Health Plan Weekly

Despite Humana Inc.’s recently downgraded Medicare Advantage (MA) enrollment projections for 2022, Wall Street analysts praised the company’s high margins after the insurer reported fourth-quarter and full-year 2021 earnings on Feb. 2.

Humana posted earnings per share (EPS) of $1.24 for the quarter and $20.64 for the full year — both slightly above the company’s expectations — and reaffirmed its previously lowered projection of MA enrollment growth of 150,000 to 200,000 individuals in 2022.

Although Cigna Corp. ended 2021 with earnings that exceeded Wall Street expectations, the company also reported continued struggles with elevated medical costs last year. Further, the insurer disclosed that it expects less Medicare Advantage growth than it originally anticipated in 2022 and a decline in individual/family plan enrollment.

For the fourth quarter of 2021, Cigna reported adjusted earnings per share (EPS) of $4.77, beating the consensus estimate of $4.50. Cigna’s full-year adjusted EPS was $20.47, reflecting year-over-year growth of 11% that the company said was largely driven by the Evernorth health services segment.

CMS on Feb. 2 released the 2023 preliminary rate notice for Medicare Advantage plans, giving plans an average pay boost of about 8%. To arrive at an expected average change in revenue of 7.98% for 2023, CMS factored in an effective growth rate of 4.75%, which is based largely on an anticipated rise in fee-for-service Medicare costs, according to a CMS fact sheet on the subject.

Medicare Part B beneficiaries will be able to acquire over-the-counter COVID-19 tests free of charge at participating pharmacies and retailers “starting in early spring,” according to CMS. Per a CMS fact sheet, beneficiaries will not need to apply for reimbursement to get the tests: “Eligible pharmacies and other entities that are participating in this initiative to allow Medicare beneficiaries to pick up tests at no cost at the point of sale and without needing to be reimbursed.” AHIP CEO Matt Eyles applauded the move. “This is a commendable model and the right path — for Medicare-eligible people and for all Americans — to ensure equitable access, swift treatment, and an effective response to the virus,” he said in a statement.

A new biannual report to Congress from HHS and the departments of Labor (DoL) and Treasury has found that carriers and plan sponsors are generally not in compliance with recent regulations requiring health plans to document the level of access plan members have to mental health care. Experts say that carriers are largely to blame, but plan sponsors also need to make a greater effort to hold insurers accountable and meet new federal reporting requirements.

Several federal laws mandate mental health care parity: Health plans are not allowed to impose benefit limitations on mental health care that are more severe than limits placed on medical and surgical benefits.