medicare advantage
medicare advantage

medicare advantage

INSURANCE

Medicaid benefit loss not expected to impact health insurers

An estimated 15 million people will lose their Medicaid benefits this month as a result of the expiration of U.S. government’s emergency pandemic measures. While there’s little doubt the Medicaid benefits loss – what health care industry nerds call “disenrollment” and “redeterminations” – will negatively impact health insurance company revenues, the effect won’t be substantial thanks to a corresponding reduction in claims expenses, according to credit analysts and other industry watchers.

In announcing better-than-expected first quarter earnings on Tuesday, the nation’s largest Medicaid insurer, Centene, said its Medicaid premium revenue would drop to $77 billion in 2024, compared to $84 billion in 2023, and its earnings per share estimates were trimmed to $6.60, down from $7.15 in previous forecasts.

The company squarely put the blame on “redeterminations” of the Medicaid enrollments but said it does not expect a long-term impact. However, it said that the average cost per member of the those retaining Medicaid coverage after redetermination will be somewhat higher than before – what the company called “acuity.” This is likely due to the setting of state payment rates under cost trends of the current Medicaid population.

Rate adjustments anticipated

“We now believe it is prudent to build in a more conservative view of the potential disconnect between rates and acuity that could manifest in some of our states in 2024,” said Centene’s CEO Sarah London. “We view any disconnect as a temporary one. We fully expect that states will ultimately provide sufficient rate adjustments to reflect any changes in acuity of the Medicaid population, but we are building a provision in our 2024 target in case there is a gap in timing in some of our states. In the long term, rate has always equaled acuity in Medicaid.”

Fitch Ratings, the leading provider of credit ratings for global

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INSURANCE

Bright Health to sell Medicare Advantage arm, focus on NeueHealth

The last remnant of Bright Health Group’s health insurance operation is up for sale as the company negotiates with lenders to avoid bankruptcy, the company announced Friday.

The insurtech must find a buyer for its California Medicare Advantage business by the end of May to qualify for a credit extension through June, Bright Health notified investors in a filing to the Securities and Exchange Commission. Under the terms of the amended credit facility, the company would have to maintain $50 million in cash, down from $85 million under the current agreement.

Bright Health needs the credit to avoid bankruptcy: The company overdrew its $300 million line of credit last month and had until next Monday to reach the minimum threshold to maintain access to lenders.

Bright Health did not immediately respond to an interview request.

If the company sells its Medicare Advantage line in California, it would mark the end of the insurance company’s insurance business. Bright Health previously participated in the Medicare Advantage, health insurance exchange and employer-sponsored health plan markets in 15 states. The company has 125,000 Medicare-Medicaid dual-eligible members in the Golden State, where it lost $40.8 million last year, according to regulatory filings.

Going forward, Bright Health will focus solely on its NeueHealth primary care business, which comprises 74 clinics in Florida and Texas that serve 375,000 patients, the company said in a news release Friday.

The credit agreement announced Friday requires Bright Health executives to attend weekly meetings with creditors about the Medicare Advantage sale and biweekly meetings about its finances. Bright Health is barred from taking on new debt or investments.

If insurance regulators in Texas or Florida place the company under receivership or under additional supervision, lenders have the right to dissolve the credit agreement. Bright Health reported a $163 million

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INSURANCE

Best Health Insurance Stocks to Buy in 2023

Investing in companies that offer essential products and services can be a smart wealth-building strategy. Like it or not, health insurance ranks as one of the most important necessities for Americans today.

What are the top health insurance stocks to watch? And, what do you need to know before investing in them? As the major health insurers might say, “We’ve got you covered.”

Health insurance document, stethoscope, and bills.

Source: Getty Images

Top health insurance stocks for 2023

Here are four publicly traded health insurance companies and one exchange-traded fund (ETF) likely to perform well this year:

1. UnitedHealth Group

UnitedHealth Group (UNH -0.53%) ranks as the biggest health insurer in the world by far. Its UnitedHealthcare business unit offers health plans for employers and individuals and is also a major player in the market for Medicare Advantage, Medicare supplemental plans, and Medicaid.

The company’s Optum business segment provides information- and technology-enabled health services, including OptumRx pharmacy benefits management (PBM) services. While UnitedHealthcare generates more than three-fourths of the company’s total revenue, Optum is the bigger growth driver for UnitedHealth Group.

Optum could soon grow even larger. It plans to acquire home health provider LHC Group (NASDAQ:LHCG) for $5.4 billion this year. Optum already owns primary care and ambulatory surgery center facilities. The move into home health is a natural next step. However, the deal must first be approved by regulators.

2. Anthem

Although Anthem (ANTM -1.14%) is only a fraction of the size of UnitedHealth Group in terms of market capitalization, it’s still one of the largest health insurers. Anthem operates Blue Cross and/or Blue Shield plans in 14 states but is licensed to sell health insurance throughout the country.

