By Taylor McDonald – CSG Actuarial – May 7, 2019
CSG Actuarial, with information from the NAIC and other sources, reports total earned premiums in the Medicare Supplement market in 2018 totaled $32.4 billion, a 4.9% increase over 2017. The total Med Supp lives covered in 2018 increased to 14.05 million, up 3.9% from 2017. The top 12 carriers in terms of 2018 Medicare Supplement premiums were:
The 2018 overall Med Supp market loss ratio of 79.0% reflects a continued trend in the market of the overall loss ratios creeping back up towards “Pre-Modernized” levels of around 80%.
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Walgreens Partnership Boosts Humana's Medicare Enrollment
By Bruce Jepsen – Forbes – February 7, 2019
Humana says its joint venture with Walgreens Boots Alliance is helping boost enrollment in Medicare Advantage, the fast-growing privately administered health coverage for U.S. seniors.
Humana reported a 9% increase in Medicare Advantage membership the health insurer attributed to physicians at more than 230 clinics including two sites inside Walgreens stores. It’s the latest sign showing the early stages of a joint venture between Humana and the nation’s largest drugstore chain is working and could be expanded beyond a pilot in the Kansas City market.
"Our 233 owned, joint ventured and alliance clinics, the majority of which are payer agnostic, including our two 'Partners in Primary Care' clinics inside Walgreens stores experienced positive results in the annual election period," Humana CEO Bruce Broussard told analysts Wednesday during the company's fourth quarter earnings call. "Humana MA membership grew over 9% in these clinics in the (annual election period) excluding the more mature Conviva clinics."
Humana, which has invested hundreds of millions of dollars acquiring and partnering with medical care providers in recent years, said its relationships helped it take Medicare Advantage market share away from rival insurers. Humana said it expects 2019 individual Medicare Advantage membership growth of “375,000 to 400,000 members, representing 12% to 13% growth,” the insurer reported Wednesday as part of its fourth-quarter 2018 earnings release.
Walgreens and Humana last year opened “senior-focused primary care clinics” inside drugstores as a way to complement Walgreens pharmacy services and Humana’s Partners in Primary Care centers that opened last year in Kansas City. The effort is designed in part to keep people out of the more expensive hospital setting and make sure Medicare patients have their care more closely monitored by Walgreens pharmacists and physicians in Humana’s health plan networks.
The two companies think they can do a better job of reaching patients who visit Walgreens retail locations and making sure they get better care upfront before they get sick. When the partnership was announced, Walgreens and Humana called it “a senior-focused neighborhood approach to health that brings together primary care, pharmacy, in-person health plan support and other services for Medicare beneficiaries.”
The Medicare Advantage growth is key for Humana, which is in a competitive battle with rival insurers like Aetna, UnitedHealth Group and Cigna, looking to tap into a market of more than 10,000 baby boomers aging into the Medicare population every day.
Medicare Advantage plans contract with the federal government to provide extra benefits and services to seniors, such as disease management and nurse help hotlines, with some even providing vision and dental care and wellness programs. CMS is changing regulations to allow Medicare Advantage plans to provide broader coverage in the future, which is also expected to boost enrollment. L.E.K. Consulting has projected Medicare Advantage enrollment will rise to 38 million, or 50% market penetration by the end of 2025.
Humana ended 2018 with 3.06 million individual Medicare Advantage members, which was up 7% from 2.86 million as of Dec. 31, 2017.
Cigna Plans Broader Medicare Advantage Offerings
By Bruce Jepson – Forbes – January 10, 2019
Fresh from the completion of the Express Scripts acquisition, Cigna CEO David Cordani plans to broaden the insurer’s offerings to more seniors choosing Medicare Advantage plans as part of a major business expansion in coming years.
Cigna’s disclosure this week at the JPMorgan Healthcare Conference comes as the insurer and its rivals including Aetna, Anthem, Humana and UnitedHealth Group are expanding into new geographic regions to sell more Medicare Advantage products. All of these insurers are taking advantage of a market of more than 10,000 baby boomers aging into the Medicare population every day.
“We are well positioned today and going forward for existing and new markets,” Cordani said of future MA offerings. “Today, Cigna focuses on the individual, not the group M.A. marketplace. The group M.A. marketplace presents a future growth opportunity for us.”
