in their Federal Medical Assistance Percentage (FMAP) in exchange for maintaining continuous enrollment of nearly all Medicaid recipients. Once the PHE ends, states have 12 months to initiate eligibility reverifications for everyone enrolled in Medicaid and CHIP and 14 months overall to complete redetermination efforts.

Clover Health Hires New CFO as Firm Aims to Improve Efficiencies, Lower Costs

Medicare Advantage-focused startup Clover Health, which continues to expand its footprint and gain enrollees despite questions about its profitability, will soon have a new chief financial officer. According to a May 25 press release, Scott Leffler will join Clover in August after serving as CFO and treasurer of Sotera Health, where he oversaw the company’s global finance, procurement and IT organizations.

Leffler’s hiring follows several key additions to the company’s management team this year. During the first quarter, Clover Health appointed Conrad Wai as chief technology officer and Joseph Martin as general counsel. And in May, the company hired Aric Sharp as CEO of value-based care. The news of Leffler’s appointment comes after Clover Health spent more than 10 months seeking a replacement for Joe Wagner, who left the company in August 2021 for personal reasons.

Startups Oscar Health, Bright Health Exit Markets & Tighten Belts

Startup insurers Oscar Health, Inc. and Bright Health Group, Inc. have decided they will no longer sell individual and/or family plans in certain states after this year. Ari Gottlieb, a principal at consulting firm A2 Strategy Group, tells AIS Health that those are signs the companies are looking to stem large losses and shore up their businesses as their stock prices fall and raising additional capital becomes harder.

Gottlieb says he anticipates Cigna Corp, which invested in Oscar earlier this year, could buy the company as soon as the end of the year. The fate of Bright remains unknown, although Gottlieb does not see Oscar, Bright or the two other publicly traded startup insurers (Alignment Healthcare and Clover Health Investments Corp.) becoming profitable anytime soon. Gottleib says Cigna may buy Bright also.

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PHE Unwinding Delay Gives States, MCOs Time to Ease Transitions

With radio silence from HHS on May 16 — when states at the very latest had expected to hear whether the COVID-19 public health emergency would end in July — HHS at press time appeared to be gearing up for another extension of the PHE. This will give states, insurers and other stakeholders more time to prepare for the inevitable resumption of Medicaid eligibility redeterminations, which could cause millions of adults and children to lose health insurance coverage.

The PHE has been extended multiple times since the start of the pandemic and remains a moving target. As a condition of receiving enhanced federal funds during the PHE, states have been required to ensure continuous Medicaid and CHIP coverage for most enrollees by pausing eligibility redeterminations. And the Biden administration has promised to provide states 60 days’ notice before any possible termination or expiration. But without such notification, sources estimate the next end date could be Oct. 13. Bloomberg on May 16 reported that the PHE would be extended past mid-July, “according to a person familiar with the matter.”

Medicaid Rolls Soar to Nearly 89 Million Beneficiaries as Redeterminations Loom

Nationwide Medicaid enrollment has grown more than 22% since the outset of the COVID-19 pandemic, topping 88.7 million lives, according to the latest update to AIS’s Directory of Health Plans. But the end of the Public Health Emergency (PHE) — which at press time was likely to be extended beyond mid-July — could leave between 5.3 million and 14.2 million people without coverage when redeterminations resume, asserted a May 10 analysis from the Kaiser Family Foundation. A separate study from the Georgetown University Heath Policy Institute found that 6.7 million children stand to lose CHIP coverage at the end of the PHE. See a state-by-state overview of three years of pandemic-fueled Medicaid enrollment changes in the chart below.

Cigna Eases Investor Fears With Better Medical Cost, Membership

Cigna Corp. pleased Wall Street with its first-quarter 2022 financial results, touting a solid increase in commercial self-funded membership and a better-than-projected medical loss ratio (MLR) of 81.5%.

The insurer posted first-quarter 2022 net income of $1.18 billion ($3.68 per share) on revenue of $44.0 billion, up from net income of $1.16 billion ($3.30 per share) on revenue of $40.1 billion for the same period in 2021.

Cigna’s self-funded commercial membership rose 9% to 12.5 million through March 31, while insured commercial membership rose 2% to 2.2 million. In all, Cigna had 17.8 million medical members on March 31, 2022, up about 700,000 or 4% from Dec. 31, 2021, when it stood at 16.7 million.

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PHE Extension, Medicare AEP Boost ’22 Earnings Projections

Better-than-expected first-quarter 2022 earnings aided by Medicare open enrollment successes and the extension of the public health emergency (PHE) drove several insurers at press time to raise their earnings guidance for the year. Some, however, approached their projections with caution as variant-driven surges in the COVID-19 pandemic continue to create uncertainty around utilization.

Reporting first-quarter earnings on April 27, Humana Inc. said its results from the latest Medicare Annual Election Period (AEP) were slightly better than projected and it is making progress on a $1 billion value creation plan unveiled last quarter that will allow the company to further enhance its Medicare offerings. For the AEP that ended Dec. 7, improvements were “driven by higher sales and improved voluntary termination rates,” explained President and CEO Bruce Broussard during an April 27 conference call to discuss recent quarterly earnings. Broussard also provided a detailed update on Humana’s efforts to improve the sales experience through its various distribution channels.

Geographic Expansions Assisted 2022 AEP Winners’ Major Gains

Medicare Advantage membership has grown by 8.5% since February 2021 to top 28.6 million lives, according to AIS Health’s analysis of data that included enrollment during the 2022 Annual Election Period (AEP). While nearly two-thirds of all new enrollees selected a plan from market leaders UnitedHealthcare, Humana Inc. or CVS Health Corp.’s Aetna, several regional insurers performed well above average, driven largely by service area expansions, provider pacts and benefit enhancements. (Per AIS’s research methodology, the following figures do not include lives enrolled in CMS’s Financial Alignment Initiative demonstration plans serving about 451,000 Medicare-Medicaid dual eligibles or participants in Programs of All-Inclusive Care for the Elderly.)