Radar on Medicare Advantage

Following a slew of announcements from Medicare Advantage insurers unveiling new service areas for 2022, SCAN Health Plan on Sept. 9 said it plans to expand its reach beyond California to two new states next year. The Long Beach, Calif.-based insurer currently serves more than 220,000 members in California and is one of the nation’s largest not-for-profit MA plans.

During the upcoming Annual Election Period (AEP), which starts on Oct. 15, Medicare beneficiaries residing in Clark County, Nevada, can enroll in SCAN Health Plan. And in the Arizona counties of Maricopa, Pima and Pinal, individuals can sign up with SCAN Desert Health Plan. UnitedHealthcare currently dominates both markets, followed by Humana Inc. (see charts below). In addition, SCAN’s MA plans will be available in two new California counties — Alameda and San Mateo — enabling it to reach more than 5 million potential customers across 17 markets in three states. SCAN will communicate with potential customers in five different languages, including English, Spanish, Korean and Chinese.

As Medicare Advantage organizations prepare to promote their plans for the 2022 Medicare Annual Election Period (AEP), marketing experts say they see a continued shift to year-round and online campaigns. But with the increased use of digital engagement and enrollment leading to some member dissatisfaction, plans must take extra steps to ensure a positive experience early on, they warn.

CMS as of press time had not yet released its annual “landscape” files for the MA and Part D programs, but data released this time last year indicated that MA beneficiaries in 2021 had an average number of 47 plan choices per county, up from 39 in 2020, and that more than 4,800 MA plans were operating in 2021, compared with 4,300 in 2020. Marketing for the AEP begins on Oct. 1, and open enrollment runs from Oct. 15 through Dec. 7.

As Congress considers expanding Medicare benefits through the budget reconciliation process, a new HHS report expresses the agency’s support for “bold legislative action” to bring down drug prices and outlines a “comprehensive” plan that includes several administrative actions it could take to promote competition among drug companies. Notably, the report calls for legislation allowing HHS Secretary Xavier Becerra to directly negotiate drug prices with manufacturers for coverage under the Medicare Parts B and D programs and to make those prices available to other payers, and the exploration of various concepts by the CMS Innovation Center.

The HHS Office of the Assistant Secretary for Planning and Evaluation on Sept. 9 issued the report in response to President Joe Biden’s Executive Order on Promoting Competition in the American Economy, which called for a multitude of actions from HHS, including lowering the prices of and improving access to prescription drugs and biosimilars. Meanwhile, lawmakers are considering adding dental, hearing and vision benefits to fee-for-service Medicare as part of a $3.5 trillion spending package that Senate Democrats aim to pass via budget reconciliation, and drug pricing has been viewed as a way to pay for those enhancements.

by Carina Belles

Enrollment in Employer Group Waiver Plans (EGWPs) grew 19.5% from 2018 to 2021, at an average rate of about 6% per year, according to the August 2021 update to AIS’s Directory of Health Plans. About 18% of all Medicare Advantage members are enrolled in an EGWP, with UnitedHealthcare, CVS Health Corp.-owned Aetna and Kaiser Permanente leading the market. Overall, the top 10 payers have an iron grip on market share, enrolling 92.7% of all EGWP members.

Hoping to boost enrollment in the struggling Medicare Diabetes Prevention Program (MDPP) expanded model, CMS has proposed changes that would increase reimbursement and significantly shorten the services period for participants. While stakeholders agree that the changes are needed, some warn they’re only incremental steps to shore up the MDPP, which has faced a shortage of suppliers and challenges posed by the requirement that the program be delivered to beneficiaries in person.

“The MDPP rules and regulations, including the payment mechanism and the two-year commitment — in contrast to one year for the CDC DPP [U.S. Centers for Disease Control and Prevention Diabetes Prevention Program] — have made enrollment very difficult if not impossible for MDPP suppliers,” asserts Liz Joy, M.D., senior medical director for wellness and nutrition at Intermountain Healthcare.