"Medicare consumers overall ... crave stability of benefits and a hassle-free experience that gets them the care and coverage they need at a price they can afford," says one health plan executive.
Health plan marketing has begun for the 2022 Medicare Advantage (MA) season, with the annual enrollment period running from October 15–December 7. This compressed time frame is to MA payers what Black Friday is for retailers: the single-largest opportunity to gain customers and revenue. The analogy is apt given the massive opportunity MA represents for private insurers and the programmatic advantages over traditional Medicare that these companies promote and seek to capitalize on.
This is the first of a three-part series from HealthLeaders that will highlight key themes and spotlight the largest MA insurers in order of market share, including their key differentiators, enrollment totals, and market share. This information was provided by each payer via their national press releases and/or additional data obtained via HealthLeaders' inquiry with the goal of obtaining and reporting as much comparable data as was available at time of publication. Enrollment data differs slightly from the Kaiser Family Foundation's (KFF) analysis of CMS data highlighted in the HealthLeaders look-back of 2021 MA plans.
This week's article will feature UnitedHealthcare (UHC) and Humana. Blue Cross Blue Shield and Aetna (a CVS Health company) will be highlighted in feature two, with week three showcasing plans from Kaiser Permanente, Centene, and Cigna. Collectively, these plans represent 22 million members, with UHC and Humana representing approximately 45% of this number.
Premiums, benefits, and costs
Every MA insurer in the U.S. is looking to capitalize on a rare phenomenon in any industry: significant, organic growth. MedPAC reports that baby boomers "began aging into Medicare in 2011 at a rate of about 10,000 people per day, a rate that will continue until 2030." They further report that "over the next 15 years, Medicare’s enrollment is projected to increase almost 50 percent—rising from 54 million beneficiaries today to more than 80 million beneficiaries in 2030." That is the same year that the MA enrollment is projected to overtake traditional Medicare.
No- to low-cost premiums and cost-sharing is one reason why. Available data show that $0 premiums predominate, representing 65% of all MA plans. This is particularly attractive compared to Medicare Supplement policies. Zero copays also apply to a growing number of services—from provider visits to lab visits. Plans also offer $0 pharmacy deductibles and $0 copays on many tier 1 and tier 2 drugs, especially when filled at preferred retail or mail-order pharmacies.
Benefits that Medicare doesn’t offer or not as fully are another reason for the MA program's growth—from vision, dental, and hearing to home-delivered meals and transportation to services once considered alternative medicine and those identified based on social determinants of health (SDOH). There are also disease-specific savings for diabetes and, since 2020, for COVID-19.
Combine these factors with the overall stability, enhancement, and affordability of increasingly attractive benefit packages. This is the note payer executives consistently strike in their 2022 Medicare portfolio statements. Tim Noel, CEO of UnitedHealthcare Medicare & Retirement, summarizes it this way: that members "crave stability of benefits and a hassle-free experience that gets them the care and coverage they need at a price they can afford."
UnitedHealthcare is the largest provider of MA benefits in the U.S., with service areas and provider networks that reach 94% of all Medicare-eligible beneficiaries. Noel notes that for 2022, "every expanded benefit, every enhanced program and every investment in a new offering is because we have been listening intently and shaping our plans to deliver on what we hear from consumers." UHC offers Medicare Supplement plans co-branded with AARP, which gives members access to brain health and driving refresher programs with auto insurance premium discount opportunities. UHC also offers standalone prescription drug plans (PDP) co-branded with AARP and Walgreens.
- MA enrollment and market share: 7.3 million, 27%.
- Footprint: All 50 states, plus Washington, D.C.; includes 276 new counties.
- $0 premium: Available to 3 million members.
UHC reports that 98% of its members will have stable or improved benefits in 2022. The company will offer new, lower copays for specialist visits and physical, occupational, and speech therapy. Nearly 90% will have access to comprehensive dental coverage through select plans, with specific coverage for higher-cost services such as crowns, bridges, root canals, and dentures.
Drug cost highlights include more tier 1 covered drugs and gap coverage including more $0 copays and $0 deductibles across plans and delivery options. Among consumers, 70% of UHC's current members and 90% of its eligible beneficiaries will have access to $0 tier 1 retail pharmacy copays with the same copay extending to tier 2 for mail order for most plans.
As part of its customer experience focus, UHC further highlights its expanded HouseCalls program featuring in-home testing for diabetes, hepatitis C, and SDOH factors.
Humana is the second-largest provider of MA benefits in the U.S. Alan Wheatley, President, Retail, remarks: “After considering the needs of our members and how we could offer them more for 2022, we designed our Medicare plans to address people’s whole-life needs—with a particular focus on their most important health care needs …"
- MA enrollment and market share: 4.9 million, 18%.
- Footprint: All 50 states, Washington, D.C., and Puerto Rico; includes HMOs in 115 new counties, dual-eligible special needs plans (D-SNP) in 268, and local PPOs (LPPO) in 162.
- YOY growth: 72 new plans (42 MAPD non-SNP, 27 SNP, and 3 MA).
- $0 premium: 52% of plans.
In its 2022 press release, Humana places less emphasis on $0 premiums, copays, and prescription drug cost-shares than other carriers. It does highlight its D-SNP Prescription Drug Savings Benefit to reduce Part D copays for many of those plan members. Instead, Humana stresses SDOH factors such as food security and transportation access. This includes a Healthy Foods Card for groceries, also for D-SNP members.
The company offers the $0 premium Humana Honor MA plan, which was "designed with U.S. military veterans in mind" and will now be available in 47 states. The plan includes dental benefits and a buy-down feature that reduces Part B premiums. All of Humana's MA plans are USAA endorsed but not co-branded. The company does offer co-branded, stand-alone PDP plans with Walmart that include the retailer's Sam's Club pharmacies.
Humana is the only carrier that HealthLeaders covered that emphasized its sales process, including more personnel available virtually, by phone, and in-person for agents who are fully vaccinated.
Part two of this series will highlight Medicare portfolio strategy and the next two largest carriers: Blue Cross Blue Shield and Aetna.
Laura Beerman is a contributing writer for HealthLeaders.
Medicare Advantage enrollment is outpacing traditional Medicare enrollment.
No- to low-cost premiums and cost-shares—in addition to expanded benefits—are just a few of the reasons why.
Through evolving plan designs, payers seek to gain market share in ways that are similar and differentiated.