Cigna, one of the largest health insurance providers in the U.S., is reshaping its Medicare Advantage (MA) offerings by reducing its coverage across eight states. The changes, which will impact 36 health plans, are part of its’s effort to optimize its Medicare Advantage services, ensuring viability, network adequacy, and enhanced provider engagement. This article will explore the details of it’s decision, the states affected, and the impact on Medicare beneficiaries.
Cigna’s Medicare Advantage Plan Reductions
Cigna’s decision to reduce the number of Medicare Advantage plans is poised to affect several states and thousands of beneficiaries. While 36 plans are set to be impacted, most have relatively low enrollment, which may minimize the disruption for beneficiaries. However, certain counties will see a complete exit from Cigna’s MA services, leaving many residents searching for new plan alternatives.
States Affected
The eight states affected by Cigna’s Medicare Advantage restructuring are:
1. Colorado
2. Florida
3. Illinois
4. Missouri
5. North Carolina
6. Tennessee
7. Texas
8. Utah
Florida is expected to be the most affected, with up to 4,000 of the 5,395 beneficiaries impacted residing in the state. Cigna’s membership in Florida will see significant reductions, particularly in PPO (Preferred Provider Organization) plans, which will no longer be offered in the state and some counties in two other states.
Impact on Beneficiaries
In total, around 5,395 beneficiaries will be affected by the changes, with alternative plans available in most areas except for select counties in Missouri and North Carolina, where it is fully exiting the market. These members will need to find new Medicare Advantage plans to maintain their healthcare coverage in 2025.
Reasons for the Plan Adjustments
Cigna Healthcare regularly evaluates its service areas to ensure that the Medicare Advantage plans it offers meet the highest standards of care. Several factors contributed to the decision to reduce plans in these eight states.
Viability and Network Adequacy
One of the main reasons behind it’s decision is the evaluation of service areas for long-term viability. When certain regions show signs of underperformance, such as low enrollment or gaps in the provider network, Cigna may choose to withdraw its Medicare Advantage offerings.
Provider Engagement
Cigna also places a strong emphasis on provider engagement. If gaps are identified between healthcare providers and the network, and these issues cannot be resolved, Cigna opts to withdraw its plans rather than offering suboptimal services to its members.
Cigna’s Partnership with Health Care Service Corp (HCSC)
In January 2024, Cigna entered into a significant $3.7 billion agreement with Health Care Service Corp (HCSC) to sell its Medicare business. This sale included a broad portfolio of Medicare services, including Medicare Advantage, Part D plans, supplemental benefits, and the CareAllies business.
The $3.7 Billion Deal
The deal between Cigna and HCSC is expected to reshape both organizations’ Medicare offerings. Cigna’s decision to trim its Medicare Advantage plans aligns with the broader shift towards handing over more responsibility to HCSC.
Evernorth’s Role in Pharmacy Services
As part of the deal, Evernorth, a subsidiary of Cigna, has partnered with HCSC to provide pharmacy services. This collaboration will allow Evernorth to expand its reach and offer enhanced pharmacy services to Medicare beneficiaries under HCSC’s purview.
Market-Wide Implications
Cigna isn’t the only major insurer feeling the effects of market and regulatory shifts. The Medicare Advantage space has been under pressure due to regulatory changes and increased utilization.
Humana’s Market Exit
In response to similar pressures, Humana announced its exit from 13 Medicare Advantage markets in 2025. This move will impact around 10% of Humana’s MA membership base, highlighting the broader challenges that insurers face in managing costs while providing high-quality care.
The Impact of Regulatory Changes
The Medicare Advantage market is heavily regulated, and recent changes have placed additional burdens on insurers. Many health plans have reported high utilization rates in the first half of the year, leading to increased costs and prompting companies like Cigna and Humana to reassess their service offerings.
Alternatives for Affected Members
While Cigna is trimming its Medicare Advantage plans in select counties, the company has emphasized that alternatives are available for most affected beneficiaries. In Florida, for example, other Cigna MA plans will still be available in several counties, and members are encouraged to explore their options during the next open enrollment period.
Additionally, Cigna has assured members that they will be contacted with information about alternative coverage options. Those who need assistance navigating these changes can also reach out to licensed insurance agents or use Medicare’s Plan Finder tool to explore other Medicare Advantage plans in their area.
Frequently Asked Questions (FAQs)
1. Which states are most impacted by Cigna’s plan reductions?
A. The states most affected by the plan reductions are Florida, Missouri, and North Carolina, with Florida seeing the largest impact on membership.
2. Will all beneficiaries lose their coverage?
A. No, while 36 plans are affected, most beneficiaries will have alternative plan options available. However, select counties in Missouri and North Carolina will see full exits, and beneficiaries in these areas will need to find new plans.
3. How will this impact my pharmacy services?
A. Cigna’s subsidiary, Evernorth, will continue to provide pharmacy services in partnership with Health Care Service Corp (HCSC), so there should be minimal disruption to pharmacy benefits.
Conclusion
Cigna’s decision to reduce its Medicare Advantage plan lineup across eight states is part of a broader trend among insurers to reevaluate their offerings in light of regulatory changes and increased utilization. While the reductions will impact over 5,000 beneficiaries, alternatives are available in most areas. Its partnership with Health Care Service Corp and Evernorth will continue to shape the future of its Medicare business, offering new opportunities for enhanced services. Affected members should explore their options during open enrollment and find plans that best meet their healthcare needs.
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