Health Plan Weekly

For the Medicare Advantage industry, change wasn’t a major outcome of the Biden administration’s first year in office. But for 2022, MA organizations face a host of unknowns — such as potential risk adjustment and star ratings changes that could impact plan revenue — and challenges that include staying competitive in an increasingly rich benefits landscape. For AIS Health’s annual roundup of perspectives on the year ahead, industry experts weigh in on how doing business in 2022 might differ from previous years.

AIS Health: What do you view as some of the biggest challenges or uncertainties facing MAOs in 2022?

Although the pandemic-driven economic crisis led to a massive increase in unemployment, loss of commercial health coverage has not been as great as predicted, and enrollment has rebounded over the past year. Meanwhile, the launch of a special enrollment period for the federal health insurance exchange and the temporarily expanded premium subsidies in the individual market led to membership growth in managed Medicaid and exchange plans, according to AIS’s Directory of Health Plans. Among the top five Blue Cross Blue Shield plans, all but BCBS of Illinois saw enrollment increases compared with December 2020.

Humana Inc. said it is decreasing its net membership growth estimate for its individual Medicare Advantage products, sending the insurer’s stock tumbling. In a Jan. 6 filing with the Securities and Exchange Commission, Humana said it now expects to add 150,000 to 200,000 members to its individual MA plans in 2022, down from a range of 325,000 to 375,000 members. The company said its revised estimate “is primarily attributable to higher than anticipated terminations during the AEP [annual election period], combined with the expectation of higher than originally projected terminations for the remainder of 2022.”

Carriers and plan sponsors are taking stock of what federal policies deserve a fresh look as they work though tumultuous events like the pandemic and the telehealth boom. In the next year, major industry trade groups plan to push for policies including drug price reform and comprehensive telehealth regulation.

For the Alliance of Community Health Plans (ACHP), a trade group of nonprofit carriers, top priorities include changing Medicare Advantage risk adjustment rules to account for audio telehealth encounters, making some pandemic-era rules for telehealth permanent and passing drug price reforms. (ACHP also laid out more priorities in a Dec. 9 blog post.)

Recently, CMS revealed that private health plans had to deliver $2 billion in rebates to their customers for the 2020 reporting year, with the bulk of that money going toward individual market enrollees. Affordable Care Act experts say that while the large rebate payout does mean premiums have been overpriced, it’s also indicative of just how profitable the ACA exchanges have become for insurers.