MA, Part D Sponsors Tout Extra Benefits, Provider Pacts for 2018

Reprinted from MEDICARE ADVANTAGE NEWS, biweekly news and business strategies about Medicare Advantage plans, product design, marketing, enrollment, market expansions, CMS audits, and countless federal initiatives in MA and Medicaid managed care. 

By Lauren Flynn Kelly, Managing Editor

October 19, 2017 Volume 23 Issue 20

Medicare Advantage and Part D sponsors appear to be sweetening the deal for potential and existing enrollees this Annual Election Period, as multiple companies are touting enhanced supplemental benefits beyond the usual fitness programs and dental coverage in addition to new provider partnerships and service areas, according to an AIS Health analysis of company press releases and marketing materials that have been released since Oct. 1. And despite the return of the health insurance tax (HIT) established by the Affordable Care Act (see story, p. 5), premium increases for 2018 appear to be more modest than anticipated, according to a preliminary analysis of the 2018 CMS landscape and benefit files conducted by actuarial consulting firm Oliver Wyman.

“I think our expectation was that carriers were going to not put beneficiaries on a seesaw, so they weren’t going to reduce premiums in 2017 only to grow them back in 2018,” observes Josh Sober, a principal in the Milwaukee office of Oliver Wyman. “And the premium increases are there, but they’re coming down from what we saw in 2017.”

Restricting its analysis to products in metropolitan statistical areas that persisted from 2017 to 2018, Oliver Wyman observed an average premium change on an enrollment-weighted basis of 91 cents, or an increase of about 3.1% from $29.02 per member per month to $29.93 PMPM. This is compared with an increase observed in those same areas of about $2 from 2016 to 2017. Those changes do not apply to Special Needs Plans (SNPs) or Employer Group Waiver Plans.

“So not only had carriers apparently anticipated the reinstatement of the health insurance tax and not given too much back in 2017, but they’re actually in a slightly more competitive or optimistic place this year than they were last year,” Sober tells AIS Health. This is also supported by a higher number of net new contracts for 2018, which appear to be mostly from MA organizations that already have products in the market, he adds.

Wellness benefits and population health programs appear to be on the rise for 2018, observes Sober. “For the markets we’ve looked at, we’re seeing increases in transportation benefits, which we think is related to getting some of the sicker enrollees to primary care a little bit more easily,” Additionally, Sober says the firm is seeing a faster-than-expected reduction in expanded prescription drug gap coverage as the so-called donut hole closes.

Anthem, Centene Expand MA Offerings

Here are highlights from company press releases unveiling new offerings and product enhancements for 2018:

·         AmeriHealth New Jersey added RWJBarnabas Health, one of the most comprehensive health systems in the state, to its first-tier provider network in the AmeriHealth Advantage plan, expanding the plan’s reach to six additional counties in northern New Jersey. Members in that plan can obtain services from RWJBarnabas Health’s Physician Enterprise and acute care hospitals at lower copayments and out-of-pocket costs.

·         Anthem, Inc., in addition to service area expansions by many of its subsidiaries, unveiled a new collaboration with Cleveland Clinic to offer the new Anthem MediBlue Prime Select $0 premium HMO plan, through which members can receive physician and hospital services exclusively through the Cleveland Clinic. According to Crain’s Chicago Business, the plan differs from Anthem’s other MA offerings in the state in that it is the insurer’s only exclusive network arrangement in Northeast Ohio. Meanwhile, Anthem Blue Cross is expanding its MA reach in California with plans in six additional counties. Three SNPs and the Anthem Value Plus HMO will feature access to the CareMore physician-led delivery system as well as the Nifty After Fifty clinically supervised full-body training program for mature adults.

·         Anthem subsidiary Amerigroup boasted service area expansions in several states, as well as an array of supplemental benefits. Depending on the plan, these extras include: LiveHealth Online, which enables members to connect with board-certified doctors through two-way live video using a smart phone, tablet or computer with a webcam, at a $0 copay; access to a quarterly stipend to pay for certain over-the-counter health products; $0 copays for prescription drugs on multiple coverage tiers; 24 routine podiatry visits per year (with a $0 copay, depending on the plan); $3,000 annual hearing aid benefits; and an allowance of routine transportation services for pharmacy and medical visits within 60 miles.

·         Centene Corp. introduced Allwell from Sunflower Health Plan in Kansas. Allwell will offer HMOs for the first time in Johnson and Wyandotte counties that feature a variety of benefits, such as $0 premiums, $0 primary care provider copays and optional dental coverage, said Centene.

·         Humana Inc., in addition to a new co-branding partnership with Cleveland Clinic in Ohio, said it expanded its existing relationship with TruHearing to including hearing care and hearing aid benefits within MA plan offerings in 27 new states for a total of 34. Members will be able to obtain two hearing aids per year (one per ear) and three provider visits for fittings and evaluations with copays ranging from $399 to $999, depending on the choice of hearing aid and plan selection.

·         Sunrise Advantage Plan is one of at least three new institutional SNPs offered by nursing home chains. The plan will offer comprehensive care coordination with participating Sunrise Senior Living communities in Illinois, New York, Pennsylvania and Virginia.

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