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MA Payers Focus on Cutting Out-of-Pocket Costs, Home Health in 2021

Three major Medicare Advantage payers emphasized lower out-of-pocket costs for home healthcare telehealth benefits, premiums, and prescriptions.

Kelsey Waddill
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Published: 01 Oct 2020

As Medicare open enrollment approaches,  benefits from major payers emphasize lowering out-of-pocket costs and home healthcare benefits.

UnitedHealthcare, Humana, and Cigna are significant players in the Medicare Advantage space. All three received five stars in CMS Medicare Advantage Star Ratings.

Additionally, UnitedHealthcare and Humana are two of the largest Medicare Advantage health plans, accounting for 43 percent of all Medicare Advantage enrollees in 2018.

An overview of their health plan benefits for 2021 reveals a couple of commonalities that may demonstrate key priorities for Medicare Advantage plans this coming year.

As payers face a new year with highly uncertain expenditures, these major health plans emphasized lowering out-of-pocket healthcare spending and providing home healthcare benefits in their offerings this year.

UnitedHealthcare

UnitedHealthcare is expanding its Medicare Advantage footprint beyond its current 6.5 million enrollees.

The payer will add 300 counties to its Medicare Advantage market—the largest expansion this company has made in five years. The payer also has the largest provider network in the US, with 850,000 in-network care providers

Home healthcare products have emerged as an essential service due to the coronavirus pandemic.

“The COVID-19 pandemic is a watershed moment that is profoundly altering the health care landscape. At-home health care went from being a convenient care option to, at times, the only option for many people,” said Tim Noel, chief executive officer of UnitedHealthcare Medicare and retirement.

All UnitedHealthcare Medicare Advantage plans will offer a $0 telehealth copay.

UnitedHealthcare has also incorporated a home healthcare program called HouseCalls into most of its Medicare Advantage plans. With HouseCalls, UnitedHealthcare will cover a home visit by a licensed clinician—the member’s primary care provider or another professional—to deliver preventive care for chronic disease management.

The payer is also targeting member populations with complex conditions and chronic diseases. Navigate4Me provides coordinated care to help members with complicated care strategies or those who need to self-quarantine due to COVID-19.

The Medicare Advantage health plans also feature several opportunities for saving on out-of-pocket healthcare costs for qualifying members, particularly regarding prescription drug spending.

For example, dual special needs plan members will have no copay for their prescription drugs UnitedHealthcare is also expanding the number of tier 1 and tier 2 generic drugs it covers with $0 copay. The payer is also participating in the Part D Senior Savings Model for insulin.

The payer is also offering wellness programs, supplemental benefits, quarterly credit for over-the-counter products, healthy food benefits, and rewards for receiving preventive care.

Humana

Humana boasts almost 8.4 million Medicare members across the nation and 4.5 million of those are in a Humana Medicare Advantage plan. The payer is extending its HMO products to 125 more counties.

“For 2021 we’ve expanded our footprint, increased plan value and we’re enabling safe education and enrollment for beneficiaries – we call that Human Care, delivering what matters most for our members,” said Alan Wheatley, president of retail segment at Humana.

All Medicare Advantage Part D prescription plan members will offer $0 telehealth benefits for primary care, urgent care, and outpatient behavioral healthcare.

Members with coronavirus will be able to receive treatment for free as well as 14 days of meal deliveries.

Many of the plans include access to Humana’s fitness program, Go365, as well as Medicare Parts A and B, Part D prescription drug coverage, out-of-pocket protection, and chronic disease management tools.

Additionally, Humana Medicare Advantage plans will offer Humana At Home—a home healthcare program. Members receive a care coordinator who will help them organize their prescriptions, transportation, and will educate members about how to avoid hospital readmission.

Cigna

In 2021, Cigna will expand its Medicare Advantage health plans to 23 states, boosting its county footprint by 22 percent—its most extensive expansion to date.

The payer has also expanded its network by 25,000 physicians. Over eight in ten members (85 percent) will receive care from providers who are in value-based care arrangements with Cigna.

“No matter the setting, our Medicare Advantage plans ensure our valued customers get the proper preventive care, chronic condition management and emotional support they need during these challenging times,” emphasized Brian Evanko, president of Cigna's government business.

Every Medicare market will include a Cigna plan with no premium and many plans will cover supplemental benefits such as vision and dental benefits, fitness, and meal delivery following a hospital discharge.

The plans will offer benefits that target social determinants of health including transportation and food access, such as Healthy Benefits Plus. This program enables members to afford fresh produce with a $30 monthly produce card.

The 2021 Medicare annual election period starts on October 15, 2020 and ends December 7, 2020.

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