Clever Care<\/a>, a regional MA company, is facing a unique set of challenges as it navigates rising headwinds in the industry. According to interim CEO Karen Walker Johnson, the company\u2019s most significant challenges are not tied to the rising hospital utilization rates among its members. Instead, the company is focused on delivering culturally competent care and meeting the diverse needs of its beneficiaries, which include a significant number of seniors from Asian-American communities.<\/p>\r\n\r\n\r\n\r\nChanging Expectations of MA Beneficiaries<\/h2>\r\n\r\n\r\n\r\n
Medicare Advantage beneficiaries are becoming increasingly savvy, with higher expectations of their plans. Top-rated insurers for customer satisfaction have noticed that members are demanding more personalized care and tailored services. Leaders at four of J.D. Power\u2019s top-ranked Medicare Advantage plans have noted that beneficiaries now expect not only excellent healthcare but also ease of access, digital tools, and seamless communication with their providers. Meeting these expectations is becoming crucial for insurers to maintain member satisfaction and retention.<\/p>\r\n\r\n\r\n\r\n
Humana\u2019s 2025 MA Exits<\/h2>\r\n\r\n\r\n\r\n
In a notable development for 2025, Humana announced that it will stop offering Medicare Advantage plans in 13 counties, impacting around 560,000 members. This decision, disclosed by CFO Susan Diamond, reflects the company’s strategic adjustment to market conditions. While Humana remains a major player in the MA space, these exits will affect members who will need to seek alternative coverage options in those counties. This also highlights the importance of reviewing plan options annually, especially in a fluctuating market.<\/p>\r\n\r\n\r\n\r\n
Learning from Medicare+Choice: Lessons from the Past<\/h2>\r\n\r\n\r\n\r\n
The challenges facing MA today are not without precedent. According to an analysis from Oliver Wyman, the issues MA plans are encountering can be compared to the difficulties faced by Medicare+Choice, the precursor to MA, in the late 1990s. By learning from these past challenges, insurers can develop strategies to navigate the current turbulence and position themselves for future success.<\/p>\r\n\r\n\r\n\r\n
FAQs<\/h2>\r\n\r\n\r\n\r\n1. What are the key changes coming to MA in 2025?<\/h3>\r\n\r\n\r\n\r\n
A. Several significant changes, including plan exits and reduced bonus payments, are expected to reshape the MA landscape in 2025.<\/p>\r\n\r\n\r\n\r\n
2. How will the reduction in bonus payments impact MA plans?<\/h3>\r\n\r\n\r\n\r\n
A. The 8% reduction in bonus payments for 2024 could result in changes to plan offerings, as insurers adjust to the new financial realities.<\/p>\r\n\r\n\r\n\r\n
3. What does CMS’s suspension of Centene’s MA enrollment mean?<\/h3>\r\n\r\n\r\n\r\n
A. CMS suspended Centene\u2019s enrollment in Missouri due to the company\u2019s failure to meet the required medical loss ratio for three consecutive years, affecting new enrollments.<\/p>\r\n\r\n\r\n\r\n
Conclusion<\/h2>\r\n\r\n\r\n\r\n
The MA landscape is undergoing rapid change, with significant updates that will affect both beneficiaries and insurers in the coming years. From declining bonus payments to plan exits and regulatory challenges, Medicare Advantage plans must adapt to a complex environment while ensuring that beneficiaries receive high-quality care. As 2025 approaches, staying informed about these changes will be critical for Medicare beneficiaries seeking the best coverage options for their healthcare needs.<\/p>\r\n\r\n\r\n\r\n
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