All about Medicare Advantage

Plus: Watch your mail

Sep 22, 2023

Good morning and Happy Friday,

Welcome to the Friday Pulse Check, your weekly e-newsletter from Fulcrum Strategies. We’re here to keep you connected to the stories that are affecting your practice and patients. Today I’m focusing on Medicare Advantage in the news.

Understanding Medicare Advantage Plans | AAA1B

In the news:

UnitedHealthcare pulling its Medicare Advantage from several markets

In a notice published on its website this week, UnitedHealthcare said they are dropping some of its Medicare Advantage plans from some markets, including the co-branded AARP plan and the fee-for-service UnitedHealthcare MedicareDirect plan. The company did not specify which markets. What does this mean for you? Be on the lookout for a termination or non-renewal letter for UnitedHealthcare Medicare Advantage plans; come January 1, a patient’s UHC Medicare Advantage card may not be active.

LIVE UnitedHealth Group stock price: UNH 0.00%↑

Medicare Advantage patients have lower utilization

A white paper published this week by Inovalon, a cloud-based healthcare software company, and Harvard Medical School showed that patients enrolled in Medicare Advantage plans had lower expenses and utilizations compared to patients on fee-for-service Medicare plans. According to the white paper, Medicare Advantage patients have 50% fewer inpatient hospital stays and 22% fewer emergency department visits and primary care outcomes are comparable to fee-for-service plans but with fewer visits. The authors concluded the Medicare Advantage was more efficient than fee-for-service care but did not elaborate as to why this was the case. Read the white paper here.

Which payor has the most tv ads?

Medicare Advantage ads are everywhere on tv, particularly around the open enrollment period. So, which insurance company actually has the most? The Kaiser Family Foundation looked into it. Keep in mind this varies by TV market and what plans are available in each area:

BlueCross BlueShield (Elevance: ELV 0.00%↑)
26% of Medicare Advantage ads are for BlueCross BlueShield plans (including Anthem/Elevance plans) and the various Blues have 14% of all Medicare Advantage enrollees in the country.
Other insurers
Less interesting, but this is all of the smaller insurance companies combined. This category includes Wellcare, Priority Health, and others. They make up for 24% of TV ads and 16% of Medicare Advantage enrollees.
Centene
Centene comes in at number three with their variously named products across the country. They had while only 4% of Medicare Advantage enrollees, they had 12% of all TV ads.
UnitedHealthcare
UnitedHealthcare is the nations largest Medicare Advantage insurer. They have 29% of all Medicare Advantage enrollees. Perhaps that is why they only need to have 11% of the TV ads.

Here’s numbers 5 through 8:

CVS Health (CVS 0.00%↑)
Ad share: 10 percent
Share of MA enrollment: 11 percent

Cigna (CI 0.00%↑)
Ad share: 9 percent
Share of MA enrollment: 2 percent

Humana (HUM 0.00%↑)
Ad share: 8 percent
Share of MA enrollment: 18 percent

Kaiser Permanente
Ad share: 2 percent
Share of MA enrollment: 6 percent

The FLATLINING Podcast from Fulcrum Strategies

This week on the podcast, Ron and I took a look at an issue that is increasingly making some of our Fulcrum Strategies clients in North Carolina anxious: Medicaid expansion.

Several months ago, Governor Roy Cooper (D) took a victory lap after the veto-proof Republican state legislature agreed to take federal money to expand Medicaid access in the Tar Heel state. In exchange, a lot of the major hospitals are getting some of that money and the certificate of need laws are going away. Here’s Gov. Cooper on MSNBC’s Morning Joe:

It was all fine and dandy until it came time to passing the state budget. Some lawmakers are holding up the budget over …. new casinos. When we recorded the podcast, the state House’s plan was to separate Medicaid and include it in a separate bill with the casinos. Last night, the House approved a budget that included Medicaid expansion. At this writing, the bill is currently in the state Senate.

Everyone thought this was a done deal several months ago, but as we discussed on the podcast, healthcare politics can be ugly and people don’t necessarily like to see how the sausage is made.

Listen to this episode

Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, Stitcher, Pandora, TuneIn, and Audible.

Final Thought

I spoke to a payor earlier this week who managed their self-funded state’s employee health plan. They came to me to ask if my client would be willing to take a more than 15% cut to their reimbursement. Of course the answer of my client is now.

The payor explained that they had a responsibility to their client, the state, to make sure they were getting the best deal possible and I explained that my client has a responsibility to its patients to hire the best providers possible.

Though it hasn’t happened yet, this is where payors get sneaky. If this is happening to your group, be on the lookout for any mail coming from the payors and read your contract to so you know how to reject amendments. That next piece of mail from an insurance company could be an amendment to cut your revenue.

Have a good weekend,

Matthew