RADAR on Medicare Advantage

  • News Briefs

     Medicare Advantage enrollment reached nearly 24.7 million members as of the Jan. 1, 2020, payment date, according to the February enrollment report from CMS, which includes final figures from the Annual Election Period. The February data represents year-over-year MA membership growth of 9.2% (vs. an increase of 4.5% in fee-for-service Medicare) and MA penetration of 36.2%, up from 35.2% a year ago, estimated securities analyst A.J. Rice in a Feb. 17 research note from Credit Suisse. Rice added that the five major managed care organizations account for roughly 61.5% of total MA enrollments, with UnitedHealth Group and Humana Inc. leading the pack in MA membership growth. View the report at https://go.cms.gov/2P979OV. Contact Rice at aj.rice@credit-suisse.com.

     A federal appeals court on Feb. 14 unanimously struck down the Trump administration’s decision to allow Arkansas to implement Medicaid work requirements and ruled that HHS’s approval of the “Arkansas Works” program was “arbitrary and capricious.” According to the opinion from the U.S. Court of Appeals for the District of Columbia Court (Gresham v. Azar, No. 1:18-cv-01900), a “critical issue” in the case was the HHS secretary’s “failure to account for loss of coverage.” Arkansas Works was implemented in June 2018 and resulted in more than 18,000 Medicaid recipients losing coverage in a six-month period. U.S. District Judge James Boasberg in March 2019 vacated the agency’s approvals of work requirements in Kentucky and Arkansas (RMA 4/4/19, p. 1). HHS appealed the decision, and Kentucky ultimately abandoned its challenged demonstration project. View the ruling at https://bit.ly/38JzGCr.

  • Proliferation of $0 Premium PPOs, Supplemental Benefits Drive Continued MA Switching

    A new report from Deft Research finds that switching among Medicare Advantage members during the recent Annual Election Period (AEP) was steady at 13%, compared with last year’s rate of 14% after switching among MA members hit a low of 11% in 2018. Meanwhile, the Medicare Supplemental market saw an increase in switching from 7% in 2019 to 9% during the 2020 AEP. In an Executive Research Brief highlighting data from the 2020 Medicare Shopping and Switching Study, Deft observed that the rise of $0 premium PPO plans and expanding supplemental benefits are two likely drivers of MA switching. Although the MA market is still dominated by $0 HMO plans, more than 300,000 seniors moved into $0 PPO options that were newly available for 2020, observed Deft.
  • Medicaid MCOs Use Resource Centers to Aid Member Health

    From engaging members in cooking and self-defense classes to coaching them on specific health conditions, Medicaid managed care organizations are building out brick-and-mortar centers to better serve their enrollees. Three such MCOs shared their experiences at the 11th Annual Medicaid Innovations Forum, hosted by Strategic Solutions Network in Orlando from Feb. 5 to 7.

    In an unusual case of competitors joining forces, Blue Shield of California Promise Health Plan and L.A. Care Health Plan said they are building out 14 co-branded “Community Resource Centers” that will serve a projected 1 million individuals in the Los Angeles area annually.

  • Proposed MA Rule Floats Many Star Ratings Changes — Can Plans Keep Up?

    In addition to codifying previous policy changes and extending some new flexibilities to Medicare Advantage organizations, a recent 900-page proposed rule (85 Fed. Reg. 9002, Feb. 18, 2020) from CMS contains some significant changes to the star quality ratings. And while CMS is giving plans plenty of lead time to prepare for proposed modifications that would take effect with the 2021 measurement year, it may be hard for plans to keep up with the sheer volume of planned changes, suggests Melissa Smith, senior vice president of stars & strategy at Gorman Health Group, LLC.

    “I think the good news is that CMS is delivering on its promise for transparency and stability and plenty of warning,” says Smith, referring to a 2019 final rule that codified key aspects of the Parts C and D star ratings rather than allowing CMS to continually make retroactive changes to measures (RMA 4/5/18, p. 7).

  • MA, Part D Rule Contains Many Highlights for Health Plans

    In lieu of a draft Call Letter attached to its annual rate notice for the coming year (see story, above), CMS on Feb. 5 issued a 900-page proposed rule containing a slew of non-rate-related changes to the Medicare Advantage and Part D programs for contract years 2021 and 2022. While that rule (85 Fed. Reg. 9002, Feb. 18, 2020) seeks to codify numerous policy changes that were already made via statute and subregulatory guidance — including CMS’s expanded definition of “primarily health related” supplemental benefits and the entry of patients with end-stage renal disease (ESRD) into the MA program starting on Jan. 1, 2021 — it also features new and noteworthy proposals such as flexibility around network adequacy and medical loss ratio calculations, industry experts tell AIS Health.

    “There are not game-changers in this regulation, but there are another series of program tweaks that are, in total, pretty helpful to MAOs,” observes Michael Adelberg, a principal with Faegre Drinker Consulting and a former top CMS MA official.

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