Health Plan Weekly

Here’s how major health insurers’ stock performed in October 2023. UnitedHealth Group had the highest closing stock price among major commercial insurers as of October 31, 2023, at $535.56. Humana Inc. had the highest closing stock price among major Medicare insurers at $523.69.

A KFF report released on Nov. 8 found that 3,959 Medicare Advantage plans are available for individual enrollment next year, the second-largest number of plans since 2010 and a 1% decrease from this year.  Meanwhile, the average beneficiary will be able to choose from 43 plans, the same as this year's record high. Eighty-nine percent of MA plans will offer prescription drug coverage in 2024; while 83% will offer telehealth benefits; and at least 97% will offer some dental, vision, fitness or hearing benefits.

A group of 32 Reps. led by Jerrold Nadler (D-NY) and Judy Chu (D-CA) sent a letter on Nov. 3 to CMS Administrator Chiquita Brooks-LaSure requesting increased oversight of artificial intelligence tools (AI) used to guide coverage decisions for Medicare Advantage plans. The elected officials wrote that “in recent years, problems posed by prior authorization have been exacerbated by MA plans’ increasing use of AI or algorithmic software managed by firms such as NaviHealth, myNexus, and CareCentrix to assist in their coverage determinations in certain care settings.” They asked CMS to require MA plans to report prior authorization data, compare guidance generated by AI tools with actual coverage decisions and assess whether plans are inappropriately using AI tools.

Ahead of the 2024 open enrollment period for Affordable Care Act exchange plans that began on Nov. 1, major U.S. health insurers issued a spate of press releases touting their plan options and listing new areas in which they’d offer coverage. While ACA marketplace experts say that 2024 will not feature any seismic changes in terms of insurer competition — given the exchanges’ history of mass insurer exits and panic over “bare counties” with no available health plans, that may be a good thing. 

“Overall participation by carriers is down from last year, when there was also a slight decline,” says Katherine Hempstead, Ph.D., who for years has helped produce the Robert Wood Johnson Foundation (RWJF) ACA Marketplace Participation Tracker. “So after several years of increased entry into new states, now we have seen a real leveling off,” adds Hempstead, who is RWJF’s senior policy adviser.  

The Biden administration on Oct. 27 released a new proposed rule governing the troubled balance billing arbitration process established as part of the No Surprises Act (NSA), the 2021 law that banned surprise medical billing. Professional and trade groups for providers, which have filed legal challenges to previous rulemaking governing the arbitration process — called Independent Dispute Resolution (IDR) — declined to say whether they would challenge the proposed rule if implemented in its current form, but at least one legal expert thinks that the rule has a good chance of lasting. 

The NSA forced payers and providers to hold patients harmless, from a medical-billing perspective, when they inadvertently seek out-of-network care. Thus, the law set up the IDR process to resolve payment disputes that payers and providers are now responsible for settling themselves instead of balance-billing patients. 

Humana Inc.’s stock dipped after its third-quarter 2023 earnings report, with analysts largely blaming the firm’s revised estimate of its full-year medical loss ratio (MLR). The Medicare Advantage-focused insurer said that while it had been expecting health care utilization to stabilize, instead it continued at the elevated level that Humana first started noticing earlier in the year. 

“This morning, we reported that our insurance segment benefit ratio exceeded expectations by 40 basis points due to higher medical costs in our Medicare Advantage business,” Chief Financial Officer Susan Diamond said during the company’s Nov. 1 earnings call. “We continue to experience an increase in COVID admissions in the third quarter, whereas our forecast previously assumed that this would occur in the fourth quarter.”