Membership Growth

Medicare Advantage Enrollment Tops 28 Million in 2022 Annual Election Period

Approximately 2.2 million people enrolled in a Medicare Advantage plan from February 2021 to February 2022, bringing the total MA population to 28.6 million medical lives. That’s an 8.5% year-over-year increase, according to AIS Health’s analysis of data that included enrollment from the 2022 Medicare Annual Election Period (AEP), down from 9.9% growth during the prior-year period. Nearly two-thirds (64.3%) of all new enrollees selected a plan from UnitedHealthcare, Humana Inc. or CVS Health Corp.’s Aetna, while Centene Corp.’s major market expansion paid off, garnering more than 30% enrollment growth for the insurer. Meanwhile, Florida Blue parent GuideWell Mutual Holding Corp.’s completed acquisition of Triple-S Management Corp., one of the largest MA insurers in Puerto Rico, allowed it to crack the top 10 for the first time. Anthem, Inc. also completed a Puerto Rico MA deal with its July 2021 acquisition of MMM Holdings from InnovaCare Health. On the state level, four states saw MA growth of more than 20% (vs. 10 last year), including Delaware and Vermont, which have historically low penetration rates.

ACA Exchange Enrollment Hits Record High

A record 14.5 million people enrolled in Affordable Care Act marketplace coverage from Nov. 1, 2021, through Jan. 15, 2022, including 10.3 million people who live in states using HealthCare.gov and 4.2 million in states with their own marketplace, according to CMS. Three states — Kentucky, Maine and New Mexico — transitioned to their own state-based exchanges for the 2022 plan year. Among the 33 states using HealthCare.gov, all but Hawaii saw an enrollment increase for 2022 compared with 2021, with eight experiencing signup surges of more than 30%.

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Humana Seeks to Calm Investors With EPS Outlook, $1B Value Plan

As publicly traded Medicare Advantage insurers begin to report fourth-quarter and full-year 2021 earnings, Humana Inc.’s recent disclosure of lower-than-expected individual MA growth for 2022 has raised questions among the investment community around the use of external sales channels and their impact on membership churn. But reports by UnitedHealth Group and Anthem, Inc. in late January seemed to assure investors that Humana’s experience was not reflective of an overall trend, while executives during Humana’s Feb. 2 earnings call vowed that the MA-focused insurer is making every effort to ensure its external partners appropriately convey what members are buying and confirmed its long-term growth outlook.

Potential 5-Star SEP Disruption Depends on Marketing Prowess

With 74 Medicare Advantage Prescription Drug plan contracts earning a 5-star rating for 2022, compared with just 21 such plans last year, an unprecedented number of MA-PD plans have the ability to market 5-star products throughout the year — thanks in large part to COVID-related adjustments to the star ratings that are not likely to reoccur. According to multiple industry experts, that anomaly presents a unique set of challenges for plans that weren’t expecting to be 5 stars and could create some unusual midyear enrollment shifts.

That all depends, however, on how aggressive 5-star plans are with their marketing and how many enrollees take advantage of the so-called 5-star special enrollment period (SEP). While MA insurers have the advantage of marketing their 5-star plans year round, enrollees who are in a service area where a 5-star plan is available may switch from their current Medicare plan to a 5-star contract one time between Dec. 8 and Nov. 30.

Star Ratings Surge Could Disrupt the Market During Special Enrollment Period

The pandemic-fueled boom in 5-star rated Medicare Advantage contracts could cause “significant market disruption” in 2022, suggests a new report from Wakely. In an analysis of enrollment data from CMS, the actuarial consulting firm found that 5-star contracts account for 19% to 30% of MA intra-year enrollment growth (i.e., enrollment gains occurring between February and December of a particular year), with 5-star contracts growing between 3.8% and 5.1% midyear. Since 5-star plans have the advantage of marketing their products all year long and enrolling members who qualify for the 5-star special enrollment period, the major increase in the number of available 5-star plans has the potential to create unprecedented enrollment shifts later this year. The report warned, however, that midyear plan switchers may have a less-than-favorable risk profile.

As Medicaid Enrollment Soars, States Ask MCOs to Intensify Social Determinants of Health Efforts

States are moving to better address social determinants of health (SDOH) and improve health equity in their Medicaid programs, and they’re asking MCOs to drive the change, according to an analysis of recent requests for proposals (RFPs) from advocacy group Together for Better Medicaid. The report identified RFPs from 10 states that have extensive SDOH and equity-based requirements for MCOs, from member screenings and staff training to close collaboration with community-based organizations (CBOs). Meanwhile, Medicaid enrollment has surged in all 10 states amid the COVID-19 pandemic. National Medicaid enrollment climbed 18.4% from March 2020 to December 2021, according to AIS’s Directory of Health Plans. See an overview of the most common SDOH requirements and the 10 states’ recent enrollment patterns below.

News Briefs: Centene Agrees to Pay $21.1 Million to Settle NH Medicaid Pharmacy Issues | Jan. 20, 2022

Centene Corp. this month agreed to pay $21.1 million to resolve inaccuracies related to the reporting of pharmacy benefit services costs for New Hampshire’s Medicaid Managed Care Management Program. In a Jan. 6 press release unveiling the settlement agreement, Attorney General John Formella said the state Dept. of Health and Human Services and Dept. of Justice began investigating Centene’s provision of pharmacy benefit services after similar probes in other states were made public. The agreement follows similar settlements in Arkansas, Illinois, Kansas, Mississippi and Ohio over the last year for a total of $214 million in payouts. Centene did not admit any liability, wrongdoing or violation of federal or state law. “This no-fault agreement reflects our commitment to prompt and transparent resolution of this matter and relentless focus on delivering high-quality healthcare outcomes to our members in the Granite State,” Centene said in a statement published by The Daily Journal.

2022 Outlook: MAOs Face Payment Unknowns, Increased Competition This Year

For the Medicare Advantage industry, change wasn’t a major outcome of the Biden administration’s first year in office. But for 2022, MA organizations face a host of unknowns — such as potential risk adjustment and star ratings changes that could impact plan revenue — and challenges that include staying competitive in an increasingly rich benefits landscape. For AIS Health’s annual roundup of perspectives on the year ahead, industry experts weigh in on how doing business in 2022 might differ from previous years.

AIS Health: What do you view as some of the biggest challenges or uncertainties facing MAOs in 2022?

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2022 Outlook: MAOs Face Payment-Related Unknowns, Increased Competition

For the Medicare Advantage industry, change wasn’t a major outcome of the Biden administration’s first year in office. But for 2022, MA organizations face a host of unknowns — such as potential risk adjustment and star ratings changes that could impact plan revenue — and challenges that include staying competitive in an increasingly rich benefits landscape. For AIS Health’s annual roundup of perspectives on the year ahead, industry experts weigh in on how doing business in 2022 might differ from previous years.

AIS Health: What do you view as some of the biggest challenges or uncertainties facing MAOs in 2022?

Medicaid MCOs Brace for Return of Churn, Other Challenges

As a condition of receiving enhanced federal funds during the COVID-19 public health emergency (PHE), states were required to take certain steps to ensure continuous Medicaid and CHIP coverage for most enrollees, leading to a nearly 18% jump in Medicaid enrollment. But with the latest PHE extension set to expire on Jan. 16, states will no longer receive such funds and will therefore no longer be required to maintain continuous coverage, although CMS has given them 12 months after the month in which the PHE ends to complete eligibility redeterminations. As a result, supporting states’ reverification efforts and ensuring that eligible members stay on the rolls or have a viable landing spot will be critical to Medicaid managed care organizations this year, industry experts tell AIS Health, a division of MMIT.