Cigna has more than 435,000 Medicare Advantage enrollees, which is far fewer than UnitedHealth, Aetna and Humana. But Cigna and an increasing number of other insurers see a bigger opportunity as the Centers for Medicare & Medicaid Services changes rules allowing health plans to provide richer benefit packages to attract more seniors to Medicare Advantage plans.
Cigna is also looking to offer new less restrictive health plans that allow seniors more choices outside of health plan networks by introducing preferred provider organization (PPO) plans for Medicare Advantage enrollees. Unlike PPOs, HMOs restrict doctor choices to their networks. Cordani didn’t disclose a timetable for the PPO offerings.
“Today, Cigna participates largely in the individual HMO portion of the marketplace, not the individual PPO part of the marketplace,” Cordani said. “That presents additional growth opportunity for us as we go forward, but that growth is built off of the success of the individual HMO market.”
Medicare Advantage plans contract with the federal government to provide extra benefits and services to seniors, such as disease management and nurse help hotlines with some even providing vision and dental care and wellness programs.
There are now more than 22 million Americans enrolled in privately-administered Medicare Advantage plans for 2019 with the number expected to continue to rise. Medicare Advantage enrollment will rise to 38 million, or 50% market penetration by the end of 2025, according to a report from L.E.K. Consulting.
Cigna also sees an opportunity as Medicare moves to value-based payment models and away from traditional fee-for-service reimbursement that has been shown to lead to unnecessary tests and procedures due to its emphasis on volume of care delivered.
Cordani said 85% of Cigna's Medicare Advantage “customers are in aligned value-based relationships.” “Those are very important in terms of how our model works: hand in glove with high-performing physician organizations and integrated hospital systems for the benefit of our M.A. customers,” Cordani said.
Cigna closes $67B Express Scripts acquisition, promising affordability and choice
Express Scripts is now part of Cigna after the $67 billion acquisition closed on Thursday. (Express Scripts)
By Evan Sweeney – FierceHealthCare – December 20, 2018
Cigna officially absorbed one of the largest pharmacy benefit managers in the country on Thursday, closing its $67 billion purchase of Express Scripts.
The acquisition gives Cigna significant leverage in a market in which insurers are increasingly partnering, acquiring or being bought by PBMs. With Express Scripts under its wing, Cigna joins CVS, UnitedHealth and Humana and Anthem as the primary vertically integrated powerhouses in the insurance industry.
Combined, Cigna and Express Scripts brought in more than $141 billion in revenues in 2017. In a statement, Cigna said the merger will "dramatically accelerate the number and breadth of value-based relationships."
“Today’s closing represents a major milestone in Cigna’s drive to transform our healthcare system for our customers, clients, partners and communities," Cigna President and CEO David M. Cordani said in a statement.
Best Insurance Companies for
Medicare eligible beneficiaries can enroll in a Medicare Advantage plan from a private insurance company instead of choosing Original Medicare Parts A and B. U.S. News provides a tool for Medicare-eligible beneficiaries to find the best Medicare plans for their needs. All plan information and star ratings come directly from the Center for Medicare and Medicaid Services (CMS) at Medicare.gov.
U.S. News analyzed insurance companies’ offerings in each state based on their CMS star ratings, and below provides a list of the Best Insurance Companies for Medicare Advantage. A Best Insurance Company for Medicare Advantage is defined as a company whose plans were all rated as at least three stars by CMS and whose plans have an average rating of 4.5 or more stars within the state. Read more about our methodology.
Click the links below to view the individual plans and their CMS star ratings. We also highlight Best Insurance Companies for Part D Prescription Drug Plans.
Other insurance companies have 5-star rated plans. Anyone researching Medicare Advantage plans should compare individual plans offered in their service area.
Every Year, Medicare evaluates plans based on a 5- star rating system. This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800- MEDICARE (TTY users should call 1-877- 486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
Medicare Market Insights and
Medicare Advantage (MA) plans have been eagerly preparing their Medicare products in anticipation of the 2019 Annual Election Period (AEP) which is now upon us. The 2019 Medicare Advantage market is comprised of national health plans, Blue Cross Blue Shield organizations, prominent regional health plans and specialized Medicare companies. MA plans currently provide medical coverage for over 21.5 million beneficiaries. In the last three years, these plans have collectively increased enrollment by approximately 3.7 million members and currently cover over 34% of the nearly 63 million people eligible for Medicare benefits.
