Medicare Advantage 2022 Plan Overview, Part 2: Portfolio Strategy and Major Carriers

[ad_1]

Portfolios are designed to “make care more affordable, accessible and convenient,” in the words of one executive.

The ideal value chain for any industry or business is designed to build customer loyalty and loyalty throughout life. One element of such a chain is a portfolio strategy that continues to offer maximum choice and affordability. For insurers in the Medicare market, this equates to a mix of stand-alone prescription drug (PDP) and plan designs, group plans, and Medicare supplement plans.

This spectrum gives insurers the ability to:

  1. Offer attractive options for all Medicare-eligible beneficiaries.
  2. Capture the significant organic growth represented by the 10,000 Baby Boomers entering Medicare daily.
  3. Convert existing non-Medicare customers to Medicare coverage.

Portability through supplier networks and PPOs

The latter may be easier said than done. While some consumers are more passive decision makers, choosing to stick with the brand they know when they become Medicare eligible, the internet has made online plan comparisons and selection navigation, including those offered. by a growing group of insurance startups, easier than ever. Consumers may find that their carrier’s Medicare provider network does not include their current physicians, cover their prescription drugs, or provide necessary care options as medical needs increase.

Closely related to another piece of the strategic puzzle is the importance of supplier networks: providing enough PPO plans to maintain supplier access. Portability is important not only for consumers but also for employers who provide benefits to retirees. Being strategically positioned to perform conversions also includes the important but rarely discussed factor of whether the parent company affiliate structure enables the data sharing needed by payers to target and market their Medicare eligible in an efficient and cost effective manner.

Part one of this series from HealthLeaders focused on Medicare Advantage (MA) cost design, including the growing percentage of $ 0 premium plans and co-payments, while also summarizing the 2022 offerings of the two largest MA insurers, UnitedHealthcare and Humans. Part 2 will present the plans of the companies Blue Cross Blue Shield (BCBS) and Aetna, the next plans in terms of market share. BCBS registration data comes from the Kaiser Family Foundation (KFF) and includes its Anthem branding plans. Aetna provided their registration data, which varies only slightly from the KFF 2021 stats.

Blue Cross Blue Shield, including the anthem

BCBS, a federation that includes the BCBS Association and 35 independent companies (including Anthem branding plans), ranks third for MA’s market share. One of BCBS’s stated focus areas is “to provide support that goes beyond the four walls of the hospital or doctor’s office in meeting social needs that are important to the good health of older people”.

  • Master’s enrollments and market share: 3.8 million, 14%.
  • Footprint: 47 states and Puerto Rico
  • $ 0 premium: available in 40 states and Puerto Rico

The impact of several chronic diseases is one of the many target areas in the design of the BCBS plan. Co-benefits include food insecurity and improved primary care. Community partnerships are at the heart of the strategy. Two BCBS plans partner with community organizations for meal delivery: BCBS of Massachusetts and Independence Blue Cross. The latter has also partnered with dedicated medical centers for the elderly in Philadelphia to bring primary care closer to low-income neighborhoods and in hopes of reducing emergency room visits, hospitalizations and length of inpatient stays. BCBS plans in three states (Rhode Island, Michigan, and New York) also offer “concierge services” to help members navigate complex care.

BCBS Anthem plans offer an Essential Extras package to address “overall health and its many health factors”. The option, available in seven of the 14 states where Anthem operates, allows members to choose one of the following nine benefits: dental, vision, hearing, assistive devices and groceries allowances; hours allocated for home support and personal home help; a fitness tracker and a subscription to a fitness program; meals and transportation services; and pest control.

Etna

Aetna, a CVS Health company, is the fourth MA insurer. Christopher Ciano, president, comments that the company wants to maintain its COVID-19 care goal while helping “to improve their overall physical and mental health.” Ciano reports that the company “has expanded our Aetna Medicare Solutions product portfolio to include more benefits designed to make care more affordable, accessible and convenient.”

  • Master’s enrollments and market share: 2.9 million, 11%.
  • Footprint: 46 states and Washington, DC
  • $ 0 bonus: Offered to 84% of beneficiaries.

For 2022, Aetna says about a third of its individual MA plan members will see lower maximum costs for networked care. The company also emphasizes its “holistic approach to health,” which includes leveraging its CVS Health relationship for comprehensive over-the-counter (OTC), falls prevention and smoking cessation solutions, as well as lower pharmacy costs. Regarding additional drug benefit enhancements: “The individual MAPD plans will increase the supply of prescription drugs to a maximum of 100 days for level 1 through 4 drugs. [where package size allows] … Without an increase in the quota / co-insurance “.

Company’s offerings include more dual-qualifying special needs plans (D-SNPs) and Aetna Medicare Eagle® plans for veterans who partner with their VA benefits, available in 41 states and with $ 0 bonus and $ 0 PCP and lab co-countries, plus dental, visual, hearing, OTC and fitness benefits for all the plans. Aetna has extended its palliative care and end-of-life support benefits to some master’s plans in Ohio and Pennsylvania, as well as its alternative medicine benefits, including therapeutic massage, for some plans in the Northwest region. This is one of many plans that take an allowance-based approach to some of its dental benefits.

Additional and future benefits

As mentioned in Part 1 of this series, many plan benefits have become more and more standard for AD plans, but beyond what traditional Medicare covers. This is true for BCBS and Aetna and includes improved dental care, vision and hearing; transport and delivery of meals after hospitalization; OTC and fitness; programs to combat loneliness; and insulin cost caps of $ 35 per month under the Part D Seniors Savings Program created by the Centers for Medicare & Medicaid Services (CMS).

Part three in this series will highlight the Social Determinants of Health (SDOH) and the next three biggest carriers of MA: Kaiser Permanente, Centene and Cigna.

Editor’s Note: This story was updated on October 25, 2021.

Laura Beerman is a contributing writer for HealthLeaders.

[ad_2]
Source link

Don F. Davis