CVS Makes Blockbuster Aetna Bid
Amazon may upend another industry without even launching a product. CVS Health (CVS) is said to be in talks to acquire Aetna (AET) for $66 billion in a blockbuster merger that could reshape the health insurance industry. And one of the factors rumored to be driving the deal is Amazon (AMZN, Tech30).
The Wall Street Journal reports the merger is at least partly intended to guard against the threat of Amazon entering the pharmacy market.
Both CVS and Aetna have declined to comment on the rumored deal.
In recent months, there has been a drumbeat of reports about Amazon's interest in selling prescription drugs as part of its bottomless ambition to offer every consumer product and service imaginable.
As analysts at Goldman Sachs put it in one investor note this summer, "Imagine a day when you can ask Alexa to have your Lipitor refill arrive at your doorstep in under two hours."
It may sound like a stretch for a company that started as an online bookseller. But Amazon now owns the Whole Foods grocery chain and is testing its own corner stores. It also offers one-hour delivery in certain markets. That potentially puts it in a strong position to deliver prescription drugs online and offline.
On an earnings call in August, CVS CEO Larry Merlo tried to play down the threat of Amazon as a competitor.
"There are many barriers to entry when you're looking at pharmacy," Merlo said on the call. "It's highly regulated, so the barriers to entry are high."
Amazon may be scaling those barriers, however. On Thursday, the St. Louis Post-Dispatch reported Amazon had gotten the green light for wholesale pharmacy licenses in at least a dozen states.
Amazon's "speculated entry into the Drug Value Chain is becoming more real with wholesale pharmacy licenses," Ana Gupte, an analyst at Leerink, a boutique investment firm focused on the health care industry, wrote in an investor note Thursday.
Gupte said Amazon posed "a massive threat to CVS" at a time when it's struggling to get enough foot traffic into its stores.
Asked about its plans on an earnings call Thursday, Amazon CFO Brian Olsavsky said he "can't confirm or deny any of the rumors related to pharmacy."
If the rumors are true, it certainly wouldn't be the first time Amazon disrupted a market with little more than a rumor. All it took was a whisper of Amazon's interest in meal-kit delivery services to shatter Blue Apron (APRN)'s stock this year.
One analysis found Amazon was mentioned on more than 100 earnings calls last quarter, including the CVS call, as businesses and investors weigh the "Amazon effect" across a wide range of industries.
For Amazon, "every new opportunity represents a $500B-$1T market, including food/restaurant and pharmaceutical," according to an investor note Friday from James Cakmak, an analyst with Monness, Crespi, Hardt.
Medicare Blog | Medicare News | Medicare Information
Medicare Vs. Medicare Advantage: How to Choose
As health insurers struggle with shifting government policies and considerable uncertainty, one market remains remarkably stable: Medicare Advantage plans.
That’s good news for seniors as they select coverage for the year ahead during Medicare’s annual open enrollment period (this year running from Oct. 15 to Dec. 7).
For 2018, 2,317 Medicare Advantage plans will be available across the country, “the most we’ve seen since 2009,” said Gretchen Jacobson, associate director of the Kaiser Family Foundation’s program on Medicare policy. (Kaiser Health News is an editorially independent program of the foundation.)
Medicare Advantage is an alternative to traditional Medicare. Run by private insurance companies, the plans — mostly health maintenance organizations (HMOs) and preferred provider organizations (PPOs) — are expected to serve a record 20.4 million people next year, or slightly more than one-third of Medicare’s 59 million members.
On average, seniors will have a choice of 21 plans, though in some counties and large metropolitan areas at least 40 plans will be accessible, Jacobson said. Availability tends to be far more restricted in rural locations.
While a few insurers are entering or exiting the Medicare Advantage market, most established players are remaining in place. Eight insurers dominate the market: UnitedHealthcare, Humana, Anthem, plans affiliated with Blue Cross and Blue Shield, Kaiser Permanente, Aetna, Cigna and WellCare. (Kaiser Health News is unaffiliated with Kaiser Permanente.)
Despite Medicare Advantage plans’ increasing popularity, several features — notably, the costs that older adults face in these plans and the extent to which members’ choice of doctors and hospitals is restricted — remain poorly understood.
Here are some essential facts to consider:
Medicare Advantage plans must provide the same benefits offered through traditional Medicare (services from hospitals, physicians, home health care agencies, laboratories, medical equipment companies and rehabilitation facilities, among others). Nearly 90 percent of plans also supply drug coverage.
In 2018, 68 percent of plans offered will be HMOs, while 27 percent will be PPOs, Jacobson said. The remainder are small, specialized plans that are expected to have relatively few members. In general, HMOs require members to seek care from a specific network of hospital and doctors while PPOs allow members to obtain care from providers outside the network, at a significantly higher cost.
