Radar on Medicare Advantage

As the Medicare Advantage program continues to expand at a relentless pace, Aetna in recent years has made growing MA a key strategic priority and identified Medicare Part D as an important enabler of its overall Medicare growth strategy. This month marks the two-year anniversary of Aetna’s acquisition by CVS Health Corp., and the insurer anticipates a strong 2021 Annual Election Period (AEP) driven by $0 premium offerings, increased integration with CVS Health and differentiated MA plan offerings that include plans designed to complement health care coverage for veterans.

AIS Health spoke with Aetna Medicare President Christopher Ciano about the company’s trajectory in MA and how its portfolio has evolved in recent years.

Two years after CMS proposed its long-awaited alternative to an “overly prescriptive” Obama-era Medicaid rule and just days after U.S. voters elected Joe Biden as their next president, the Trump administration on Nov. 9 issued the 2020 Medicaid & CHIP Managed Care final rule. For Medicaid managed care organizations, the rule contained several positives, such as clarifying how much states can adjust capitation rates during a rating period and prohibiting retroactive changes to risk-sharing mechanisms in MCO contracts, industry experts tell AIS Health.

The 289-page final rule finalized many policies contained in the Notice of Proposed Rule Making issued in November 2018, which was intended to reduce administrative burden, streamline the 2016 managed care regulatory framework and “promote transparency, flexibility, and innovation in the delivery of care” (RMA 11/15/18, p. 1). It was compiled with the input of a work group CMS formed with the National Association of Medicaid Directors and state Medicaid directors.

From strengthening the Affordable Care Act to addressing the COVID-19 pandemic, President-elect Joe Biden will have plenty of health care-related items on his plate when he moves into the White House in January. Part of Biden’s campaign pledge to improve health care coverage included lowering the Medicare eligibility age to 60, but his ability to enact any kind of sweeping health care reform will be severely limited by a likely divided Congress. When it comes to Medicare, industry observers suggest regulatory changes to strengthen the program and better protect beneficiaries are more likely under a Biden administration.

If Biden were to succeed with his Medicare-at-60 plan, “it would probably be a very big boon for Medicare Advantage,” given that a younger aging population might not use as many services as an older population and since MA is now a popular alternative to traditional Medicare, observes Stephanie Kennan, a member of McGuireWoods Consulting’s federal public affairs group and former senior health policy adviser to Sen. Ron Wyden (D-Ore.). Passing such a change, however, depends on several key factors, says Kennan.

✦ Oklahoma last month released a request-for-proposals from qualified insurers interested in participating in the state’s first managed Medicaid program. Beginning on Oct. 1, 2021, managed care organizations would coordinate medical, behavioral and pharmacy benefits for low-income adults (including the expansion population) and children in the new SoonerSelect program, while aged, blind or disabled enrollees and dual-eligible beneficiaries would remain in fee-for-service Medicaid for the time being. The Oklahoma Health Care Authority is seeking to contract with at least three MCOs to provide statewide coverage, and it expects to unveil awards in January or February. Visit www.okhca.org/soonerselect.

✦ CMS late last month released a series of Health Plan Management System (HPMS) memos aimed at clarifying various uncertainties related to the COVID-19 pandemic going into next year. In an Oct. 28 memo to Medicare Advantage organizations, Medicare-Medicaid Plans (MMPs) and Medicare Cost plans, CMS announced that fee-for-service Medicare will foot the bill for COVID-19 vaccinations administered in 2021. In a separate frequently-asked-questions document posted Oct. 15, CMS said MAOs, Part D plan sponsors and MMPs may not waive the Part B premium for an enrollee during the public health emergency, even though some MA plans during the current open enrollment period are offering “premium rebates” to cover Part B premium payments. And in a third memo dated Oct. 29, CMS notified plans that it will continue to use the 2020 audit protocols when conducting 2021 program audits. CMS had intended to use the updated protocols, which contained numerous changes, for the 2021 audits, but they are still awaiting OMB approval. View the HPMS memos archive at https://go.cms.gov/3oWvQya.

As Medicare Advantage and Part D sponsors started promoting their offerings during the 2021 Annual Election Period that began on Oct. 15, several major insurers notably mentioned their participation in the first year of the CMS Part D Senior Savings Model (SSM). Perhaps the Trump administration’s most tangible action on insulin costs, the model is intended to reduce Medicare expenditures and improve care quality, but the expense to seniors will vary by plan type and region, according to two consulting firms.

Introduced through the CMS Center for Medicare & Medicaid Innovation (CMMI) in March, the five-year model is intended to lower out-of-pocket costs for diabetic seniors by featuring “predictable” copayments of no more than $35 for a broad set of insulins beginning in 2021 (RMA 3/19/20, p. 1). Specifically, the model will test a change to the Manufacturer Coverage Gap Discount Program by waiving current rules for supplemental benefits used to reduce cost sharing in the coverage gap and enabling Part D sponsors to offer enhanced alternative plan benefit packages (PBPs) that feature standard copays through all phases of the Part D benefit up to catastrophic coverage — instead of cost sharing that changes based on the benefit phase.