With Medicare Advantage open enrollment about two weeks away, major payers have announced plan details for 2020, including geographic expansions and new benefits addressing population health factors.
MA has been a wildly successful program for commercial insurers, and payers are correspondingly upping their investment. A third of all Medicare-eligible seniors are expected to be in an MA plan next year.
CMS gave MA plans a boost with a 2019 payment rule allowing more flexible benefits for social determinants of health and virtual services. Some of those plans rolled out last year, with about 40% offering one of the new types of supplemental benefits, but payers said they didn't have enough time to produce extensive offerings.
Now for 2020, insurers are increasing the focus on population health.
Sean Creighton, managing director with Avalere, told Healthcare Dive the new options represent a sea change for the program. "Clearly, Medicare Advantage has the ability and the opportunity to innovate in ways that's just harder under fee for service," he said.
He expects the population health focus to continue as payers have more time to figure out the landscape. "In 2019, the plans didn't have a lot of time to either assess what benefits they would offer or put those new benefits in their pricing or benefits packages," he said. "For 2020, they've had the time to do this, but they really still haven't had a huge amount of time to test or figure out what they want to do in all circumstances."
UnitedHealth Group, which is the nation's largest private insurer and offers the most MA plans, is expanding to 100 additional counties and will sell 100 new plans next year. Most will allow virtual visits "for minor health issues or behavioral health support, often at no cost," the company said.
Cigna is expanding into new counties and states, including its first plans for Colorado. Cigna plans will include newly allowed benefits addressing social determinants of health, such as transportation assistance, an acupuncture allowance, adult day care services and air conditioner program.
Humana is putting its HMO plans in 160 new counties and its PPOs in 172 new counties. It will also, for the first time, offer a virtual primary care visit benefit on all plans.
The company will offer this expanded virtual capability next year for behavioral health, urgent and primary care. And it will make possible prescription refills or medication adjustments for members until they're able to see their primary care doctor in person. Humana is also expanding its plans, doubling the number of New Jersey counties that will feature them.
In Maine, Anthem will offer a package of 10 services addressing population heath factors. They will include pest control, food deliveries, transportation and adult day center visits. Pest control will be a new option under Anthem in California as well.
CMS Administrator Seema Verma recently touted the MA program's success at a payer industry conference, announcing premiums would hit a 13-year low in 2020 and saying MA is "what can happen when government gets out of the way and allows private market competition to flourish."
Still, payers aren't necessarily going all in on the new supplemental benefits. A recent survey from the Robert Wood Johnson Foundation and Urban Institute found that payers still cite multiple barriers in rolling out social determinant benefits, including the fact that there's no new funding tied to offering the expanded services.
And research in JAMA showed providers aren't necessarily homing in on those areas either. Only a quarter of hospitals and 16% of physician practices screen patients for social needs affecting health outcomes.