Welcome to week one of our Fall 2019 AEP Digital Listening Bulletin. In this bi-weekly e-mail, we’ll take a look at the trends, conversations, and themes that we are seeing dominate the Annual Enrollment Period discussion as carriers, brokers, agents and enrollees go through this annual process.
As the season heats up, we expect the conversations to get more detailed and heated as well. Stay tuned!
Theme One: Politics—As Usual
Not surprisingly, the President’s October 3rd Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors dominated much of the conversation over the last two weeks as we entered AEP.
Equally unsurprising, sentiment is split—with political affiliation driving perception. Those for it argue for the benefits of premium decrease, increased choice, expanded coverage and decreased regulation. Those against it largely argue on the basis that it is a backdoor to privatization of healthcare. Some choice tweets:
- “THANK YOU PRESIDENT TRUMP FOR TAKING CARE OF OUR…SENIORS! Healthcare is something a senior cannot live without & it is something they should have to worry about! DS Dems are on a quest to give free healthcare to illegals funded by our seniors Medicare…NO!”- @LynneDeena
- “Yes, thank you President Trump, today I got a 3-D Mammogram and it was paid for through Medicare Advantage because of you!” -@Nkhboone
- “Trump’s Executive Order is Backdoor Privatization of Medicare. My proposed premium for Medicare part D is a 98% increase over 2019. Am I being leveraged to move to a Advantage plan with part D and “Advantage Trump”?” – @jckrizek
- “Alert! Don’t let your parents, relatives sign up for the President’s new Medicare Advantage. It is a thinly veiled attempt to privatize Medicare via “the back door.” Fewer choices, fewer doctors, less coverage. Don’t let your relatives become Trump’s chumps! Say no to Advantage.” – @h_gossett
Politics notwithstanding, more than 24.4 million people are expected to enroll in Medicare Advantage for 2020, up from 22.2 million in 2019.
Theme Two: “Tastes Great. Less Filling”
CMS announced that “on average, Medicare Advantage premiums in 2020 are expected to decline 23 percent from 2018 while plan choices, benefits and enrollment continue to increase”. Like the iconic Miller ad, carriers are taking full advantage of that dichotomy and touting lower-cost plans and enhanced benefits as a key part of their marketing message and plan positioning:
- “Cigna Expands Its Medicare Advantage Offerings and Benefits While Minimizing Costs to Consumers”
- “Highmark lowers costs, increases benefits for Medicare Advantage plans”
- “Blue Cross NC Lowering 2020 Medicare Advantage Rates by 31 Percent”
Cigna and Humana both announced 2020 plans that include coverage for various Social Determinants of Health—from air conditioners to rides to places of worship and grocery stores as new benefits get added to MA plans. Research has shown that these SDOH factors influence a person’s health more than the medical care he/she receives and will be a focus area as carriers look to drive value-based care solutions.
Not everyone is buying into the “Costs Less. Delivers More” value proposition. We are picking up a lot of customer sentiment around hidden price increases, bait-and-switch methods and general feelings of distrust.
- “@SeemaCMS @CMSGov Why is Medicare allowing Insurance companies such as Humana‘s Medicare Advantage plans to drive max out of pocket limit increases in one year to more than $1500 Humana plan in SE Fl HS 5216 went from $3400 to $5100 for in network, and from $5100 to $8500? This is ridiculous!” –http://twitter.com/KevinMac53/status/1182647078968856577
- “I’ve warned you before about the fraud that is Medicare Advantage programs, but today my discontent increased, because Blue Cross Blue Shield would not pay for my flu shot. Can you imagine? Seniors beware. This is a bait and switch from Medicare to the company’s own insurance.” – http://twitter.com/TerryHeaton/status/1179803064531931136
- “Medicare Advantage plans are also a terrible waste of public dollars. They have overcharged Medicare by $30 billion in the past three years alone. Today’s executive order is yet another giveaway to the PROFIT-DRIVEN corporations that run Medicare Advantage plans.” – @sevenbowie
Kaiser Health News filed an FOIA lawsuit in September against CMS to force the release of 90 government audits of Medicare Advantage health plans conducted for 2011, 2012 and 2013 but never made public. Although the agency has disclosed the names of the health plans under scrutiny, it has not released any other details. Nearly all major carriers are listed.
