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Earlier this year, Bright Health Group announced it will exit six insurance markets as its financial struggles mount. Now, the insurtech has announced that it is axing its full lineup of plans on the Affordable Care Act's exchanges and cutting its Medicare Advantage (MA) offerings to two states for the 2023 plan year. The company said it plans to focus on its multipayer care model in markets where that is thriving and will have MA plans available in California and Florida for next year. The move, Bright Health Group said, will enable the company to build a stable growth trajectory with less risk, putting it on a quicker path to profitability. "This is not a decision we made lightly, but one we believe is in the best interest of progressing our mission and the next chapter of our continued story of transforming healthcare in America," Bright Health CEO Mike Mikan told investors on a call Tuesday morning. Cutting back its insurance product, Bright said, significantly reduces the amount of regulated capital the company needs, and it expects the change to release $250 million in excess regulated capital if state regulators give their approval. The company said it will continue to provide services to members through the end of the year and that it will support members in the upcoming open enrollment windows to ensure they don't face breaks in coverage. Mikan added on the investor call that value-based care models like Bright's have shown they can "deliver on the promise of better, more affordable healthcare." Putting a greater focus on the company's model allows it to expand the types of products and financing that can find success in a value-based approach. In addition to the news that it would exit certain markets, Bright Health Group also said it has raised $175 million in funding that it can use to drive toward greater profitability. The insurtech went public in June of last year, raising nearly $1 billion and setting a new high for insurance initial public offerings. The company reported a $1.2 billion loss for 2021 in its full-year earnings. And while Bright is pivoting its focus, rivals in the insurtech space aren't giving up on the exchanges. Oscar Health CEO Mario Schlosser told Fierce Healthcare that the company is bullish on the individual market and that Bright's exit opens the door for "more opportunity to assert ourselves" in the space. He did acknowledge that the ACA market can be difficult to navigate, as risk adjustment is complicated and membership fluctuates. "I think the market is in the most stable position it's been since the founding, and this should not distract from that," he said.  |
The Centers for Medicare & Medicaid Services (CMS) released the 2023 Star Ratings for Medicare Advantage (Medicare Part C) and Medicare Part D prescription drug plans to help people with Medicare compare plans ahead of Medicare Open Enrollment, which kicks off on October 15. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Star Ratings are released annually and reflect the experiences of people enrolled in Medicare Advantage and Part D prescription drug plans. The Star Ratings system supports CMS’ efforts to empower people to make health care decisions that are best for them.
People with Medicare can use the Medicare Plan Finder tool, available on Medicare.gov, to compare plan quality through the Star Ratings, along with other information, such as cost and coverage. Approximately 72% of people currently in Medicare Advantage plans that offer prescription drug coverage are enrolled in a plan that earned four or more stars in 2023. Approximately 51% of Medicare Advantage plans that offer prescription drug coverage will have an overall rating of four stars or higher in 2023.
Medicare Open Enrollment begins October 15, 2022, and ends December 7, 2022. During this time, Medicare beneficiaries can compare coverage options, including Original Medicare and Medicare Advantage, and choose high quality health and drug plans for 2023. Medicare Advantage and Part D plan costs and covered benefits can change from year to year, so Medicare beneficiaries should look at their coverage choices and decide on the options that best meet their health needs. They can visit Medicare.gov (https://www.medicare.gov), call 1-800-MEDICARE, or contact their State Health Insurance Assistance Program. 1-800-MEDICARE is available 24 hours a day, seven days a week, to provide help in English and Spanish, as well as support in over 200 languages. People who want to keep their current Medicare coverage do not need to re-enroll.
CMS released the 2023 premium and coverage information for 2023 Medicare Advantage and Part D plans on September 29, 2022. Projections for 2023 indicate lower premiums for both Medicare Advantage and basic Part D coverage compared to 2022. Additionally, starting in 2023 under the Inflation Reduction Act, people with Medicare prescription drug coverage will have improved and more affordable benefits, including a $35 cost-sharing limit on a month’s supply of each covered insulin product, as well as adult vaccines that are recommended by the Advisory Committee on Immunization Practices (ACIP) at no additional cost.
For more information on the 2023 Medicare Advantage and Part D Star Ratings, including a fact sheet, please visit: http://go.cms.gov/partcanddstarratings.
Preparation is key. Use the tools available to you to your advantage and learn what’s worked in the past, applying best practices to fuel your own success. If you’re new at this, talk to some industry veterans. If you’re tenured, reflect on what’s worked well for you in the past and explore opportunities to take your efforts to the next level this AEP.
Get a head start as much as possible. 
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A strong focus on being personable and showing empathy can go a long way toward business retention. Your future success depends on how well you do during this AEP, and you want to build on this success year after year.
