Technology-Focused Startup Insurers Expand Their MA Footprints

From RADAR on Medicare Advantage

Insurers that started up in the Affordable Care Act (ACA) exchange marketplace and sought to differentiate themselves with consumer-friendly technology solutions are now setting their sights on the Medicare Advantage segment.

Bright Health plans to expand to Ohio, New York and Tennessee for 2019, after launching MA products in three states this year. The company has three primary considerations as it evaluates entry into the Medicare market, says Tom Paul, president for Medicare. "The first is that we have the ability to offer competitive products….Second, we identify markets in which there's an opportunity for growth within that marketplace," and finally the insurer seeks markets where there is a comprehensive, integrated health system with which it can engage as a "Care Partner" to provide the necessary care to its members, according to Paul.

Senior-focused startup Clover Health has just revealed major plans to expand its MA footprint. Clover serves more than 30,000 seniors and others eligible for Medicare in parts of Georgia, New Jersey, Pennsylvania and Texas. When looking to expand, the company takes a "data-driven approach," similar to its approach to chronic care management, and seeks out providers that are "like-minded in their focus on improving health outcomes," clarifies a spokesperson.

Meanwhile, New York City-based Oscar Health recently stated its intention to enter the MA market in 2020. The company in June said it filed to offer insurance products in six new markets across three states in 2019.

"Medicare Advantage is definitely an attractive, growing market — due to both expanding demographics as well as a growing penetration rate, with more and more Medicare beneficiaries choosing MA — and companies like Bright and Oscar have core competencies from operating in the individual market, also a regulated and business-to-consumer business, that could apply nicely to MA. It's a logical next market for companies that have succeeded in the individual marketplace," observes Lauren Driscoll, a principal at Leavitt Partners.

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