Medicare Advantage Enrollment Grows
8% Year-Over-Year

Gains Concentrated Among Major Players

Medicare Advantage enrollment grew 8.0% from September 2018 to September 2019, according to AIS’s Directory of Health Plans (see a complete month-by-month timeline below), continuing a trend of greater MA gains as more baby boomers, seeking more personalized benefits, age into Medicare. In advance of the Annual Election Period (AEP) starting on Oct. 15, CMS on Sept. 24 said it expects MA enrollment to reach new highs in 2020, growing about 10% to 24.4 million lives.

Growth this past year was concentrated among the largest payers in the MA space, with the top five experiencing enrollment gains of about 16% on average year over year (see breakdown below). The big winner was Aetna Inc., which took on its largest-ever MA expansion in 2019, adding its offerings to more than 350 new counties.

While still on top, market leader UnitedHealthcare’s post-AEP gains were smaller than the 400,000 to 450,000 members (excluding dual eligible Special Needs Plans) the company anticipated, instead adding only about 290,000 lives.

NOTE: All enrollment totals include dual eligible Special Needs Plans (D-SNPs) except where noted. AIS defines post-AEP enrollment as total MA membership as of February 2019.

Source: https://aishealth.com/medicare-and-medicaid/medicare-advantage-enrollment-grows-8-year-over-year-with-gains-concentrated-among-major-players/

The Mad Rush to Sell Private Medicare Plans to Seniors

Health insurers across the U.S. will race to enroll more seniors in lucrative government-backed Medicare plans this month, even as a roiling debate over the role of private companies in health coverage shapes the presidential race.

The plans, known as Medicare Advantage, are the private-sector, taxpayer-financed alternative to traditional Medicare. Selling them has become a crucial profit center for the insurance industry: Baby Boomers are aging into the program, propelling its growth, while at the same time health insurance products sold to people under 65 are facing pressure from all sides.

The private plans also sit squarely in the middle of the race for the presidency: Some candidates for the Democratic nomination, including Senators Bernie Sanders and Elizabeth Warren, have backed a proposal to do away with private health insurance across all markets. Last week, President Donald Trump signed an executive order aimed at bolstering Medicare Advantage, and said Democrats would upend the program.

In 2019, about 22 million people, or roughly a third of all Medicare enrollees, got their Medicare coverage through the private plans. For each person who signs up, the insurers collect a fee from the government. It was $11,545 on average this year, which adds up to about $254 billion. The Medicare Advantage enrollment period opens Oct. 15.

Insurers see it as a lucrative market they can’t afford to pass by. Medicare products are the biggest business at the biggest health insurance company, UnitedHealth Group Inc.’s insurance unit. Centene Corp. agreed to pay $15 billion this year for WellCare Health Plans Inc. in part to get access to the company’s large Medicare business. Startups like Clover Health, which has raised more than $900 million from investors including GV, Alphabet Inc.’s venture capital arm, are targeting Medicare customers with new technologies intended to deliver care more efficiently.

UnitedHealthcare will sell Medicare coverage in 100 new counties in 2020, reaching 90% of the eligible market. Humana Inc., which specializes in Medicare Advantage, will expand to 29 new counties. Humana Chief Executive Officer Bruce Broussard told investors in July that membership was growing at the fastest pace in a decade, and the company expects to add half a million members this year. Cigna Corp., which has a comparatively smaller Medicare business, is expanding to 37 new counties next year and projecting 10% to 15% average annual membership growth through 2025. CVS Health Corp.'s Aetna unit is expanding to 264 new counties in 2020.

Medicare is especially critical to insurers as their traditional business selling health plans to employers and individuals slows. A smaller percentage of the U.S. workforce is enrolled in employer coverage than two decades ago, according to data from the Kaiser Family Foundation, a nonprofit health research group, as the cost of those benefits rises faster than workers’ earnings.

“We all know that 11,000 Americans turn age 65 every day and then the percent of those that choose” Medicare Advantage is accelerating, Anthem Inc. Chief Financial Officer John Gallina said at a conference in June. He called it “a huge opportunity that we’ve missed in the past, that we now need to capitalize on.”

Anthem’s Medicare Advantage membership grew by 25% in the 12 months ending June 2019, far faster than any other category. Anthem is expanding to 77 new counties in 2020.

