Anthem's government business fueled the bulk of its enrollment growth in 2020 as commercial enrollment was stagnant. Overall, Anthem's government business experienced a growth of nearly 17% year over year from 2019 to 2020, while the commercial and specialty unit increased just 0.2%. As part of this latest deal, Anthem is poised to add more than 572,000 government members, a significant one-time pickup. Anthem is set to gain more than 267,000 MA members in the MMM plan, which is the ninth-largest MA plan in the country, according to Anthem, which ended 2020 with 1.4 million MA members, a nearly 18% increase from 2019. Its Medicaid book of business will add more than 305,000 members through the deal, which needs approval from various regulators including the Commonwealth of Puerto Rico. Anthem's Medicaid business pegged enrollment at nearly 9 million at the end of 2020, about a 22% increase from its 2019 Medicaid enrollment. 2021 EPS guidance will not change as a result of the acquisition, Anthem said. Anthem cut its outlook for 2021 as it experienced a rebound in care in the fourth quarter, which weighed heavily on its quarterly profit. Although some insurers reported large profits during periods of 2020 as members deferred care due to the pandemic, companies have warned the trend will ultimately swing in the opposite direction when patients return for care they put off. Insurers expect some members may even be sicker as diagnoses went undetected. Anthem is acquiring the units from InnovaCare and its equity investor Summit Partners, which has invested in a slew of healthcare companies, including U.S. Renal Care, a dialysis operator and MD VIP, a concierge physician practice. Sources: https://www.modernhealthcare.com/insurance/anthem-picks-up-medicaid-plans-puerto-ric ![]() |
Medicare Blog | Medicare News | Medicare Information
Anthem to acquire largest Medicare Advantage plan in Puerto Rico
Posted by www.psmbrokerage.com Admin on Wed, Feb 03, 2021 @ 03:03 PM
|
Tags: Medicare Advantage, Anthem
A closer look at MOOP increases and the Part D Savings Model
Posted by www.psmbrokerage.com Admin on Wed, Feb 03, 2021 @ 10:23 AM
In 2020, more carriers, agencies, and consultants relied on the decision-making power of this study than ever before. Deft's first Executive Research Brief takes a closer look at key report findings linked to CMS benefit design changes. For the 2021 plan year, CMS increased the top value for maximum out of pocket (MOOP) from $6,700 to $7,550. CMS also instituted a Part D Savings Model which limits some insulin copayments to $35. Deft's study reveals the impact on consumers when MAPD's act on these changes.
Get the Research Brief here. Source: https://www.deftresearch.com/ ![]() |
Humana to open 100+ Medicare centers by 2023
Posted by www.psmbrokerage.com Admin on Mon, Feb 01, 2021 @ 02:58 PM
Humana is on track to open more than 100 Medicare centers by 2023 through its Partners in Primary Care business, the insurer said last week. Partners in Primary Care is a payer-agnostic unit of Humana. The centers focus on providing care to about 57,000 patients who have Medicare Advantage and original Medicare coverage. The centers are generally located in underserved areas that have lacked access to primary care for seniors on Medicare. All of the centers are staffed by physicians and care teams that specialize in caring for seniors. The physicians work on creating care plans for patients, including help for patients with social, behavioral and financial needs. Virtual visits are also offered to patients. In 2021, Humana plans to open up to 20 centers. They will include Humana's first centers in Atlanta and expansions in Las Vegas, Houston and Louisiana. Humana opened 15 centers in 2020. The planned centers will bring the total number of primary care centers to nearly 80 across nine states. Read more here. Source: https://www.beckershospitalreview.com/payer-issues/humana-to-open-100-medicare-centers-by-2023.html ![]() |
Tags: Humana, Medicare Advantage
Anthem's Medicare Advantage membership up 18% in 2020
Posted by www.psmbrokerage.com Admin on Wed, Jan 27, 2021 @ 03:55 PM
At Anthem, for instance, enrollment in MA was up nearly 18% at the end of 2020 compared to the year before, reaching 1.4 million members. Total Medicare enrollment, including both MA and supplement plans, was also up more than 11% at the end of 2020, Anthem told investors on Wednesday, reaching 2.4 million. "We're pleased with our continued growth in this important segment for Anthem," CEO Gail Boudreaux said on the insurer's earnings call. Chief Financial Officer John Gallina told investors that Anthem is also "projecting double digital growth at the midpoint" of 2021 for Medicare Advantage, and that the company expects "continued, measured growth" over the course of the year in MA. Boudreaux added that the insurer's Essential Extras offering in Medicare Advantage drew significant interest in 2020, with a 300% increase in members selecting a benefit through the program. In eligible plans, members have the option of choosing coverage for a number of services depending on their needs or desires, ranging from transportation to a health and fitness tracker to assistance from a personal home