Pros And Cons
The Center for Medicare Advocacy recently summarized the pros and cons of Medicare Advantage plans. On the plus side, it cited:
On the negative side, it cited:
Choosing a Medicare Advantage plan has implications for the future as well as the present. Notably, if someone enrolls in a Medicare Advantage plan when she first joins Medicare and stays with a plan for at least a year, she may not qualify for supplemental Medigap coverage if she wants to join traditional Medicare at a later date.
Medigap policies cover charges such as deductibles, coinsurance and copayments that seniors with Medicare coverage are expected to pay out-of-pocket. People who join Medicare for the first time are guaranteed access to Medigap policies, no matter what their health status is, only for a limited time. Afterward, they can be denied coverage based on their health in most states.
There’s a widespread perception that Medicare Advantage plans cost less than traditional Medicare. But actual costs depend on an individual’s circumstances and aren’t always easy to calculate.
Seniors often first consider what they’ll pay in monthly premiums. This year, the average monthly premium for Medicare Advantage plans is $30, almost $2 below last year’s. But nearly half of Medicare members are enrolled in plans that don’t charge a monthly premium — so-called zero premium plans. (Seniors also need to pay Medicare Part B premiums, although some Medicare Advantage plans cover some or all of that charge.)
To get a full picture of plan costs, which can vary annually, seniors should look beyond premiums to drug expenses (including which drugs are covered by their plan, at what level and with what restrictions); deductibles (plans can charge deductibles for both medical services and drugs); what plans charge for hospital care (some have daily copayments for the first week or so); and coinsurance rates for services such as home health care or skilled nursing care, experts said.
“It’s really critical that folks dip deep and find out about all possible costs they may incur in a plan before they sign up for it,” said Chris Reeg, director of Ohio’s Senior Health Insurance Information Program. (Every state has a program of this kind; find one near you at https://www.shiptacenter.org.)
“Part of the equation has to be what you’ll have to pay if you need lots of care,” said David Lipschutz, senior policy attorney at the Center for Medicare Advocacy “In our experience, that’s often more than people expected.”
Since 2011, Medicare Advantage plans have limited members’ annual out-of-pocket costs to no more than $6,700 — a form of financial protection. There is no similar limit in traditional Medicare. Yet, protection isn’t complete since out-of-pocket limits don’t apply to drug costs, which can be considerable. (In PPOs, a cap of $10,000 limits costs for services received from out-of-network providers as well.)
Plans have discretion in setting out-of-pocket limits. In 2018, 43 percent of plans will have out-of-pocket limits exceeding $6,000; 31 percent will set limits between $4,000 and $6,000; 20 percent will have limits between $3,000 and $4,000; and 6 percent will set limits beneath $3,000, according to a new Avalere Health analysis.
Information about Medicare Advantage plans’ deductibles, copayments and coinsurances rates for medical services as well as coverage details for the medications you’re taking can be found at Medicare’s plan finder.
Finding A Doctor
One way that Medicare Advantage plans try to control costs and coordinate care is by working with a limited group of physicians and hospitals. But reliable information about these networks is hard to find and published directories often contain mistaken or out-of-date information.
“It’s not easy to determine who’s in-network for a Medicare Advantage plan,” said Fred Riccardi, director of client services at the Medicare Rights Center. “This information isn’t on Medicare’s website and there’s no one, streamlined way to search for information about provider networks across plans.” His advice to consumers: Call all your doctors to ask if they’re participating in a plan you’re considering. (Make sure you have your plan number when you do, because a single company may offer multiple plans in your market.)
Making matters even more difficult: Plans can drop physicians or hospitals from their networks during the year, leaving members without access to trusted sources of care.
A new report discloses data about the size of Medicare Advantage plans’ physician networks for the first time. It finds that, on average, Medicare Advantage HMOs included 42 percent of physicians in a county in their networks while PPOs included 57 percent. Altogether, 35 percent of Medicare Advantage members are in plans with narrow physician networks, which tend to be the cheapest plans.
Although this data highlights the choices that seniors have with regard to physicians, it doesn’t speak to the wait time they may encounter in accessing care, Jacobson said, adding that, to her knowledge, this kind of information about Medicare Advantage plans is not publicly available.
Policyowner's Interest in Online Service Grows
New LIMRA researchService Channels finds 37 percent policyowners went online for service in 2017, 23 percent higher than in 2014. The study found that 74 percent policyowners said they would go online for service in the future, twice as likely as today in 2017.
While more policyowners are interested in going online to get help with their policy, they expect to have many options to access service. Nine in 10 policyowners said they want to be able to speak to a financial professional and three quarters say they want to contact the company directly via phone or mail. LIMRA found, overall, that meeting a financial professional and calling a life insurance company to speak with a customer service representative are still the most chosen service channels at 44 percent and 45 percent, respectively.
