Health Plan Weekly

Despite Medicare Advantage insurers’ enthusiasm for increased flexibility in allowable supplemental benefits and a slew of recent plan releases touting goodies such as pest control and “Papa Pals” for the 2020 plan year, uptake of more “resource intensive” benefits geared toward seriously ill seniors remains relatively modest, according to a new report from the Duke Margolis Center for Health Policy. That research adds to a growing body of evidence highlighting the challenges plans face in adopting new supplemental benefits.

Focusing on five categories of benefits that are applicable to seriously ill beneficiaries — adult day care, caregiver support, in-home support services, non-opioid pain management and palliative care — researchers analyzed plan benefit package (PBP) data available from CMS for 2015 through the first quarter of the 2020 contract year (the most recent data available).

Now that the open enrollment period has ended for the 38 states that use HealthCare.gov to enroll people in Affordable Care Act (ACA) marketplace plans, the preliminary sign-up numbers offer relatively reassuring news for the insurers that operate in the individual market.

From Nov. 1 to Dec. 17 — an open enrollment period that included a two-day extension — 8.3 million people chose or were automatically re-enrolled in health plans on the federal exchange, CMS said on Dec. 20. That’s down just slightly compared with 2019, when total HealthCare.gov enrollment was 8.5 million.

Conservative states are likely to push hard in 2020 for CMS approval of Medicaid waivers that will allow them to implement policies such as work requirements, while voters in some of the 14 states that have not yet expanded Medicaid could tee up referendums that would require expansion, Medicaid observers say.

Jerry Vitti, founder and CEO of Healthcare Financial, Inc., a company that connects low-income elderly and disabled populations with public benefit programs, says he anticipates additional Medicaid waiver applications from red states.

The pace of health care mergers and acquisitions — which ran at a fever pitch in 2018 and 2019 with multiple high-profile and high-value transactions — likely will cool slightly in 2020, given lofty asset prices, diminishing prospects for horizontal deals and the imminent presidential election, industry experts report.

Insurers are likely to seek out companies with assets such as care management or information technology solutions, while provider consolidation will continue in certain markets.