Health Plan Weekly

In 2024 compared to 2023, there’s minimal change in terms of HealthCare.gov issuer participation, but shoppers do face a higher average benchmark plan premium, according to CMS. Out of the 32 states that are using HealthCare.gov, eight have more Qualified Health Plan (QHP) issuers in 2024, and 96% of enrollees have access to three or more issuers, compared to 93% in 2023. Yet there are 210 QHP issuers participating in HealthCare.gov next year, an overall decrease of nine compared to 2023. Virginia stopped using HealthCare.gov in 2024.

As of Nov. 1, nearly 10.1 million people had been disenrolled from Medicare during the resumed eligibility redetermination process, according to KFF’s Medicaid Enrollment and Unwinding Tracker. KFF, which compiles data from CMS and state websites, noted that 35% of people with a completed renewal application were disenrolled from Medicaid, while the remaining 65% had their coverage renewed. The disenrollment rates range from 10% in Illinois to 65% in Texas. During most of the COVID-19 public health emergency, states have been banned from conducting routine eligibility checks on Medicaid beneficiaries, but that process restarted on April 1. 

Medica, which offers health insurance coverage in 12 states, has promoted Lisa Erickson to president and CEO, replacing John Naylor, who announced his resignation in July. Erickson joined Medica as chief financial officer in April after spending three and a half years as senior vice president of industry and network relations at Optum, UnitedHealth Group’s health services subsidiary. Medica is based in Minnetonka, Minnesota, a Minneapolis suburb. 

Blue Cross Blue Shield of North Carolina plans to acquire all 55 North Carolina locations of FastMed, an urgent care provider in which it had a minority investment, according to an Oct. 20 press release. Experts tell AIS Health, a division of MMIT, that the deal is a smart move, as long as Blue Cross NC has a sound strategic approach to operating the clinics. 

Insurers have acquired plenty of providers in recent years, but larger, publicly traded insurance companies have led that charge. The deal stands out for two clear reasons: First, Blue Cross NC is a regional carrier — albeit a large one, with 2.3 million covered lives, according to AIS’s Directory of Health Plans. Second, most payer acquisitions of providers have not targeted urgent care operations. 

After years of having just one, limited option available to combat respiratory syncytial virus (RSV) in at-risk populations, the U.S. market this year has suddenly become rich with new products. Yet insurance coverage limitations and supply issues are frustrating efforts to keep elderly adults and very young babies from contracting what can be a life-threatening illness. 

This May, the FDA approved both GSK’s Arexvy and Pfizer Inc.’s Abrysvo for people who are 60 and older, and in August, federal regulators approved Abrysvo for use in people who have been pregnant for 32 to 36 weeks, with the goal of protecting their infants after birth. Additionally, in July, the FDA approved Sanofi/AstraZeneca’s Beyfortus (nirsevimab-alip), a monocolonal antibody injection indicated for preventing RSV in newborns and infants born during or entering their first RSV season, and for children up to 24 months old who remain vulnerable to severe disease throughout their second RSV season. 

Centene Corp. reported sterling results in the third quarter of 2023, with the firm exceeding its quarterly earnings target and executing $773 million in share repurchases in that time. Executives promised further improvement on Medicare Advantage Star Ratings and touted notable individual marketplace enrollment growth during the quarter.

Centene executives credited the strong results to membership growth and low utilization in the firm’s Affordable Care Act marketplace book of business. Executives also said that the firm, which mainly has members who are enrolled in managed Medicaid plans, has capably weathered the return of eligibility redeterminations, which were suspended during the bulk of the COVID-19 public health emergency and resumed in the spring. The firm’s total Medicaid enrollment during the third quarter declined by only 2.9% year over year to 15.24 million members.