Carriers will need to be very transparent about total costs, including out-of-pocket expenses, and provide visibility into and rationale behind any increases to help overcome this distrust.
Short-term carriers should be more targeted in their messaging and look to differentiate based on unique plan benefits against specific audience needs. Longer-term expect to see more variability in plan benefits as carriers experiment with new ways to impact health outcomes as CMS expands the use of breakthrough medical devices and advances in telehealth and similar technologies under a Value-Based Insurance Design for MA.
Theme Three: A Quiet Telehealth Expansion
In April, CMS expanded the use of telehealth capabilities in MA plans to provide improved access to routine care services via phone, tablet, or laptop, and in some instances to include limited telehealth capabilities for behavioral health and urgent care as well.
We saw a lot of buzz when the rules announcement was made, but it has been relatively quiet on the telehealth front as we enter AEP.
Humana announced a six-month Virtual Care Team pilot for some 250 MA members in 34 states in partnership with Seniorlink. And Amazon waded into the broader telehealth market last month with the launch of Amazon Care, a direct-to-consumer telehealth platform initially targeted at its employees in the Seattle area. Expect that to expand quickly.
Most carriers have incorporated some form of telehealth benefits into their plans but are not promoting them heavily during AEP.
That may be because—while telehealth technology is mostly ready—many seniors are not. A new national poll suggests that people over 50 aren’t quite ready to fully embrace virtual health visits with their doctors and other providers. Key findings included:
- Only 4% of those polled had had a video-based telehealth visit with a provider via smartphone or computer in the past year.
- More than 80% of older adults polled expressed at least one concern about seeing a doctor or other provider virtually rather than in person.
- 47% worried about getting the technology to work
Short-term carriers will have to do more to educate their members on both the benefits and the technology of telehealth.
Longer-term, expect to see much more partnership and innovation in telehealth benefits as carriers experiment with new ways to impact health outcomes—like Devoted Health being the first MA plan to cover the Apple Watch as a benefit (presumably for the 53% who don’t worry about getting the technology to work!)
Theme Four: Veterans Emerging as a Target Audience
The VA Mission Act will drive an increase in veterans using their VA benefits and create additional opportunities for Medicare Advantage in the Veterans market. With more than 8.8M 65+ veterans, this market is beginning to get focused coverage from select carriers with plans that target the unique needs of veterans receiving VA coverage (as well as those not receiving VA coverage.)
Humana appears to be leading the charge this AEP with a well-publicizedannouncement of 17 Humana Honor Plans across 28 states in early October. These plans, while available to all Medicare-eligible individuals, offer health benefits and wellness programs designed in a way that complements the benefits a veteran receives through VA Healthcare. “The launch of Humana Honor is a natural next step in our commitment to veterans and their families,” said Alan Wheatley, president, Retail Segment at Humana. Humana has also extended its agreements as the national MA/MedSupp/PDP provider by the VFW and AMVETS.
Short-term we expect to see more Veteran-specific messaging this AEP. Longer-term, we expect to see other carriers begin to address the unique needs of this segment with new plans and benefits as they compete for growth opportunities. Interestingly, the VA just launched a telehealth pilotthat utilizes state-of-the-art, private, Internet-connected healthcare pods located in several VFW and American Legion posts.
Theme Five: Brokers and Brands Go Local
Average plan choices per county will increase from 33 to 39 in 2020, with more than 1,200 new plans introduced this year. Plans have even more leeway to get creative with new benefits in 2020, and they are also beefing up on the old supplemental benefit standbys like hearing, dental, vision and prescription drug benefits.
With the increasing number of plan choices and plan benefits available, the decision-making process has become even more complex for already-confused seniors. “It’s great to offer a supplemental benefit, but it doesn’t matter if the beneficiary doesn’t know what it is or how to use it,” said Michael Bagel, the Alliance of Community Health Plan’s director of public policy.
Plan and benefit proliferation create enablement and education challenges for brands and brokers as they go local to educate consumers. We are seeing a lot of local market chatter for Medicare education events. Numerous local libraries and senior centers have added AEP assistance as part of their agenda, and brokers and brands are leveraging them as they look for effective local outlets to engage with seniors.