Seniors in traditional Medicare can go to any doctor or hospital that participates, as most do. Those who choose Medicare Advantage plans trade that freedom of choice for an insurance company’s more limited network. In exchange, they get extra benefits. Medicare Advantage policies often wrap in prescription-drug plans, vision and dental care. Many offer free gym memberships or fitness programs. They also cap members’ total out-of-pocket costs. In traditional Medicare, seniors have to buy policies known as Medicare supplement or Medigap plans to limit their out-of-pocket expenses.

Starting in 2019, a federal rule change permitted Medicare Advantage plans to offer other perks like transportation and meal delivery. The goal is to address so-called social determinants of health, the many non-medical aspects of people’s lives that affect their well-being. Plans will offer a greater variety of those benefits in 2020.

Some Cigna plans in Texas will pay for air conditioners for the first time next year. Anthem will offer pest-control services, because vermin can affect chronic health conditions such as asthma. Carriers are also testing benefits like adult day care; home safety improvements, like grab bars, to prevent falls; and in-home help for people who need assistance bathing or dressing.

“We actually find a lot of beneficiaries are living in environments that really need support and help,” said Martin Esquivel, vice president of Medicare product management at Anthem.

Medicare doesn’t provide those things in its traditional fee-for-service program, partly because of the risk of inappropriate payments or fraud. In Medicare Advantage, the government’s payment to plans is limited, so that risk is managed by the plans.

The growth of Medicare Advantage shows demand for private managed-care plans exists even when seniors have a purely public option. “No one’s forcing them to do this,” said Dan Mendelson, founder of consultant Avalere Health and a partner at private equity firm Welsh Carson Anderson & Stowe. Seniors are increasingly comfortable giving up some choice of doctors in exchange for Medicare Advantage’s perks, he said. “It’s the choice that makes it really remarkable, that seniors are choosing this.”

While two-thirds of Medicare enrollees choose to stick with the original program, that share is declining. Mendelson said Medicare Advantage enrollment has grown by 8% annually in recent years. At that pace, more than half of Medicare members will be in private plans by 2025, he estimates.

Many people can get Medicare Advantage for no additional premium beyond what they pay for traditional Medicare. The average monthly premium for Medicare Advantage is $23 in 2020, down from $26.87 the prior year, according to the Centers for Medicare and Medicaid Services. It’s at the lowest level since 2007.

Plans have historically been paid generously. A decade ago, Medicare paid private plans 14% more than it would have spent for the same beneficiaries in the traditional program, according to the Medicare Payment Advisory Commission, known as MedPAC, which counsels Congress on Medicare policy. That helped finance additional benefits that enrollees found attractive, but it raised the program’s costs and put little pressure on plans to deliver more efficient care. The 2010 Affordable Care Act lowered those payments. They’re now about 1% above traditional Medicare payments, according to MedPAC.

People who choose to enroll in Medicare Advantage plans also typically have lower health spending before they enroll, compared with similar people in traditional Medicare, according to an analysis by the Kaiser Family Foundation. That means the way payments are set “may systematically overestimate expected costs of Medicare Advantage enrollees,” the Kaiser researchers wrote. Plans have been also faulted by government watchdogs for improperly denying care.

Medicare Advantage plans pay about 86% of their premium revenue out in medical claims, a similar proportion to other health insurance products, according to a separate Kaiser Family Foundation report. But the opportunity to profit is higher. Partly because Medicare beneficiaries use more medical care than younger people, there’s more money at stake for each member. Gross margins in Medicare Advantage – the difference between premiums collected and claims paid, before counting administrative costs – are about $1,600 per enrollee, roughly double the value in commercial plans, according to Kaiser’s analysis.

“This appears to be a fairly profitable market,” said Tricia Neuman, director of the Kaiser Family Foundation’s program on Medicare policy. The group sees more carriers enter the market than exit each year. “If it weren’t profitable, they wouldn’t be doing it,” Neuman said.

Big Winners
The market for Medicare Advantage plans has become increasingly concentrated. In 2018, the top four Medicare organizations had 59% of enrollment, up from 46% in 2011, according to MedPAC. And while it may seem like an attractive market, it’s difficult for new competitors to enter.

“We had no idea how hard it would be, how long it would take, the infrastructure we’d have to develop,” said Vivek Garipalli, chief executive officer of Clover Health. The company has about 42,000 members, mostly in New Jersey.

Other new technology-focused insurers are trying to break into the market. Oscar Health announced its first Medicare plans this year. Startup Devoted Health, which is led by former Obama administration officials, raised $360 million to launch its Medicare Advantage plans in 2019.

