Well Solutions Group’s Post

The first of our series of articles on Medicare Advantage discusses the current landscape of this growing facet of health care coverage, including both why individuals are drawn to these plans and what might inhibit their future growth.

The rapid growth of Medicare Advantage (MA) enrollment over the past twelve years raises significant questions about cost, quality, health equity, and the impact on Traditional Medicare (TM) viability. As MA plans now cover more than half of Medicare-eligible individuals, with projections to grow further, concerns about performance, transparency, and health equity have intensified. Key points include: Declining Star Ratings: Average star ratings dropped from 4.14 in 2023 to 4.04 in 2024. Expanded Quality Measures: New methodologies emphasize health equity, using 40 performance measures. Transparency Issues: Data gaps remain despite CMS efforts to enhance transparency. Health Equity Concerns: Vulnerable populations might be forced into lower-performing MA plans. Financial Incentives and Challenges: MA plans receive higher federal payments but face scrutiny over cost justification and service quality. Countervailing Factors: Enrollee dissatisfaction and limited networks may slow MA growth. MA insurers must improve performance and transparency to sustain growth. Subsequent articles will explore proactive steps insurers can take to prepare for the future. For more details, visit DataWell Informatics or contact us at [email protected] or 833.328.2935.

Part 1: The Current Landscape The remarkable growth in Medicare Advantage enrollment over the past twelve years is raising questions about both the cost and quality of that coverage as well as the ultimate impact on health equity and solvency of the traditional Medicare program. This is the first in a series of articles to follow, providing insight into the current landscape (both in terms of Medicare Advantage performance and growth) to help lay the foundation for steps that plan sponsors and provider organizations can be taking to prepare for the future. #medicare #medicareadvantage #healthcare #healthcaremetrics

Medicare Advantage offers options in flexible benefits and range of pricing, however it is not all sunshine and roses. An aging population and ever climbing cost of care is creating financial viability pressure. This is the first in a series of Medicare Advantage considerations and potential strategies in planning for providers, provider services, health plans and payer services . This article lays the foundation on the current Medicare Advantage Landscape. #Medicareadvantage #Heathcare #Healthcareaffordability

A new KFF analysis reveals Medicare spent an average of 27% more on people who switched from Medicare Advantage to traditional Medicare than for similar beneficiaries who were in traditional Medicare all along. In 2024, more than half of all eligible Medicare beneficiaries were enrolled in a Medicare Advantage plan. Other research has found that people who use relatively more health care services are less likely to sign up for one of the private plans and more likely to choose traditional Medicare. #Medicare #MedicareAdvantage

We are approaching the time of year when so many people renew or sign-up for health benefits — either individual or employer-sponsored coverage. October 15th marked the start of the annual enrollment period for Medicare for millions of older Americans. This year, there are significant changes to Medicare plans, and it's really important that people make informed decisions to ensure they have health coverage that meets their needs. If you have a friend or loved one who is Medicare-eligible, please encourage them to do their research before selecting a plan for 2025. https://lnkd.in/ePyWF2fj FloridaBlue #Medicare #AnnualEnrollmentPeriod #PlanOptions

Interesting POV from the CMS Administrator during Obamas Administration around the future for Medicare Advantage. With Medicare Advantage being the dominant player with more than a 50% market share, also being the primary option for provider owned health plans, this will continue to shape not only public healths approach to Medicare but also how provider owned plans will continue to invest in MA plans to compete against the more profitable larger market players going forward.

Medicare Advantage bashing continues! 🎭 Health systems are ditching the program over tough requirements and poor reimbursements, while Elevance and SCAN have taken their grievances to court, challenging CMS's star ratings. Meanwhile, customer (patient) enrollment shows signs of stagnation. What’s your view on this battle for value-based care? Are these just growing pains as we push for VBC, or are we witnessing the beginning of the end for MA plans? #HealthcareReform #MedicareAdvantage #PublicPolicy

Aetna, a CVS Health Company,Elevance Health, and Humana have terrified the Medicare broker community with announcements that they will not pay commissions on certain plans for enrollments after 11/1. These actions are not unprecedented, but the quantity of plans that will be non-commissionable is unprecedented. When a carrier temporarily makes one of their plans non-commissionable, it’s usually because the plan is growing too quickly, and they have no other way to slow enrollment in the plan. The amount of disruption we have seen in Medicare this year has been unprecedented. It is the government, legislators, and CMS that have destabilized the market. This disruption has led to an environment where carriers did not know what other carriers were going to do and how they would handle the changes. The result is some plans are far more attractive to beneficiaries than other plans, and they are growing too quickly. If a plan becomes too large, too fast, it cannot support the people who enroll and that creates a negative situation. We have seen this in the past, for example with Scan Health in Southern California. I do not see this as being the same as the situation we have with WellCare where a carrier is intentionally not paying agents commissions, including past commissions. WhileI am not happy about the result and the impact to the broker community and to my own agents and brokers, I realize that these carriers only have one lever to pull when they are getting too many enrollments. Therefore, I believe this will be a short-term problem and do not believe that this is an indication that the sky is falling.

The acceleration of Medicare payments is not merely a transactional shift in billing procedures but a dynamic response to an unprecedented healthcare challenge. It impacts providers, suppliers, payers, and analysts, influencing workflows, operations, and long-term strategic planning. As the healthcare landscape continues to evolve, agility in financial management will be a defining factor for success.