Portfolios are designed to "make care more affordable, accessible and convenient," in the words of one executive.
The ideal value chain for any industry or company is one built for lifelong customer retention and loyalty. One component of such a chain is a portfolio strategy that continues to offer maximum choice and affordability. For insurers in the Medicare market, this equates to a mix of plan designs and standalone prescription drug plans (PDP), group plans, and Medicare Supplement plans.
This spectrum gives insurers the ability to:
- Offer options that appeal to every Medicare-eligible beneficiary.
- Capture the significant, organic growth represented by the 10,000 baby boomers aging into Medicare daily.
- Convert existing, non-Medicare customers to Medicare coverage.
Portability through provider networks and PPOs
The latter may be easier said than done. While some consumers are more passive decision-makers, opting to stick with the brand they know when they become Medicare eligible, the internet has made online plan comparisons and selection navigation, including those offered by a rising group of insurtech startups, easier than ever. Consumers may find that their carrier's Medicare provider network doesn't include their current physicians, cover their prescription drugs, or offer the care choices necessary as medical needs increase.
The importance of provider networks is closely linked to another piece of the strategy puzzle: offering enough PPO plans to maintain provider access. Portability is important not only for consumers but also employers who offer retiree benefits. Being strategically positioned to make conversions also includes the important but rarely discussed factor of whether the umbrella company's subsidiary structure permits the data sharing necessary for payers to target and market to their Medicare eligibles in an efficient, cost-effective way.
Part 1 of this HealthLeaders' series targeted Medicare Advantage (MA) cost design, including the increasing percentage of $0 premium plans and copays while summarizing 2022 offerings from the two largest MA insurers, UnitedHealthcare and Humans. Part 2 will overview plans from the Blue Cross Blue Shield (BCBS) companies and Aetna, the next-largest plans by market share. BCBS enrollment data was sourced from the Kaiser Family Foundation (KFF) and includes its Anthem-branded plans. Aetna provided its enrollment data, which varies only slightly from 2021 KFF statistics.
Blue Cross Blue Shield including Anthem
BCBS, a federation that includes the BCBS Association and 35 independent companies (including Anthem-branded plans), ranks third for MA market share. One of BCBS's stated focus areas is "offering support that goes beyond the four walls of the hospital or doctor's office by addressing social needs that are important to good health for seniors."
- MA enrollment and market share: 3.8 million, 14%.
- Footprint: 47 states and Puerto Rico
- $0 premium: Available in 40 states and Puerto Rico
The impact of multiple chronic conditions is one of several target areas in BCBS plan design. Related benefits include food insecurity and enhanced primary care. Community partnerships are a central part of the strategy. Two BCBS plans partner with community organizations for meal delivery: BCBS of Massachusetts and Independence Blue Cross. The latter has also partnered with Dedicated Senior Medical Centers in Philadelphia to bring primary care closer to low-income neighborhoods and in hopes of reducing ER visits, hospital admissions, and inpatient length of stay. BCBS plans in three states (Rhode Island, Michigan, and New York) also offer "concierge services" to assist members with complex care navigation.
BCBS Anthem plans are offering an Essential Extras package to address "whole health and its many drivers of health." The option, available in seven of the 14 states where Anthem operates, allows members to choose one of nine benefits include allowances for dental, vision, hearing, assistive devices, and groceries; allotted hours for in-home support and personal home helpers; a fitness tracker and fitness program membership; meals and transportation services; and pest control.
Aetna, a CVS Health company, is the fourth-largest MA insurer. Christopher Ciano, President, comments that the company wants to maintain its COVID-19 care focus while helping "improve their overall physical and mental health." Ciano reports that the company "expanded our Aetna Medicare Solutions portfolio of products to include more benefits designed to make care more affordable, accessible and convenient."
- MA enrollment and market share: 2.9 million, 11%.
- Footprint: 46 states and Washington, D.C.
- $0 premium: Available to 84% of beneficiaries.
For 2022, Aetna indicates that approximately one-third of its individual MA plan members will see lower out-of-pocket cost maximums for in-network care. The company is also emphasizing its "holistic approach to health," which includes leveraging its CVS Health relationship for expanded over-the-counter (OTC), fall prevention, and smoking cessation solutions as well as lower pharmacy costs. As for additional drug benefit enhancements: "Individual MAPD plans will increase prescription drug day supply to a maximum of 100 days for drugs on tiers 1-4 [where package size allows] … with no increase in copay/coinsurance".
The company's offerings include more dual-eligible special needs plans (D-SNP) and Aetna Medicare Eagle® plans for veterans that pairs with their VA benefits, available in 41 states and with $0 premiums and $0 PCP and lab copays, plus dental, vision, hearing, OTC, and fitness benefits for all plans. Aetna has expanded its hospice benefits and end-of-life support select MA plans in Ohio and Pennsylvania, and its alternative medicine benefits including therapeutic massage for select Northwest region plans. It is one of many plans taking an allowance-based approach for some of its dental benefits.
Additional benefits and up next
As mentioned in Part 1 of this series, many plan benefits have become increasingly standard for MA plans but beyond what traditional Medicare covers. This is true of BCBS and Aetna and includes enhanced dental, vision, and hearing; transportation and post-inpatient-stay meal delivery; OTC and fitness; programs that combat loneliness; and $35-per-month insulin cost caps as part of the Part D Senior Savings Program created by the Centers for Medicare & Medicaid Services (CMS).
Part three of this series will highlight social determinants of health (SDOH) and the next three largest MA carriers: Kaiser Permanente, Centene, and Cigna.
Editor's note: This story was updated on October 25, 2021.
Laura Beerman is a contributing writer for HealthLeaders.
Carriers have developed diverse Medicare portfolio strategies to capture maximum market share.
Provider networks and PPO plans are critical for payers to convert commercial enrollees to Medicare coverage when eligible.
This portability complements payers diverse plan types and benefit designs.