Those companies are betting that technology can deliver better care more efficiently, by using data to help physicians manage patients with chronic conditions, for example. Medicare Advantage is an ideal proving ground to test that idea, because plans make money if they can deliver savings without compromising quality.

“Health care has effectively had zero productivity gains over the last 20 years,” said Bob Kocher, a partner at venture firm Venrock. The firm backed Devoted Health and Kocher served as the company’s chief medical officer for a year. “There should be a lot of pent-up opportunity here to apply technology to make health care much more productive, and that would also make health care more affordable.”

--With assistance from Hannah Recht.

This article was provided by Bloomberg News.

Source: https://www.fa-mag.com/news/the-mad-rush-to-sell-private-medicare-plans-to-seniors-52068.html

Medicare Producer News

Individual MA/MAPD, PDP:  August 28th, 2019

Pre-order enrollment kits for 2020 MA/MAPD plans

Starting on August 29, If you're "ready to sell" for 2020, you can order an initial amount of enrollment kits for 2020 Aetna Medicare plans (MA/MAPD) for the early weeks of the Annual Election Period (AEP). Follow these instructions to pre-order enrollment kits through Producer World.

Start planning your 2020 AEP marketing campaign

The 2020 Aetna Medicare Marketing Studio catalog is now available for you to review on the Studio. You can use this catalog to see what's new for 2020 to start planning your AEP marketing campaigns. As you plan for AEP, you'll also want to keep in mind the key dates below.

• Aug. 28 – Sept. 2: The Studio will be temporarily closed.
• Sept. 3:  Ready-to-sell agents can start ordering AEP materials. 
• Oct. 1: All pre-ordered materials will be shipped or mailed.
• Oct. 1: You can begin downloading materials for free.

Don't miss out on 2020 SilverScript PDP plans this AEP

In 2020, SilverScript PDP*, offered by SilverScript Insurance Company, will have two PDP options across the U.S., featuring: $0 deductible for Tier 1 and Tier 2 generics; $0 Tier 1 copays at preferred pharmacies; and copays as low as $1 on Tier 2 drugs.

Make sure you complete all ready to sell requirements for 2020 SilverScript PDP plans, including certification, before AEP. You can access certification using the "SilverScript Agent Portal" site in the quick links section on Producer World.

We're excited about 2020 AEP — check out what's new

Value-based enrollments (VBE): The VBE program is coming to more markets this AEP. Soon, you may be able to earn up to $50 more per 2020 MA/MAPD enrollment by initiating a VBE after enrolling a client in a plan on the Ascend app.

Dual-Special Needs Plans (DSNP): We're launching DSNPs with great supplemental benefits in 5 new states. DSNPs will be available in: AL, FL, GA, IA, KS, LA, MO, NC, NE, OH, PA, TX, VA and WV for 2020. 

Preview our 2020 Medicare plans and check out some of the plan highlights coming to your market this AEP. For an in-depth review of the 2020 MA/MAPD plans coming to your market, attend a product training. To find and register for an event near you, visit aetnamedicareagenttraining.com.

Quick links

• Search for providers
• Compare MA/MAPD plans and estimate costs
• 2020 MA/MAPD ready-to-sell requirements
• 2020 SilverScript PDP ready-to-sell requirements
• Complete Aetna’s 2020 producer certification
• How to submit enrollments
• Get commission reports on Producer World
• 2019/2020 Aetna Medicare Producer Guide

Need assistance? Here’s who to call (for brokers only)

Not appointed with Aetna? Request details here

Aetna has just released details on their 2020 retail program and you do not want to miss out on this exciting opportunity. Below are some highlights.

Why should I participate?

• Access to high traffic retail locations that can drive leads and sales
• Program requirements that are more relaxed than industry norms
• Cost efficient bundles that are competitively priced
• Agents have the opportunity for a $100 MMS credit

How much does it cost?

• CVS location will cost $275
• All other retail locations will cost $175

Request details today and one of our marketing representatives with send you all the details on how to participate.

We're excited to share a first look at Aetna's 2020 Individual Medicare products and service areas, which are pending government approval.* To preview 2020 plans, just go to https://firstlook.aetna.com and login with your Producer World username and password.

→ Not appointed with Aetna? Click here to request contracting.