helper. Anthem's Q4 earnings miss Wall Street estimations Anthem reported $551 million in profit for the fourth quarter of 2020, falling short of Wall Street analysts' predictions. That marks a 41% drop in profit compared to the fourth quarter of 2019, when Anthem brought in $943 million in profit, according to the company's earnings report released Wednesday morning. Anthem earned $4.6 billion for full-year 2020, a slight dip compared to earnings of $4.8 billion in 2019, the company said. Many insurers warned that their fourth-quarter financials may be less than stellar as healthcare utilization returns to near-normal levels and costs related to COVID-19 mount. Anthem CEO Gail Boudreaux said in a statement that despite the challenge of the pandemic, the company performed strongly over the course of the year. “Despite uncertainties with the pandemic, Anthem delivered strong growth across all of our businesses in 2020 reflecting the diversity and strength of our portfolio and our unwavering commitment to those we serve,” said Boudreaux. “I am proud of all that we accomplished during this challenging time, and we remain focused on supporting our members, customers and communities as a trusted health partner.” Anthem reported $31.8 billion in revenue for the quarter, which did surpass analysts' expectations. That figure represents a 16% increase in revenue compared to the fourth quarter of 2019 when the insurer brought in $27.4 billion. Total revenue for 2020 was $121.9 billion, an increase of 17% compared to 2019's $104.2 billion in revenue, Anthem said. Anthem also added 1.9 million members over the course of 2020, bringing its total membership to 42.9 million as of Dec. 31. For 2021, Anthem expects earnings in excess of $24.50 per share and operating revenues of approximately $135.1 billion. Source: https://www.fiercehealthcare.com/payer/anthem-misses-wall-street-predictions-551m-q4-profits ![]() |
Tags: Medicare Advantage, Anthem
CMS Boosts Medicare Advantage Rates, Cites COVID Costs
Posted by www.psmbrokerage.com Admin on Mon, Jan 25, 2021 @ 04:01 PM
By Lauren Flynn Kelly CMS on Jan. 15 released the 2022 Medicare Advantage and Part D Rate Announcement, indicating that MA organizations will see an average reimbursement increase of more than 4%. At the same time, CMS issued a 272-page rule finalizing several Part D policies that will largely apply to the 2022 plan year. Although neither document contained anything “earth shattering,” the hefty pay increase is welcome news to plans as they face cost unknowns due to the ongoing COVID-19 pandemic, suggests Milliman Principal and Consulting Actuary Brad Piper. Two factors that appeared to contribute to the higher-than-anticipated payment increase are the fee-for-service (FFS) Medicare growth rate, which was estimated to be 4.55% in the Advance Notice and was 5.59% in the final rate notice, and a slightly smaller dent in reimbursement due to an average reduction in star ratings of 0.28%, compared with CMS’s original projection of 0.34%. All-in, the agency projected an average change in revenue of 4.08% for 2022. The agency’s rate estimates also considered the impact of COVID-19 on health care costs. As the pandemic drags on, some of the care that patients put off in 2020 “is now assumed to be deferred until a later date, and that deferred care is now expected to be more intensive than was assumed in the Advance Notice,” CMS explained. On the Part D side, CMS finalized the use of the updated RxHCC risk adjustment model, using diagnosis data from 2017 FFS claims and MA encounter data submissions, along with expenditure data from 2018 prescription drug events. With this update, “it looks like they decided to use four years of [claims/encounter] data and drop off 2015,” which is when CMS began mandating the use of ICD-10 in medical coding in Medicare, points out Shelly Brandel, who is also a principal and consulting actuary with Milliman. Regarding risk adjustment in MA, however, CMS did not follow commenters’ suggestions to address the potential negative impact of the pandemic on risk scores. Nevertheless, the rate increase is higher than those of the previous three years, serving to ease some concerns related to costs, as plans in 2022 can expect to pay for COVID-19 vaccines and the return of some deferred care, observes Piper. Source: https://aishealth.com/medicare-and-medicaid/cms-boosts-medicare-advantage-rates-cites-covid-costs/ ![]() |
Tags: Medicare Advantage
Medicare Advantage Star Ratings: 30 measures to know for 2022
Posted by www.psmbrokerage.com Admin on Fri, Jan 22, 2021 @ 02:23 PM
CMS ranks Medicare Advantage on a quality scale of one to five stars, with five representing excellent performance and one reflecting poor performance. To assign stars, Medicare analyzes how health plans perform on certain measures. At the contract level, CMS only includes the measure if numeric value scores are available for both the current year and prior years. The 30 measures that will be used to calculate the 2022 Star Ratings for Medicare Advantage plans are below. Several of the values aren't included in the Categorical Adjustment Index, which CMS introduced in 2017 to account for how socioeconomic factors affect Star Ratings.