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™ , 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 2019 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 AEP.
The Competitive Medicare Landscape
MA plans, along with stand-alone PDPs (prescription drug plans), are immersed in competitive assessments as beneficiaries begin to choose plans during this Annual Election Period, which runs between October 15th and December 7th. Based on an aggregate analysis of CMS Landscape reports, a total of 3,810 distinct Medicare Advantage (MA) plan offerings are in the market lineup for the onset of the 2019 AEP. This includes MA plans, Medicare Advantage with prescription drug plans (MAPDs), Medicare/Medicaid plans (MMPs), and Special Needs Plans (SNPs). 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, 2019.
MFA’s analysis of CMS landscape data found a total of 3,077 MA plans being offered for 2019, including MMPs, up from 2,619 in 2018. In addition, a total of 733 Special Needs Plans (SNPs) are available in 2019, up from 640 in 2018. Health Maintenance Organizations (HMOs) represent 68% of all MA plan types with over 2,600 offerings for the coming year. Stand-alone PDPs nationwide increased for 2019 with 910 plan offerings, as compared to 795 plans in 2018.
According to the CMS press release, Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019 ; Medicare Advantage average monthly premiums will decrease 6% from 2018, falling to $28. Enrollment is projected to experience 11.5% growth over 2018. In addition, over 91% of people with Medicare will have access to 10 or more Medicare Advantage plans, which is up from 86% for 2018.
Plan Competition for 2019
Based on the 2019 CMS Landscape reports, Humana continues to market more MA plans than any other company nationwide, with 548 distinct plans identified in MFA’s assessment. UnitedHealth continued to increase its MA plan offerings for the 2019 calendar year with 406 distinct plans identified, up 62 plans from last year. Aetna (including Coventry and other affiliates) is offering 355 plans for 2019. Anthem and the vast majority of other Blue Cross Blue Shield plans as well as WellCare and Centene also continue to have a notable plan offerings presence, respectively.
Read the full article here
Medicare Advantage / AEP Updates:
The 2019 Medicare Star Ratings Program: Making the Cut
The Centers for Medicare & Medicaid Services (CMS) last week published its 2019 Part C and Part D Medicare Star Ratings data and, along with it, the Technical Notes describing the methodology for the Star Ratings. Here, Ashley McNairy, product director for Cotiviti’s Government Quality solutions, breaks down the changes to the cut points, which can have a significant impact on a health plan’s score.
Cut points are the ranges within which a measure’s score needs to fall in order to be assigned a certain star value. As an example, here is the cut point range for Breast Cancer Screening (C01), which measures the percentage of female plan members aged 52 to 74 who had a mammogram during the past two years:
Every year, CMS adjusts these ranges slightly based on how the measures are trending. As the industry’s performance improves in a specific metric, in other words, you can expect the ranges to increase, so it becomes harder for a plan to hit the five-star mark.
Many health plans and analysts try to predict how these cut points may change year over year, as even a 1 percent change in a measure’s cut point range could drop the plan’s rating from five stars to four stars for that measure—or potentially even drop the plan’s overall rating.
Out of the 46 Part C and Part D measures that have carried over from 2018 to 2019, almost half have higher ranges in at least one of the thresholds. Some measures only moved one or two points in a couple thresholds; however, in general the two- and three-star ranges are higher, whereas the four- and five-star ranges were closer to last year’s cut points. This simply means it is harder to get even a two-star rating in several measures.
The most notable shift to higher cut points was the Medication Reconciliation Post-Discharge measure (C20), as each cut point threshold jumped at least 10 percent. As a measure that was only first introduced in 2018, this dramatic change could indicate that the cut points were simply too low in the first year, or that plans are exceeding expectations. These ranges will likely continue to grow, with plans’ measure scores averaging 56 percent for 2019 compared to 50 percent for 2018.
The other notable shift in cut points occurred in the three Care for Older Adult measures (C09-C11). These measures are required for Special Needs Plans (SNPs), which make up about 40 percent of all contracts. Both Medication Review and Functional Status Assessment had lower thresholds in the two- and three-star ranges, but stayed relatively the same in the four- and five-star ranges. For example, a plan only needs to achieve a 1 percent score to earn two stars for Medication Review, whereas last year plans needed to hit 59 percent. This seems like an odd starting point for a threshold in a measure where the average score improved from 90 percent to 92 percent this year. Alternatively, the Pain Assessment measure, which also saw average scores improved, shifted to higher cut points across each threshold.
