Radar on Medicare Advantage

  • 2025 MA Bid Cycle Was ‘Wild Ride’ That Could Lead to Market Exits, Actuaries Say

    Compounded by known challenges in estimating Medicare Part D costs stemming from the Inflation Reduction Act (IRA), the process of finalizing Medicare Advantage insurers’ bids for the 2025 plan year was an “extra wild ride” due to a variety of unknowns, according to Matt Kranovich, principal and consulting actuary with Milliman. And while national insurers in recent months have publicly disclosed their intent to skinny down their MA offerings through things like benefit adjustments and strategic exits, similar reactions to revenue headwinds may play out across the country and lead to more market consolidation than CMS would care to see, warns Tim Murray, principal with Wakely, an HMA company.
  • Aetna, Insurtechs Outpaced Medicare Advantage Peers in Quieter OEP

    Medicare Advantage enrollment grew by 350,000 members during the 2024 Open Enrollment Period (OEP), according to CMS’s May data release and AIS’s Directory of Health Plans. That’s a 31% drop from last year, which saw 507,000 sign-ups from February to May, and it reflects a slowdown in MA growth also seen in the Annual Election Period (AEP).
  • Fast-Growing NY Insurer Credits MA Benefit Stability, Behavioral Health Focus

    CDPHP, a not-for-profit managed care organization serving Medicare Advantage members primarily in Upstate New York and the Hudson Valley, is one of several provider-led insurers that carried a strong growth trajectory from the Medicare Annual Election Period (AEP) through the Open Enrollment Period (OEP) in the first quarter of 2024, according to a recent AIS Health analysis.

    The Albany-based insurer added more than 5,000 MA members during the AEP and another 5,400 between February and May, for overall growth of 20% since October, per AIS’s Directory of Health Plans. According to CDPHP’s senior vice president and chief growth officer, Nicholas Kraft, the plan nabbed 66% of new enrollment in its market and is now the third-fastest growing MA plan in the U.S. CDPHP was also ranked No. 1 in member satisfaction among commercial insurers in New York State by J.D. Power & Co.

  • FMO Lawsuits Could Delay Agent and Broker Compensation Rules

    With Medicare Advantage plan bids off to CMS for the 2025 plan year, MA organizations now turn their attention to arrangements with agents and brokers who will sell their plans this fall and the field marketing organizations (FMOs) that support them. But at least three complaints have been filed challenging CMS’s implementation of new provisions that will impact those relationships and take effect Oct. 1.

    A central question raised in all three complaints is whether CMS exceeded its regulatory authority by abruptly setting a cap on administrative payments made to agents and brokers by MA organizations that have long been allowed in the MA program. Sources say a delay or additional clarifying guidance could result from at least two of the complaints, which were filed in a federal court with a history of striking down HHS regulations. CMS, meanwhile, is taking the stance that it is following Congress’ orders to ensure a level playing field among plans.

  • More States Offer Health Benefits to Retirees Exclusively Through MA Plans

    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.

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