View a full list of the measures here. ![]() |
Tags: Medicare Advantage
Top 10 Benefits of YourMedicare Electronic Enrollment Center
Posted by www.psmbrokerage.com Admin on Fri, Jan 22, 2021 @ 09:47 AM
Top 10 Benefits of YourMedicare Electronic Enrollment Center
Saves Client Prescription Drug Data – Since Medicare.gov no longer saves prescription drug data; you can enter data and be able to retrieve your client’s drug data securely. You can then quote multiple plans at the same time. Efficient – Save time, money and create more opportunity; you provide a compliant phone presentation, answer the beneficiary’s questions and your client can self-enroll. Electronic Scope of Appointment – Allows you and your client to complete a scope of appointment (SOA) electronically and save it in the client’s YourMedicare profile. You can print or store the electronic Scope of Appointment. Following CMS guidelines, the SOA is stored for ten years. Quote and Enroll from One Website – Most MA and PDP carriers that you are appointed with through Stephens-Matthews will appear as options when you run quotes for your clients. Compare Carrier Value – This enrollment tool will display the client’s current plan and compare it against our available plans and show the cost savings and benefits from one plan versus another. Email Signature – Allows you to send an email link to your client so the client can digitally sign and self-enroll. Text Message Signature – After obtaining the consumer’s permission, you can send a text message signature link allowing a self-enrollment with a digital signature. PURL Option – Allows you to have a unique personalized URL (Personalized Landing Page). With your unique PURL, clients can compare plans and digitally self-enroll. You maintain Agent of Record status and commissions are linked to you. All Applications are Stored – Enrollment system provides a cloud based application storage center that meets CMS’ mandatory 10 year record retention guideline. You can download the application for your records. ![]() |
Tags: Online Enrollment, Medicare Advantage, online sales, YourMedicare
CMS releases 2022 rates for Medicare Advantage, Part D: 5 things to know
Posted by www.psmbrokerage.com Admin on Tue, Jan 19, 2021 @ 01:54 PM
Five things to know:
Read more here. ![]() |
4 Positive Trends That Continue to Define Medicare Advantage Plans
Posted by www.psmbrokerage.com Admin on Tue, Jan 19, 2021 @ 10:43 AM
Medicare Advantage plans have diverse member populations, low member spending, high quality of care, and high enrollment growth. Four trends have continued to define the Medicare Advantage space in recent years, fact sheets from the Alliance of Community Health Plans (ACHP) revealed. “Congress created Medicare Advantage (MA) in 2003 to provide America’s seniors a convenient, coordinated option for their health coverage and to drive greater value and accountability in the Medicare program,” an ACHP fact sheet began. “Today, the evidence is clear: MA is working, providing exceptional coverage and care for nearly 23 million seniors.” Four fact sheets from ACHP revealed how diversity, lower out-of-pocket healthcare spending, high quality of care, and strong enrollment growth have continued to characterize Medicare Advantage plans. Diverse member populationMedicare Advantage plans continue to serve a diverse member population, compared to traditional Medicare. The Medicare Advantage population included around 25 million seniors in 2020. Of those, over 60 percent were women. READ MORE: How Non-Profit Medicare Advantage Plans Can Improve Growth Research from previous years also demonstrated that minority communities have been strongly represented in the Medicare Advantage member population. Around half of all Hispanic American seniors (52 percent) and African American seniors (49 percent) chose Medicare Advantage over Medicare when they became eligible. Over a third of all Asian Americans selected Medicare Advantage plans (35 percent). The percentage of Medicare Advantage enrollees who are people of color has increased over time. From 2013 to 2018, the share of enrollees who were people of color grew by more than 37 percent. Slightly over half of all seniors in Medicare Advantage plans made less than $30,000 per year. A little more than a quarter of Medicare Advantage members had an income of $50,000 per year or more (28 percent). Lower senior spendingSix in ten seniors did not have a premium for their Medicare Advantage plan, one ACHP fact sheet shared. Seniors also experienced lower healthcare costs due to the Medicare Advantage out-of-pocket healthcare spending cap. READ MORE: Medicare Advantage Quality of Care Surpasses Traditional Medicare A separate report by UnitedHealth Group discovered that 3.5 percent of traditional Medicare beneficiaries spent more than Medicare Advantage members. Whereas these traditional Medicare beneficiaries were spending around $12,000 in out-of-pocket healthcare spending, Medicare Advantage members had an out-of-pocket healthcare spending limit of $6,700. Medicare Advantage members