Payers are shifting their priorities in the MA space.
Medicare Advantage often takes the spotlight and next year will bring about some big changes that are sure to keep it there. Payers were up in arms over Medicare Advantage base rate cuts that will drop to 0.16% in 2025. Payers fought for higher payments, but CMS finalized this rule in April.
With this lower reimbursement rate and high medical costs, some payers are adjusting their strategies and looking at profitability and margins over membership growth.
Atena is looking to implement this strategy as it pulls out of less profitable counties. With disappointing first quarter results, Aetna CEO Brain Kane said the company will prioritize profitability over membership growth.
βIt's hard to say right now that we won't have a meaningful decrease in membership," Mr. Kane said. "It's certainly possible."
Humana is also looking to exit some markets next year after examining its first quarter results. According to The Wall Street Journal, Susan Diamond, Humana's CFO, said the company is expecting a net decline in its MA membership next year.
Some insurers have also said they will cut back on supplemental benefits due to the rate cuts, which was an adjustment we all saw coming as payers scrambled for new ways to cut costs after disappointing MA numbers.
CVS Is another payer looking to readjust. CVS Health CEO Karen Lynch said it will adjust plan-level benefits in 2025. Supplemental benefits like fitness reimbursement could be on the line.
Checkout this infographic for a quick breakdown:
Marie DeFreitas is an associate content specialist at HealthLeaders.