Medicare Advantage Premiums Down, Enrollment Way Up in 2012

September 19, 2011
|In Policy & Health Reform, Sales & Marketing, Star Ratings, Strategy, Risk Adjustment
|By GHG Advisors

We’ve long said on these pages that all the predictions of the demise of Medicare Advantage following passage of the ACA and its steep cuts to the program were premature.  Finally, confirmation from CMS: MA premiums will fall another 4% in 2012, and enrollment will grow by a brisk 10%.

The news was delivered Friday by Jonathan Blum, deputy administrator for the Centers for Medicare and Medicaid Services.  Blum said health plans are also lowering co-payments and deductibles.  He attributed the premium drop to the agency’s strong negotiations with plans as well as the plans’ continuing desire to serve the market.

Some color commentary on Blum’s announcement:

  • Government programs (Medicare and Medicaid in particular) are the only segments of the insured that are growing.  MA, for instance, will grow over 7% this year, topping 12.5 million beneficiaries.  Part D is approaching 20 million enrollees;
  • Publicly-traded companies like MA leaders Humana and United are now dependent on Medicare, deriving twice their earnings from the program than they did a decade ago (average publicly-traded health plan earnings from Medicare in 1999: 13%; today, 26%, with some like HealthSpring and Universal American over 70%.  Bottom line: the big boys ain’t going anywhere.);
  • Over 40% of beneficiaries aging into Medicare have enrolled in MA plans the last two years, indicating the Boomers are a much more plan-friendly population than the World War II generation given managed care trends in the commercial market (HMOs, PPOs and POS plans represent more than 90% of all insured Americans).;
  • Market-leading plans are adapting to the challenges of the ACA by offsetting its payment cuts with intense focus on Star Ratings quality bonuses and mastering the new state of the art in risk adjustment: the prospective home advanced evaluation.  It’s working, enabling plans to hold the line on benefits and premiums, and maintaining the attractiveness of these products vs. Medigap or traditional Medicare.

As long as the Congressional deficit Super-Committee doesn’t fire another broadside at MA plan payment rates this fall, 2012 is shaping up to be a VERY good year.