Radar on Medicare Advantage

CVS Health Corp.’s Aetna won a new group Medicare Advantage contract to serve retirees covered by Connecticut’s state health plan. Connecticut Comptroller Natalie Braswell on June 1 said the state selected Aetna after a competitive bidding process and that the new contract will save an estimated $400 million over the next three years. Beginning Jan. 1, 2023, Aetna will serve some 57,000 Medicare-eligible retirees and dependents enrolled in the state’s MA plan. Connecticut first adopted an MA plan for retirees in 2018. 

After CMS imposed a historic increase to Medicare Part B premiums partly due to cost considerations around Alzheimer’s disease treatment Aduhelm, the agency on May 27 said it will not make a midyear change but will likely lower the Part B premium in 2023. Upon raising the standard monthly premium by $21.60 to $170.10 for 2022, the agency in November said it considered “[a]dditional contingency reserves due to the uncertainty regarding the potential use” of Aduhelm, which was approved in July 2021 and priced at $56,000 per year. After Aduhelm makers Biogen and Eisai, Co., Ltd., cut that price in half starting Jan. 1, HHS Secretary Xavier Becerra instructed CMS to reassess the Part B premium. Meanwhile, the FDA issued a National Coverage Determination stating that Medicare will cover Aduhelm only for patients enrolled in randomized, controlled clinical trials conducted either through the FDA or the National Institutes of Health. CMS recommended incorporating the savings realized from this year’s lower-than-anticipated spending into the 2023 Part B premium determination.

With radio silence from HHS on May 16 — when states at the very latest had expected to hear whether the COVID-19 public health emergency would end in July — HHS at press time appeared to be gearing up for another extension of the PHE. This will give states, insurers and other stakeholders more time to prepare for the inevitable resumption of Medicaid eligibility redeterminations, which could cause millions of adults and children to lose health insurance coverage.

The PHE has been extended multiple times since the start of the pandemic and remains a moving target. As a condition of receiving enhanced federal funds during the PHE, states have been required to ensure continuous Medicaid and CHIP coverage for most enrollees by pausing eligibility redeterminations. And the Biden administration has promised to provide states 60 days’ notice before any possible termination or expiration. But without such notification, sources estimate the next end date could be Oct. 13. Bloomberg on May 16 reported that the PHE would be extended past mid-July, “according to a person familiar with the matter.”

Medicare consumers are facing an overwhelming variety of resources and plan choices and are showing signs of increased movement during the Open Enrollment Period (OEP). As a result, effective member engagement during the OEP and throughout the year is becoming increasingly important and can be achieved through using data to segment membership and deliver targeted, personalized messaging to ensure that a member is in the right plan from the start, industry experts advised during the 13th Annual Medicare Market Innovations Forum, hosted by Strategic Solutions Network, LLC (SSN).

After the Medicare Annual Election Period (AEP) that typically runs from Oct. 15 through Dec. 7, the three-month Medicare OEP starts on Jan. 1 and allows beneficiaries who selected a Medicare Advantage plan to make a onetime coverage change. This year was the fourth OEP since it was reinstated by the Trump administration after a hiatus, and seniors’ utilization of the renewed opportunity is growing.

A pilot with Drips’ trademarked “conversational texting” platform has helped WellCare significantly lower the percentage of Prescription Drug Plan policies that were being terminated due to nonpayment, according to a case study presented at the 13th Annual Medicare Market Innovations Forum, held May 11 and 12 in Phoenix.

Since WellCare was acquired by Centene Corp. in January 2020, the PDP team has been focused on “optimizing operational execution” and ensuring a positive member experience, said WellCare Senior Director of Prescription Drug Plans Talia Duany, who presented the case study with Drips. “When you’ve got 4.1 million members in an industry that’s shrinking — this year we saw the biggest [decline] in available PDP options, everyone’s moving into [Medicare Advantage] — having a robust member retention strategy” is critical.