Major payers are expanding their Medicare Advantage footprints next year, and focusing on telehealth benefits and reduced cost-sharing — both trends accelerated by the COVID-19 pandemic.
The increased competition puts more plans in the market with low or no premiums as bullish payers have reported massive profits from deferred care over the past several months. Companies will also benefit from the elimination of the Health Insurance Tax starting in 2021.
Medicare Advantage has been a key revenue driver for big payers but is not with its criticism. Major fraud concerns have cropped up as some companies have been caught gaming the system's risk-analysis mechanism.
CMS said last week that average MA premiums for 2021 are about 11% lower than they were this year and counties are getting more plan options, with an average of 47, up from 39.
The MA program covers about a third of Medicare beneficiaries, and analysts expect that to increase to about half by 2030. About 27 million people are expected to be enrolled in an MA plan by the end of next year.
Gretchen Jacobson, vice president of Medicare for the Commonwealth Fund, said it's unclear what effect the pandemic could have on participation, but she expects those predictions to hold.
"It's tough to know whether that projected trajectory will change, but for example there hasn't been any negative news about provider networks during the pandemic," she said. "But neither have their been any large positive stories about benefits increasing."
The largest MA plan provider, UnitedHealthcare, is making its biggest expansion in five years by launching in nearly 300 more counties.
Cigna is entering five new states next year and expanding its county footprint by 22%, its largest expansion ever.
And Humana is moving into 125 new counties, while CVS Health-owned Aetna is rolling out plans in an additional 115 counties. Anthem will offer its first plans in Iowa as it expands in 80 more counties.
Humana and UnitedHealthcare are touting $0 copays for telehealth visits — a potentially enticing feature as patients have turned to virtual care in unprecedented amounts in recent months. Cigna is offering no-cost telebehavioral services and adding virtual physical therapy to its plans.
Cigna said all of its markets will offer at least one plan with no premium cost, while Aetna said about 80% of members will have access to a no-premium plan. Those could be attractive to families enduring the pandemic-induced recession.
Out-of-pocket limits for MA plans increased this year, however. Jacobson said beneficiaries look at that factor as well when considering plans.
Clover Health, a smaller tech-focused startup, also said Thursday it's partnering with Walmart to offer MA plans in eight Georgia counties as the big box retailer expands in role in the healthcare industry.
One plan has a $0 dollar premium and both offer no-copay primary care visits. The provider network will include 31 hospitals and more than 8,000 clinicians.
Payers mention some benefits directly related to COVID-19, although federal regulations in place during the ongoing public health emergency already require no cost-sharing for testing and treatment.
UnitedHealthcare's healthcare navigator program will assist people with COVID-19 in getting medication, food and any needed care while quarantining. Humana will offer beneficiaries with a diagnosis up to 28 home-delivered meals.
Jacobson noted that companies were required to submit their plan information in June, when less was known about the pandemic and its likely continuation — or even worsening — into the winter months.
"They were likely trying to figure out what all of this meant for their cost structure while everyone was thinking that the pandemic may be over in the near term," she said. "And they probably didn't know to what extent care would go up or down."
The plans are continuing to include benefits focused on improving social determinants of health — a relatively new design allowed by CMS.
UnitedHealth, Humana and Cigna are all offering healthy food cards with monthly or annual allowances for members to buy approved groceries. UnitedHealth also has a fitness program that includes online workout videos and a rewards program for completing tasks like an annual physical, preventive screenings and flu shots.
Anthem is including "nutrition-related benefits, health-related transportation and access to adult day centers" in more plans next year as well.
Insurers are also hoping to snag more veterans looking for a supplement to their coverage from the U.S. Veteran's Administration.
Aetna is launching Aetna Medicare Eagle MA plans for 2021 in 27 states. They will include dental, vision and hearing coverage as well as meal benefits. Meanwhile, Humana Honor plans for veterans will be available in 46 states, up from 27 states last year.
Medicare open enrollment runs from Oct. 15 to Dec. 7 for coverage that will begin Jan. 1.