- CMS touted Thursday that Medicare Advantage premiums for 2021 are expected to decrease 11% to $21 on average compared with 2020. The 2021 premiums are expected to be the lowest in 14 years, or since 2007, CMS said as open enrollment nears for older adults.
- Enrollees with diabetes will have more than 1,600 plans to choose from that peg insulin costs to a $35 monthly copay starting in January.
- The average number of plans per county is increasing from an average of 39 plans in 2020 to 47 next year.
Medicare Advantage is a popular program among older adults and a growing share of Medicare-eligible opt for a private MA plan instead of traditional Medicare coverage. About one-third of all Medicare members are covered by an MA plan, according to the Kaiser Family Foundation.
MA is only expected to grow and the Congressional Budget Office expects 51% of all enrollees to be in an MA plan by 2030.
CMS boasted that enrollment is expected to reach an all-time high of 26.9 million members in 2021. However, analysts with SVB Leerink said their enrollment projections exceed that of CMS. They expect 28 million MA enrollees by the end of 2021.
SVB Leerink analysts point to Centene, Humana and UnitedHealthcare as payers best positioned to pick up more share next year.
However, the Government Accountability Office has issued reports estimating the private plans have overbilled the government by billions. More recently, the HHS OIG released a report that found MA organizations inflate patients' risk adjustment scores to collect higher payments. HHS OIG found an additional $2.7 billion in risk adjustment payments were made without an actual link to any clinical services performed despite the additional diagnosis code tacked on.
Another benefit to payers will be the elimination of the health insurance fee that takes effect next year. The fee added significant costs for payers. Using Humana as an example, SVB Leerink said it amounted to about an extra $26 per member, per month burden in 2019.
Also, for the first time starting in January, older adults with end-stage renal disease will be able to enroll in an MA plan. This may pose a headwind to payers as these patients tend to need a lot of care that is typically expensive.
The Trump administration has been trying to revamp how kidney care is delivered in this country. It's main aim has been to push more dialysis care into the home and prioritize transplants with living donors. Just last week the administration unveiled its final payment model for kidney care.