Only one measure’s cut points stayed exactly the same: the Part C Customer Service measure, which is part of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Cut points for this measure stayed the same even as the other CAHPS measures all experienced slight changes. This could be due to overall health plan performance averaging the same for this measure for both 2018 and 2019.
With the quality of care in Medicare Advantage plans increasing each year and becoming more competitive for both market share and rebates, plans are understandably looking for more predictability in their Star Ratings. Out of the Cotiviti clients that had enough data for either an overall Summary Rating or a Part D score, 13 percent increased their rating, with several being either a four-and-a-half- or five-star plan. The majority of plans that worked with Cotiviti received the same rating as in 2018, which is a success to celebrate considering the many hurdles that plans have to overcome each year as the thresholds change.
Star Navigator is a quality improvement solution that enables Medicare Advantage plans to determine the most direct path to higher Star Ratings, then track and communicate their progress toward goals. Learn more from our fact sheet.
Medicare Advantage Riding High As New Insurers Flock To Sell To Seniors
Health care experts widely expected the Affordable Care Act to hobble Medicare Advantage, the government-funded private health plans that millions of seniors have chosen as an alternative to original Medicare.
To pay for expanding coverage to the uninsured, the 2010 law cut billions of dollars in federal payments to the plans. Government budget analysts predicted that would lead to a sharp drop in enrollment as insurers reduced benefits, exited states or left the business altogether.
But the dire projections proved wrong.
“The Affordable Care Act did not kill Medicare Advantage, and the program looks poised to continue to grow quite rapidly,” said Bill Frack, managing director with L.E.K. Consulting, which advises health companies.
And as beneficiaries get set to shop for plans during open enrollment — which runs from Monday through Dec. 7 — they will find a greater choice of insurers.
Fourteen new companies have begun selling Medicare Advantage plans for 2019, several more than a typical year, according to a report out Monday from the Kaiser Family Foundation. (KHN is an editorially independent part of the foundation.)
Overall, Medicare beneficiaries can choose from about 3,700 plans for 2019, or 600 more than this year, according to the federal government’s Centers for Medicare & Medicaid Services.
CMS expects Medicare Advantage enrollment to jump to nearly 23 million people in 2019, a 12 percent increase. Enrollees shopping for new plans this fall will likely find lower or no premiums and improved benefits, CMS officials say.
With about 10,000 baby boomers aging into Medicare range each day, the general view of the insurance industry, said Robert Berenson, a Medicare expert with the nonpartisan Urban Institute, “is that their future is Medicare and it’s crazy not to pursue Medicare enrollees more actively.”
Bright Health, Clover Health and Devoted Health, all for-profit companies, began offering Medicare Advantage plans for 2018 or will do so for 2019.
Mutual of Omaha, a company owned by its policyholders, is also moving into Medicare Advantage for the first time in two decades, providing plans in San Antonio and Cincinnati.
Some nonprofit hospitals are offering Medicare plans for the first time too, such as the BayCare Health system in the Tampa, Fla., area.
While Medicare beneficiaries in most counties have a choice of several plans, enrollment for years had been consolidated into several for-profit companies, primarily UnitedHealthcare, Humana and Aetna, which have accumulated just under half the national enrollment.
These insurance giants are also expanding into new markets for next year. Humana in 2019 will offer its Medicare HMO in 97 new counties in 14 states. UnitedHealthcare is moving into 130 new counties in 13 states, including for the first time Minnesota, its headquarters for the past four decades.
Seniors have long been attracted to Advantage plans because they often include benefits not available with government-run Medicare, such as vision and dental coverage. Many private plans save seniors money because their premiums, deductibles and other patient cost sharing are lower than what beneficiaries pay with original Medicare. But there is a trade-off: The private plans usually require seniors to use a restricted network of doctors and hospitals.
The federal government pays the plans to provide coverage for beneficiaries. When drafting the ACA, Democratic lawmakers targeted the Medicare Advantage plans because studies had shown that enrollees in the private plans cost the government 14 percent more than people in the original program.
