Health Plan Weekly

As of this year, a dozen states provide health coverage to their Medicare-eligible retirees only through Medicare Advantage plans, according to a recent KFF review.

Employer-sponsored health care coverage for retirees was generally designed to coordinate with or wrap around traditional Medicare. Yet over the past few years, many states have shifted to contracts with private insurers to provide all Medicare-covered benefits and extra benefits for their retirees. These moves may help states reduce spending on retiree health costs and simplify administration.

Satisfaction with commercial insurance plans increased on a year-to-year basis by 3 points on a 1,000-point scale, according to the J.D. Power 2024 U.S. Commercial Member Health Plan Study. However, the results, released on May 29, indicate satisfaction varies significantly among carriers. For instance, the highest-performing plans saw their member satisfaction scores increase by 20 points while the lowest-ranked plans saw member satisfaction scores decrease by 8 points. J.D. Power said the largest differences in customer satisfaction among the high-performing and low-performing plans were in plans’ ability to help members save time and money, help them obtain health services, and gain members’ trust. 

CDPHP and the Lifetime Healthcare Cos. have agreed to an affiliation in which Lifetime would become the parent company of CDPHP, according to a May 22 press release. The companies’ boards of directors have unanimously approved the deal, which still must be approved by state and federal regulators. Lifetime is the parent company of Excellus BCBS and Univera Healthcare, which like CDPHP are nonprofit health plans based in New York. If approved, the insurers would maintain their brands.  

CMS on May 9 extended through June 2025 waivers meant to help states and Medicaid managed care organizations navigate the unwinding of COVID-19 pandemic-related eligibility rules. The waivers, which include provisions allowing MCOs to reach out to members about redeterminations and help members complete eligibility paperwork, were originally set to expire in January 2025.

The extension of the waivers — specifically, 1902 (e)(14) waivers — could help MCOs leave behind the upheaval caused by the return of eligibility redeterminations, which resumed in spring 2023 after a multiyear pause tied to the COVID-19 public health emergency. The crush load of eligibility checks has been difficult for states to manage. Many states disenrolled eligible Medicaid beneficiaries for administrative reasons, typically because the beneficiary made an error in their eligibility check or didn’t return paperwork in time to meet a redetermination deadline. The chaos, which was the subject of mutual recrimination between states and CMS, has caused no shortage of headaches for MCOs.

Amid an ongoing mental health crisis that has seen a near 40% increase in patients grappling with mental health conditions since 2020, Centene Corp.’s WellCare of Kentucky launched a pilot program to address two conditions — panic attacks and post-traumatic stress disorder (PTSD) — that are often overlooked.

Working with digital therapeutics company Freespira Inc., the pilot program takes an innovative approach to managing conditions at home with supportive technology and personalized coaching. AIS Health, a division of MMIT, connected with leaders of the two organizations, Timothy Houchin, M.D., a board-certified adult, child and forensic psychiatrist and senior medical director for WellCare Kentucky, and Joseph Perekupka, CEO of Freespira, to discuss the collaboration and learn about the early outcomes.

Extending enhanced premium tax credits for the Affordable Care Act individual marketplace would cost the federal government $134 billion if extended from 2025 to 2029 and $383 billion if extended from 2025 to 2034, according to a new projection from the Congressional Budget Office (CBO). The federal agency’s projection also predicts that “an average of 3.8 million more people” per year would have health insurance than if the premium tax credits were allowed to expire. A more in-depth CBO “score” of extending the tax credits is also in the works following a request by Republican leadership in the House of Representatives — who seem poised to oppose any move to extend the tax credits.

Congress must extend the enhanced tax credits — called advance premium tax credits (APTCs) — which were initially passed as part of the 2021 American Rescue Plan Act (ARPA) and extended as part of the 2022 Inflation Reduction Act (IRA). If Congress doesn’t act, the credits will expire at the end of the 2025 plan year.