It competes in the same arenas as UnitedHealth Group, with offerings that include employer-sponsored and individual health plans, Medicare Advantage, Medicare

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INSURANCE

Medicare Wants To Claw Back $4.7 Billion From Private Health Insurers

The US Medicare agency will seek about $4.7 billion over 10 years in clawback payments from private insurers that manage its programs under a long-awaited rule finalized Monday, a blow to the industry that sets up a possible court fight.

The rule, which governs audits of Medicare Advantage insurers by the Centers for Medicare and Medicaid Services, is stricter than the industry had lobbied for. It finalized a 2018 proposal for auditing the private plans that administer programs for the agency, a move intended to recover excessive payments based on exaggerated claims of patient illness.

“Today we are taking some long overdue steps to move us in a direction of accountability,” Health and Human Services Secretary Xavier Becerra said on a call with reporters.

Private Medicare health plans are a growing source of profit for insurers like Humana Inc., UnitedHealth Group Inc. and CVS Health Corp. Managed-care companies fiercely opposed the 2018 proposal, and the final version contains few concessions to industry. If it survives court challenges, the policy could increase the amount Medicare insurers will eventually have to repay the government over what officials say isn’t backed up by patients’ medical records.

Humana fell as much as 3.5% in extended trading after US markets closed, while United Health declined as much as 2.3%. CVS lost up to 2% while Centene Corp. and Elevance Health Inc. fell less than 1%.

Insurers in Medicare Advantage get paid more for enrolling sick patients, and the audits are meant to check those payments against medical records to ensure that they’re accurate.

CMS will limit the impact of its reviews on insurers’ payments for the earliest years under audit — from 2011 to 2017 — officials said Monday. The agency plans to look at certain insurer contracts for signs of diagnostic errors, and

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INSURANCE

Bright Health Insurance Review: Who Should Sign Up?

Bright HealthCare: Our thoughts

Bright HealthCare insurance is the best for those who are willing to save money on health insurance by having access to a smaller network of providers and no out-of-network access.

Plans are usually affordable, and in some states they may be the cheapest plans available. However, the trade-off is that the insurer only works with a limited number of affiliated doctors and health care facilities in each market it serves. Before signing up, it’s important to check if there are medical providers in your region that are covered by the insurance company.

Bright HealthCare also has a very high rate of dissatisfied members, which could mean you’ll be frustrated when managing your health care. According to the National Association of Insurance Commissioners (NAIC), the rate of complaints for Bright HealthCare is seven times higher than the national average, and on the Better Business Bureau (BBB), customers rated the company 1.44 out of five. Common complaints include poor customer service and denial of claims.

Plan options and costs

Bright HealthCare offers health insurance plans for individuals, families, small businesses and seniors. Policies are available through a state health insurance marketplace, Healthcare.gov and Medicare.gov, or you can purchase insurance directly from the company.

Individual and family health plans

Because the plans are compatible with the Affordable Care Act (ACA), they have the standard features of free preventative care, coverage for pre-existing conditions, and free pediatric dental and vision.

The main difference between Bright larger insurance companies is its narrow network of providers. Bright has what it calls a “carefully curated” network of “Care Partners”. This means that rather than trying to provide a broad selection of in-network providers, it strategically selects affiliate providers and facilities in each market. Insurance benefits are limited to these in-network

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INSURANCE

Oscar, Bright, and Clover Failed to Disrupt Health Insurance

  • The health insurers Oscar, Clover, and Bright set out to disrupt the health-insurance industry.
  • High barriers to entry and operational missteps kept them from upending much of anything.
  • Americans are left with a costly, complex system ruled by dominant insurers that only grows bigger.

About a decade ago, a new breed of health insurer began to emerge. Armed with billions in venture capital, these upstarts bet that they could use modern technology to make healthcare better, cheaper, and simpler to navigate.

Oscar Health drummed up buzz with eye-catching New York subway ads and a cofounder named Kushner. The Reddit-famous Clover Health won the seal of approval from the investor Chamath Palihapitiya. In Bright Health’s case, its founders’ connections to UnitedHealthcare, the biggest, richest US health insurer, gave it some credibility.

Hype swelled around these companies, and they notched massive valuations before each went public in 2021.

Today, they’re mostly the poster children of just how challenging it is to break into the insurance industry. No longer new enough to be called startups, they continue to face setbacks, and their losses grow deeper. While their CEOs are talking about finally breaking even soon, the companies are having to rein in growth when they’ve barely got a toehold to begin with.

Any disruption has been limited, to say the least.

“I don’t think they’ve had much of an impact,” Lawton Robert Burns, a professor of healthcare management at the University of Pennsylvania’s Wharton School, said.

The insurers’ failure to disrupt the industry raises a key question: Is it possible for any startup to displace — or even compete with — established giants such as United Healthcare and Humana? As the prospects for fixing the costly and complicated system dim, the consequences could be grave.

“We have a high-cost healthcare system that’s just

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