Health Plan Weekly

An analysis of Humana Inc. commercial insurance data from markets across the U.S. shows a wide variation of prices across regions for seven common procedures, according to a research letter published on Oct. 27 in JAMA Health Forum. Benjamin L. Chartock, Ph.D., the study’s lead author, tells AIS Health, a division of MMIT, this is the first peer-reviewed paper that examined data shared by insurers via the final Transparency in Coverage (TIC) rule that HHS and the Depts. of Labor and Treasury released in October 2020.

The TIC regulation went into effect starting in July 2022, with more requirements phasing in this year and next year. Chartock admits that, while insurers as of January 2023 are required to provide on their website a list of prices for 500 shoppable items, services and prescription drugs as well as a price comparison tool to allow people to compare cost-sharing and provider information, “it’s extremely complicated in terms of processing [for consumers], and on its own, it is not very useful data.”

Plans participating in the Medicare Advantage Value-Based Insurance Design (VBID) Model next year must begin reporting beneficiary-level utilization data on three key supplemental benefit categories: food, transportation, and general supports for living (e.g., utilities assistance). That requirement was included in a 2024 request for applications released late last year, and CMS officials have since hinted that the agency is interested in gathering additional information about supplemental benefit usage from the MA industry at large. But in a move that flew largely under the radar, the agency in September issued a proposal to begin requiring all MA organizations to submit information about supplemental benefits at a greater level of detail than some plans may be able to provide at this time, industry experts tell AIS Health, a division of MMIT.

Supplemental benefits have been on the rise since plan year 2019, when CMS’s reinterpreted definition of “primary health-related” enabled MAOs to include benefits like adult day health services, support for caregivers of enrollees and therapeutic massage in their plan benefit packages (PBPs). And with the passage of the CHRONIC Care Act of 2018, MA plans in 2020 began offering Special Supplemental Benefits for the Chronically Ill (SSBCI), a category of “non-primarily health related” items and services that can be made available to certain beneficiaries.

The Cigna Group may be considering the sale of its Medicare Advantage business, according to Reuters. The insurer is working with an investment bank to evaluate its options and the potential sale could bring in several billions of dollars, the sources told Reuters.

Cigna’s MA plans cover more than 580,000 lives in 35 states and the District of Columbia, according to the latest data from AIS’s Directory of Health Plans (DHP). The insurer is better known for its administrative services only employer-based health plans, and only 3.4% of its enrollees are in MA plans.

Here’s how major health insurers’ stock performed in October 2023. UnitedHealth Group had the highest closing stock price among major commercial insurers as of October 31, 2023, at $535.56. Humana Inc. had the highest closing stock price among major Medicare insurers at $523.69.

A KFF report released on Nov. 8 found that 3,959 Medicare Advantage plans are available for individual enrollment next year, the second-largest number of plans since 2010 and a 1% decrease from this year.  Meanwhile, the average beneficiary will be able to choose from 43 plans, the same as this year's record high. Eighty-nine percent of MA plans will offer prescription drug coverage in 2024; while 83% will offer telehealth benefits; and at least 97% will offer some dental, vision, fitness or hearing benefits.

A group of 32 Reps. led by Jerrold Nadler (D-NY) and Judy Chu (D-CA) sent a letter on Nov. 3 to CMS Administrator Chiquita Brooks-LaSure requesting increased oversight of artificial intelligence tools (AI) used to guide coverage decisions for Medicare Advantage plans. The elected officials wrote that “in recent years, problems posed by prior authorization have been exacerbated by MA plans’ increasing use of AI or algorithmic software managed by firms such as NaviHealth, myNexus, and CareCentrix to assist in their coverage determinations in certain care settings.” They asked CMS to require MA plans to report prior authorization data, compare guidance generated by AI tools with actual coverage decisions and assess whether plans are inappropriately using AI tools.