were not the only stakeholders who saved on healthcare spending due to their health plan selection, the ACHP fact sheets stated. Medicare Advantage cost taxpayers 9.5 percent less than traditional Medicare did. This statistic included the costs of Medicare Advantage plans’ extra benefits. Traditional Medicare saw an improper payment of 6.7 percent in 2020, compared to Medicare Advantage’s 6.0 percent improper payment rate. “MA incentivizes health plans, providers and health systems to closely coordinate care to improve health outcomes and reduce costs,” the ACHP fact sheet argued. “In areas where MA is prevalent, doctors employ those innovations learned with MA when caring for patients in traditional Medicare – creating efficiencies and providing higher quality care.” Higher quality of careThe Medicare Advantage Star Ratings system incentivizes Medicare Advantage plans to value quality over quantity, another ACHP fact sheet confirmed. READ MORE: Prescription Coverage Draws Beneficiaries to Medicare Advantage Almost eight in ten Medicare Advantage members (78 percent) were in a Medicare Advantage plan that boasted 4 stars or more, 52 percent more than when the Medicare Advantage Star Ratings system started eight years prior. Nearly all Medicare Advantage members were satisfied with their health plan (99 percent), whereas 85 percent of traditional Medicare beneficiaries expressed satisfaction. Medicare Advantage plans’ higher quality care was perhaps most evident in their low hospitalization rates. Medicare Advantage plans had a 57 percent lower unnecessary hospitalization rate than Medicare did, the ACHP fact sheet explained. High enrollment growthMedicare Advantage plans also experienced high enrollment growth. From 2013 to 2020, Medicare Advantage saw a 60 percent increase in its enrollment. Medicare Advantage members also had more Medicare Advantage health plan options in which to enroll. In the past nine years, the number of Medicare Advantage plans rose 161 percent. The Better Medicare Alliance found that the number of Medicare Advantage plans has increased 49 percent since 2017 alone. The trend is expected to continue, with experts predicting that Medicare Advantage will hit 33 million enrollees by 2030. Meanwhile, enrollment in traditional Medicare dropped more than 100,000 beneficiaries in 2019, a separate ACHP fact sheet stated. Looking to the future, payer experts have predicted that improving member experience for dual eligibles will be a significant focus for Medicare Advantage plans. “Duals are unique: they have to work with the state, they have to work through federal,” Mike Polen, senior vice president and chief executive officer of Medicare at Centene, told HealthPayerIntelligence. “What you're continuing to see is the need to integrate those two programs together so that the member has a seamless overall experience. Again, the focus is on being able to coordinate their care better than they currently are today, looking for solutions where you're integrating the various state and federal programs together, which ultimately should reduce costs and improve quality for the member.” This group also presents an opportunity for Medicare Advantage plans to boost enrollment even further, an analysis by LEK Consulting added. ![]() |
Tags: Medicare Advantage
CMS: Medicare Advantage, Part D plans to see 4% pay bump in 2022
Posted by www.psmbrokerage.com Admin on Tue, Jan 19, 2021 @ 10:27 AM
According to a Centers for Medicare & Medicaid Services (CMS) fact sheet, the agency is expecting payments to rise by 4.08% in 2022, up from 2.82% as proposed in its advance notice. CMS said in an announcement that it is releasing the rates three months earlier than is normal to give plans more time to formulate bids amid the COVID-19 pandemic. Bids are due June 7. Administrator Seema Verma said these results further highlight the administration's efforts to introduce greater flexibility into Medicare Advantage and Part D. RELATED: CMS finalizes rule that forces Part D plans to launch price comparison tool for members “The vindication of our fresh approach to healthcare policy, one that discards the consensus of the last several decades—prescriptiveness, overregulation, and micromanagement from Washington D.C. at every turn—is complete and undeniable," Verma said in a statement. “CMS’ efforts to lower prices and improve benefits has delivered historic results.” In the fact sheet, CMS also said that it will complete phasing in the 2020 CMS-HCC risk adjustment model as mandated under the 21st Century Cures Act. The agency first began rolling out the model for the 2020 plan year. This will mark a departure from the 2021 plan year, for which 75% of risk scores were calculated using the 2020 model and 25% were calculated using the 2017 iteration of the CMS-HCC model. As such, risk adjustment for 2022 will rely fully on Medicare Advantage encounter data and fee-for-service claims for diagnoses, CMS said. Source: https://www.fiercehealthcare.com/payer/cms-medicare-advantage-part-d-plans-to-see-4-pay-bump-2022 ![]() |