Radar on Medicare Advantage

Three years after states’ annual efforts to verify enrollees’ Medicaid eligibility were paused because of the COVID-19 public health emergency (PHE), states as of April 1 may begin terminating Medicaid coverage for individuals who no longer qualify. For much of the PHE, states and their managed care partners have been working to update beneficiary contact information for the inevitable return of redeterminations, and Medicaid managed care organizations can play a big role in raising awareness about the process, according to industry experts.

“I think that many members, probably 60% to 70% of folks, are just completely unaware that this is happening, and a lot of other folks just don’t realize the rigmarole they have to go through in order to maintain eligibility,” remarks Jerry Vitti, founder and CEO of Healthcare Financial, Inc., a firm that connects low-income, elderly, and disabled populations with Medicaid and other public benefit programs. “But plans can do mailings, do outreach, and be a connection point to Medicaid agencies where they can get enrolled.” Unfortunately, “they have uneven demographic information on these folks since the population is so transient, but they can reach out to members…and do I think plans can do a really good job to build awareness of what’s happening and the implications.”

After a lackluster 2022 open enrollment season characterized by churn associated with its external marketing channels, Humana Inc. is touting above-industry growth after the 2023 Annual Election Period (AEP) that concluded last month. Presenting at the 41st Annual J.P. Morgan (JPM) Healthcare Conference in San Francisco, Humana Chief Financial Officer Susan Diamond said investments in the company’s products, sales channels and other aspects of its Medicare Advantage business are helping it  “get back to an industry leading position” and achieve double-digit percentage enrollment gains this year.

According to the latest monthly enrollment data posted by CMS, MA now enrolls more than 30.6 million individuals, including more than 25 million in individual MA plans. That data reflects enrollment as of the Jan. 1, 2023, payment date (i.e., enrollment accepted through Dec. 2, 2022). Those figures do not reflect the full outcome of the AEP, which ran from Oct. 15 through Dec. 7, and are lower than CMS’s projection of 31.8 million for 2023, pointed out Citi’s Jason Cassorla in a Jan. 17 investor note. “[W]e expect enrollment to rise in the final 5 days of AEP and subsequently grow throughout 2023 considering both age-ins” and the Open Enrollment Period that runs from Jan. 1 through March 31, he wrote.

New research conducted by Avalere on behalf of the Better Medicare Alliance (BMA) suggests Medicare Advantage plans aid in earlier detection of type 2 diabetes and that seniors diagnosed with type 2 diabetes generally fare better than similar patients in fee-for-service (FFS) Medicare. Specifically, lower medical spending and rates of inpatient hospitalizations/emergency department visits observed by researchers may be particularly compelling for policymakers as they consider the overall value of the MA program.

With MA serving more seniors than ever before — having just reached a milestone of enrolling more than 30 million Medicare-eligible beneficiaries — and one-third of seniors estimated to have a diagnosis of type 2 diabetes, it is important to look at how these patients’ care differs in MA vs. traditional Medicare, asserted Matt Kazan, managing director with Avalere, during a Jan. 12 webinar hosted by BMA. In many cases, there are “major differences,” he noted.