What's behind Aetna's industry-leading Medicare Advantage growth?

It's no secret that big insurers are facing challenges in the Medicare Advantage space, leaving enrollment growth flat or even on the decline for much of the industry in 2024.

But at CVS Health, Aetna Medicare Advantage membership is outpacing the competition, boasting 15% growth during the annual enrollment period and around 4 million total members.

Becker's sat down with Aetna's Medicare president, Terri Swanson, to learn more about the strategy driving CVS' industry-leading growth.

Question: Aetna outpaced the industry with Medicare Advantage growth during the annual enrollment period. What's behind that success?

Terri Swanson: The biggest factor behind our growth is our strategy, which is fairly simple. We really want to provide older adults access to affordable care, convenience and choice that helps them achieve their best health, and we know that's a unique equation for each person. We've designed our 2024 plans with choice and flexibility in mind, and it's the largest offering and the most regions in our history. 

We've also done a lot of plan simplification to hone the message and enhance the value proposition for members. The things that we think matter most are having really strong and compelling core benefits. At the end of the day, you have health insurance to make sure that you can see your doctor. Every county where we offer a plan has options that include $0 primary care with no monthly premium, $0 cost sharing for tier one drugs, along with dental, vision and hearing benefits. We've also got good and stable maximum out-of-pocket limits. The other thing that has been really attractive is being able to offer a unique set of assets and capabilities that we enjoy as being part of CVS Health. We've got MinuteClinic in many locations, CVS Pharmacy, healthy home visits through Signify Health, and Oak Street Health primary care clinics that specialize in senior care.

Q: CVS Health has lowered its 2024 earnings guidance because of rising spending in Medicare Advantage. What is your plan to overcome the market challenges seen across the industry this year?

TS: The big question for us is how we move forward with continuing to help our Medicare Advantage members understand how to make the most out of their benefits, and making sure that they have access to care that drives their best health. We want to give them choice and flexibility, but we also want to make sure that they use their benefits, proactively access preventive services, and avoid disruptive health events from occurring in their lives.

Q: What is your long-term view of Medicare Advantage, both for the program and at CVS Health?

TS: Medicare Advantage has proven to be an incredibly popular program. More than 32 million people are in the program, meaning more than half of the Medicare population has made that choice. We think that this is going to continue to be a really strong growth opportunity within the industry and for CVS Health because it's a really powerful value proposition. Medicare Advantage beneficiaries spend over $2,400 less out-of-pocket annually compared to those enrolled in fee-for-service, and they have access to other benefits that simply aren't included in original Medicare. In addition, our country's aging population is going to continue to grow, and we feel we're uniquely positioned long term to help them with their needs through our portfolio of products. Our scale and our mission is really aligned with the Medicare Advantage opportunity.

Q: Can you share a real-life Medicare Advantage member experience at Aetna that has resonated with you over the past year?

TS: This is a very personal business — it's people, not numbers, at the end of the day. Just this month I heard an example of an Aetna social worker who really went above and beyond to support one of our members in a D-SNP plan. This member is a single-leg amputee who uses a wheelchair. He's in his mid-70s and lives in a first-floor apartment in Indianapolis. Even being on the first floor, there are steps outside that made it literally impossible for him to leave his apartment on his own. He was missing appointments with his primary care physician, and that's how this came to light for our social worker. Our social worker spent literally eight months filling out forms, visiting state offices, escalating requests and ultimately filed a complaint with the Indiana Civil Rights Commission to get a ramp installed outside this member's apartment. 

Not only does this allow him to visit his PCP, but it lets him leave his apartment when he needs to on his own. The difference that our Aetna team makes in the lives of individual people is really powerful. It's why we all come to work in the morning — stories like this are happening every day for our staff and our members.

Q: Final thoughts?

TS: We at CVS Health strongly believe that collaboration with providers is the cornerstone of having a great member experience and being able to improve their health in a sustainable way. As the insurance company, being able to make sure that the member has access to high-quality providers and that the provider has great information from us is really a partnership based on surrounding the member with the right services to ensure that they can achieve their best health.

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