Humana and CVS intend to raise premiums and reduce benefits on their MA plans in 2025, reports Rebecca Pifer for Health Care Dive. They want to increase their profits further, even though the government already overpays them billions of dollars a year.
As many as 700,000 CVS and Humana MA enrollees could switch to other plans, and CVS and Humana don’t seem to care. UnitedHealth is likely to grow its business in the process, depending upon whether it decides to cut benefits and/or raise premiums. The insurers offering Medicare Advantage are unlikely to increase their out-of-pocket caps and their deductibles, which people with Medicare apparently care most about.
We won’t know what these insurers will decide to do until October. To be clear, CVS and Humana, like all of the big insurers, are first and foremost in the Medicare Advantage business to generate profits for their shareholders. Enrollee needs are secondary. They will exit markets where they don’t see good profits.
CVS, Humana and UnitedHealth all own medical provider groups. So, they are likely to continue their MA businesses in counties in which those groups have clinics and they can generate better profits.
Insurers are most likely to raise copays for specialty care, which people can’t really wrap their heads around before enrolling and needing specialty care. Insurers also could cut supplemental benefits, such as money for home improvements and pet care.
The insurers have a lot of discretion, but they can’t change anything they want. The government limits their ability to change “total beneficiary cost,” which is limited to $40 per enrollee each month.
Here’s more from Just Care:
- 33 experts call on CMS to continue reining in Medicare Advantage overpayments
- Medicare Advantage needs serious fixes; $88 billion in government overpayments must end
- Medicare Advantage: Expect lots of care denials
- Five concerning policy outcomes of Medicare Advantage program
- New poll confirms serious access to care concerns in Medicare Advantage
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