Health Plan Weekly

✦ Medicare Advantage (MA) enrollment grew by 9.4% year over year in February 2020, covering approximately 24.4 million lives, according to an analysis by Axios. The growth rate increased from 2019’s 6.8% enrollment rise. UnitedHealth Group Inc. maintained its position as the top MA payer, with approximately 6.3 million lives, a 10% increase from last year. Read the Axios story at https://bit.ly/2I0ky88.

✦ The rate of Alzheimer’s and dementia diagnoses in commercially insured Americans increased by 200% from 2013 to 2017, according to a report compiled by the Blue Cross Blue Shield Association. According to the report, approximately 131,000 people aged 30 to 64 were diagnosed with either condition in 2017. Of commercially insured Alzheimer’s and dementia patients, 58% were women as of 2017. The average age of people living with a form of dementia was 49. Read the report at https://bit.ly/38545Ke.

With an estimated pay boost just under 1% and the continued increase of encounter data used in determining Medicare Advantage plans’ risk scores, MA reimbursement in 2021 isn’t looking as robust as it has in recent years now that both parts of the 2021 Advance Notice have come out.

Meanwhile, MA plans face new uncertainties as patients diagnosed with end-stage renal disease (ESRD) can begin enrolling in such plans on Jan. 1, 2021. And while some changes in Part II of the Advance Notice stand to lower rates for serving ESRD enrollees, CMS in a separate memo proposed a new methodology for setting maximum out-of-pocket (MOOP) cost limits that will partly account for ESRD costs starting in 2021.

Florida’s health insurers remain highly profitable as the overall market has grown significantly more concentrated, with companies such as Anthem, Inc. and Florida Blue snapping up numerous smaller HMOs over the past several years, particularly in the Medicare Advantage (MA) space, says the author of a new report on the Florida market.

Independent analyst and consultant Allan Baumgarten, who studies state health care markets, tells AIS Health that he expects consolidation to continue.

Organizations representing health insurers are blasting the Trump administration’s proposed insurer price transparency regulations, saying the rule is anti-competitive and could even force prices higher.

In written comments on the rule to CMS Administrator Seema Verma, health insurer trade groups said they agreed in principle that transparency is good, but the administration’s approach — released in its proposed rule last fall (HPW 11/25/19, p. 1) — is too heavy-handed. “The plans are not opposed to getting consumers the information that they need to make decisions about benefits,” says Dan Mendelson, Avalere founder and former CEO. “But there are a couple of issues here that are causing the plans to oppose this particular rule.”