*IMPORTANT: Aetna's First Look is for producer-use only. It's confidential and proprietary. Plan designs and service areas described on the 2020 First Look site are pending government approval and are therefore subject to change. Distribution to consumers, other insurers or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna.

2020 Aetna MA/MAPD highlights

• MA/MAPD plans will be in 46 states and D.C. - including 264 new counties
• Commissionable DSNP plans will be in 13 states, including (NEW for 2020) AL, IA, NE, NC and WV
• Value-based enrollment option is expanding to all states in our MA/MAPD footprint except WA and NC

2020 SilverScript PDP highlights

While Aetna does not have an Aetna-branded prescription drug plan (PDP) product for 2020, our parent company, CVS Health*, offers SilverScript® PDPs that you can sell. Agents must be contracted with Aetna and complete 2020 SilverScript certification prior to selling these plans. SilverScript is one of the leading PDP providers in the country, serving over 6 million people with Medicare. In 2020, SilverScript is offering two PDP options. Benefit highlights include $0 deductible for Tier 1 and Tier 2 generics; $0 Tier 1 copays at preferred pharmacies; and copays as low as $1 on Tier 2 drugs.

Login to our 2020 First Look site to learn more about plans that will be available in your market.

Not appointed with Aetna? Click here to request contracting.

Get certified to sell 2020 products

• 2020 Aetna MA/MAPD certification
• 2020 SIlverScript PDP certification: To access it, you’ll need to access a link available on Producer World.

Remember, certification is just one of the requirements you need to complete to be ready to sell this AEP. Review requirements to sell.

The producer certification process for 2020 Aetna Medicare MA/MAPD products kicks off on July 10th. Certification is one of the annual requirements you must complete to sell Aetna 2020 plans during AEP. Their 2020 producer certification includes AHIP, plus several Aetna-specific training modules, and costs only $125 (retail prices is $175).
 
So even though AHIP plans to release their 2020 courses on June 17, we encourage you to wait and complete AHIP through Aetna's certification process starting July 10. It’s an easy way to save $50.

Link to certification will be available here when launched on July 10th.

Image: www.Canva.com

We want to notify you about an issue affecting all Medicare members who elected to pay plan premiums from their Social Security Administration (SSA) or Railroad Retirement Board (RRB) check.

Background

Normally, when members select this premium payment option, the SSA/RRB withholds funds from members’ SSA/RRB checks to cover their plan premiums.

Unfortunately, due to a system issue, this did not occur for two or more months starting February 1, 2019. This issue affected all carriers, not just Aetna. Although the system issue is now fixed, the SSA/RRB cannot retroactively deduct premium payments from members’ checks.

What do members need to do?

Because these members now have past-due accounts, their premium payment method has changed to direct billing, effective February 1, 2019. This means they now need to pay any past-due premium amounts to Aetna directly.

Member communication

Members will receive a letter explaining what happened and what they need to do later this month. Letters are being mailed in waves, between May 10-24, so members will receive them over several weeks. View the member letter.

What happens next?

• We’ve already submitted a new request to restart SSA premium deduction for the affected members, effective June 1, 2019. If the request is accepted by SSA, they will send members a letter of approval. Please be aware this can take up to 90 days.
• Please explain to your clients that SSA will only deduct future premiums from their Social Security check as of the effective date noted in their approval letter, so any balances owed up until that effective date must be paid to Aetna directly. Members need to pay premiums directly to us for any months the SSA or RRB doesn’t cover.
• While these members are not currently at-risk for termination due to nonpayment, they do need to begin making payments to ensure their plan does not face termination for nonpayment in the future.

Encourage members to call us with any questions

Although this issue was out of our control, we realize it will be an inconvenience for our members. If they have any questions, please encourage them to call Member Services by dialing the number on their member ID card. The Member Services team is available 7 days a week, from 8 a.m. to 8 p.m.

As always, thank you for your dedication to our members and for your help educating them on this matter. If you have any questions, please contact the Aetna Medicare Broker Services Department at 1-866-714-9301 or brokersupport@aetna.com.

If you have Dual-eligible Special Needs Plans (DSNPs) in your market, you can now find, download, print and order DSNP marketing materials on the Aetna Medicare Marketing Studio (MMS). You can find the materials in the designated DSNP category on the MMS menu. DSNP materials include: 

Aetna is constantly adding new materials to the Studio. Make sure you check back often to find out what’s new. If you are not appointed with Aetna, Click here to request contracting and sales materials.