Come mid-October, the Medicare Advantage program will enter its annual enrollment period, marked by significant changes for older adults.
Among these changes are increased government scrutiny, tighter CMS regulations, reduced base payments, and rising healthcare costs.
"Additionally, the presidential election will distract beneficiaries during the early weeks of AEP, and the late Thanksgiving holiday will cause many beneficiaries to delay their decision-making until the final week, adding significant stress to an already difficult decision," Fran Soistman, CEO of insurance marketplace eHealth, wrote.
The health insurance industry has also launched a "seven-figure lobbying blitz," including a digital and social media campaign, to counter mounting challenges and highlight the benefits MA plans can offer to older adults.
In response to these market shifts, MA carriers are prioritizing their margins over membership by reducing certain benefits and exiting unprofitable markets. As margins tighten and negotiations with providers become more strained, some health systems are choosing to no longer accept some or all MA plans.
"Taken together, some are calling these cuts 'the great disruption,'" wrote Sachin Jain, MD, CEO of SCAN Group, a nonprofit MA carrier with more than 285,000 members, in a LinkedIn post on Sept. 4.
Dr. Jain outlined five key observations about the evolving landscape:
- Benefit stability will win out among beneficiaries over "innovation."
- MA organizations will need to improve care management, including avoiding hospitalizations and proactively managing chronic conditions.
- MA competition will increasingly focus on a plan’s effectiveness and service quality.
- Brokers will become more important than ever.
- Stronger relationships will prevail over "partnering with everyone."