Medicare plans weathered the billions in funding cuts in part by qualifying for new federal bonus payments available to those that score a “4” or better on a five-notch scale of quality and customer satisfaction.
Health plans also gained extra revenue by identifying illnesses and health risks of members that would entitle the companies to federal “risk-adjustment” payments. That has provided hundreds of billions in extra dollars to Medicare plans, though congressional analysts and federal investigators have raised concerns about insurers exaggerating how sick their members are.
A study last year found that those risk adjustments could add more than $200 billion to the cost of Medicare Advantage plans in the next decade, despite no change in enrollees’ health.
For-profit Medicare Advantage insurers made a 5 percent profit margin in 2016 — twice the average of Medicare plans overall, according to the Medicare Payment Advisory Commission, which reports to Congress. That’s slightly better than the health insurance industry’s overall 4 percent margin reported by Standard & Poor’s.
Betsy Seals, chief consulting officer for Gorman Health Group, a Washington company that advises Medicare Advantage plans, said many health plans hesitated to enter that market or expand after President Donald Trump was elected because they weren’t sure the new administration would support the program. But such concerns were erased with the announcement on 2019 reimbursement rates.
“The administration’s support of the Medicare Advantage program is clear,” Seals said. “We have seen the downstream impact of this support with new entrants to the market — a trend we expect to see continue.”
Getting Consumers To Switch
Since the 1960s, Mutual of Omaha has sold Medicare Supplement policies — coverage to help beneficiaries in government-run Medicare pay the portion of costs that program doesn’t pick up. But the company only briefly entered the Medicare Advantage business once — in its home state of Nebraska in the 1990s.
“In the past 10 or 20 years it never seemed quite the right time,” said Amber Rinehart, a senior vice president for the insurer. “The main hindrance was around the political environment and funding for Medicare Advantage.”
Yet after watching Medicare Advantage enrollment soar and government funding increase, the insurer has decided now is the time to act. “We have seen a lot more stability of funding and the political tailwinds are there,” she said.
One challenge for the new insurers will be attracting members from existing companies since beneficiaries tend to stick with the same insurer for many years.
Vivek Garipalli, CEO of Clover Health, said his San Francisco-based company hopes to gain members by offering low-cost plans with a large choice of hospitals and doctors and allowing members to see specialists in its network without prior approval from their primary care doctor. The company is also focused on appealing to blacks and Hispanics who have been less likely to join Medicare Advantage.
“We see a lot of opportunity in markets where there are underserved populations,” Garipalli said.
Clover has received funding from Alphabet Inc., the parent company of Google. Clover sold Medicare plans in New Jersey last year and is expanding for 2019 into El Paso, Texas; Nashville, Tenn.; and Savannah, Ga.
Newton, Mass.-based Devoted Health is moving into Medicare Advantage with plans in South Florida and Central Florida. Minneapolis-based BrightHealth is expanding into several new markets including Phoenix, Nashville, Cincinnati and New York City.
BayCare, based in Clearwater, Fla., is offering a Medicare plan for the first time in 2019.
“We think there is enough market share to be had and we are not afraid to compete,” said Jim Beermann, vice president of insurance strategy for BayCare.
Hospitals are attracted to the Medicare business because it gives them access to more of premium dollars directed to health costs, said Frack of L.E.K. Consulting. “You control more of your destiny,” he added.
The 2019 AEP is quickly approaching - Are you ready?
With the Annual Enrollment Period just weeks away, it is important to make the best use of the limited window you have. It’s a stressful, pressure-packed time of year for agents in the senior market who can’t afford mistakes that force them to take finite time away from selling to deal with issues, or not having a solid strategy in place to ensure their time is being spent efficiently.
By now you should already be familiar with the different plans and benefits for the companies you intend to sell. If you are not, feel free to contact us and we can walk you through all the options available. It is also important to know the Do's and Don'ts in regards to CMS Guidelines to stay compliant. Below are some helpful reminders to make sure you are as productive as possible this AEP and stay within the required guidelines.
Helpful Reminders / Links:
Let PSM be your one stop shop for all your AEP Needs. We have a dedicated and knowledgeable staff ready to assist to make sure this is your best season yet. Email us at firstname.lastname@example.org or call us at 800-998-7715 for assistance.
We appreciate the opportunity to be a resource for your business and wish you the best of luck this AEP. Happy selling!