RADAR on Medicare Advantage

  • Stakeholders Consider Impact of BBBA Drug Pricing Reforms on Formularies, Innovation

    The Build Back Better Act (BBBA), which passed the House on Nov. 19 but at press time was looking less and less likely to meet Democrats’ self-imposed Christmas deadline, contains multiple drug pricing reforms that could lead to more than $300 billion in savings over the next decade, according to estimates from the Congressional Budget Office (CBO). These provisions include an overhaul of the Medicare D benefit, which a recent Avalere Health analysis suggests could lead to greater increases in mandatory manufacturer discounts on brand drugs within the benefit’s six “protected classes” compared with brand Part D drugs overall.
  • Ahead of 2023 Rate Setting, BMA Issues End-of-Year Wish List

    As CMS gets ready to set Medicare Advantage rates for the 2023 calendar year, the Better Medicare Alliance in a Dec. 6 letter urged Administrator Chiquita Brooks-LaSure to take several actions to address social determinants of health (SDOH) and close the gap on longstanding racial disparities. The research and advocacy group supports more than 170 ally organizations that include several major MA insurers. Among its recommendations, BMA asked that CMS:
  • News Briefs: New Research Shows Rise in Telehealth Use Among Medicare Enrollees| Dec. 16, 2021

    New statistics showing a rise in telehealth usage among Medicare beneficiaries during the pandemic make a strong case for permanently expanding telehealth coverage for Medicare patients. A new report from the HHS Assistant Secretary for Planning and Evaluation (ASPE) found that the number of FFS beneficiary telehealth visits rose from approximately 840,000 in 2019 to nearly 52.7 million in 2020, with the largest increase seen in behavioral health specialist visits. Black and rural beneficiaries demonstrated lower use of telehealth compared with white and urban beneficiaries, respectively. The report did not include results for Medicare Advantage members, since plans had discretion to offer telehealth prior to the pandemic, noted ASPE. Meanwhile, a new Medicare Telemedicine Data Snapshot from CMS showed that the number of Medicare beneficiaries (including MA enrollees) using telemedicine services between March 1, 2020, and Feb. 28, 2021, increased over 30 times the number of users from the prior year (March 2019 to February 2020). Dual eligibles had higher use of telehealth than those with just Medicare. “These latest numbers prove that when given the resources and opportunity to use telemedicine, many of these patients will opt to use the technology,” wrote Connected Nation, which seeks to fill broadband and digital technology gaps through partnerships across all sectors. “We would argue that among the critical needs is to expand not only access to broadband but also working to ensure it is affordable and that others understand both how to access the technology and how it can benefit them.”
  • In AEP Home Stretch, MAOs Make Final Push for Enrollment

    With a bevy of plan options and supplemental benefits available to seniors and the omnipresence of multicarrier brokers, regional Medicare Advantage organizations are working doubly hard to get in front of potential and existing customers during this final stretch of the 2022 Annual Election Period (AEP). Complicating their efforts are continued slowdowns with mail delivery, which could impact brochures getting to Medicare-eligible beneficiaries before the AEP ends on Dec. 7, according to marketing experts.
  • Expecting Hot Medicare AEP, E-Brokers Beefed Up Internal Sales Forces

    As the Medicare Annual Election Period (AEP) was in full swing last month, electronic marketing organizations (EMOs) like eHealth, Inc. and GoHealth, Inc. saw increased traffic to their online marketplaces and improved use of other digital tools. But both publicly traded firms, which posted third-quarter 2021 earnings in early November, have reported trouble converting telesales into enrollments and retaining members from the prior year — an area that is often seen as a weak spot for carriers that work with the large brokers.
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