The policyowner’s generation also played a role in their use of service channels. The research shows Millennial policyowners (born between 1981 and 1995) are most likely to use the most service channels and are most likely to use digital channels (such as email, websites, text, chats and mobile devices) to connect compared to older consumers.
Research shows the types of transactions influence which service channel policyowners used. Simpler transactions, such as setting paperless preference and obtaining general information, were more likely to be completed online; while the policyowners were more inclined to talk to someone when they conducted more complex business, like changing their policy face amounts. Policyowners used mail or email more often when they completed services that require documentation such as name or beneficiary changes.
For more information on the way consumers interact with service channels, LIMRA members can read, Pinpointing Preferences 2017: Life Insurance Policyowner Service Channel Preferences.
Spotlight on the 2018 Competitive Medicare Advantage Market
Medicare Advantage (MA) plans continue to be a popular option for seniors, providing medical coverage for nearly 20 million beneficiaries. In the last three years, MA plans picked up approximately 3.3 million members and these carriers currently cover almost 34% of the 59 million people eligible for Medicare benefits. With the Annual Election Period (AEP) approaching, health plans invested in this segment have been preparing to diligently market their products in anticipation of enrolling more members.
As Medicare companies finalize sales and marketing strategies, they analyze data from Medicare Plan Finder (MPF), an online tool that makes it easy for seniors to review options and shop for new Medicare plans. Medicare Benefits Analyzer™ (/products/Medicare-Benefits-Analyzer.aspx), a Mark Farrah Associates' database, helps simplify the analysis of the Medicare Plan Finder data for companies competing in this segment. This brief presents a snapshot of the 2018 Medicare Advantage market with insights from the Centers for Medicare and Medicaid Services (CMS) Medicare Landscape reports and discusses the plans that will be vying for business during the upcoming AEP.
Medicare Landscape Observations
Between October 15th and December 7th, MA plans, along with stand-alone PDPs (prescription drug plans), will be immersed in competitive assessments as beneficiaries begin to choose plans that best fit their needs. According to CMS, Medicare Advantage average monthly premiums will decrease by $1.91 in 2018, plan offerings will increase and enrollment is projected to experience 9% growth, as compared to 2017. Medicare Advantage enrollees remaining in their current plan will have the same or lower premium for 2018 and there will be more plans offering zero out-of-pocket premium payments for members.
Based on an aggregate analysis of CMS Landscape reports, a total of 3,259 distinct Medicare Advantage (MA) plan offerings are in the market lineup for the onset of the 2018 AEP. During the AEP, Medicare beneficiaries can choose to change MA plans or switch from Original Medicare to MA, and plan benefits will become effective on January 1, 2018. MFA's analysis of CMS landscape data found a total of 2,619 distinct MA plans being offered for 2018, including Medicare/Medicaid plans, up from 2,311 this year. In addition, a total of 640 Special Needs Plans (SNPs) are available in 2018, up from 589 in 2017. HMOs continue to be the most prevalent plan type with over 2,300 offerings, representing 71% of all MA plans and SNPs being offered for next year. Stand-alone PDPs nationwide increased for 2018 with 795 plan offerings, as compared to 757 plans in 2017.
Eighty-nine percent, for a total of 2,332 MA plans, include Part D benefits and monthly premiums range from $0 to $375. Forty percent of 2018 MA plans (excluding SNPs), are available at the $0 plan premium level. Per the breakdown in the table below, 27% of all plans will be charging monthly premiums ranging from $2 to $50 while 18% of plan premiums are in the $51 to $100 range.
Only 2% or 63 plans are charging monthly premiums greater than $200. These benefits-rich plans typically have low copays and as a result estimated out-of-pocket expenses are often minimal. For the second year in a row, the highest premium plan for 2018 is HealthPartners Freedom Ultimate with Enhanced Rx cost plan being offered in Minnesota. This plan promotes no copays for in-network PCP and specialist office visits.
MA Plan Competition for 2018
The 2018 Medicare Advantage market is comprised of national health plans, Blue Cross Blue Shield organizations, prominent regional health plans and specialized Medicare companies. Based on the 2018 CMS Landscape reports, Humana continues to market more MA plans nationwide than any other company with 466 distinct plans identified in MFA's assessment. UnitedHealth continued to increase its MA plan offerings for the 2018 calendar year with 344 distinct plans identified, up 62 plans from last year. Aetna (including Coventry and other affiliates) is offering 251 plans for 2018. Anthem and the vast majority of other Blue Cross Blue Shield plans as well as Cigna, WellCare, Centene and Kaiser also continue to have a notable plan offerings presence, respectively.
Tags: Medicare Advantage