UnitedHealthcare to expand Medicare Advantage footprint in 2022
The insurer said the expansion will focus on lowering prescription drug costs - and on improving benefits and the member experience.
Photo courtesy of United Health Group
UnitedHealthcare, which already has significant market control with its Medicare Advantage plans, will strengthen its foothold in the space by expanding its MA plans in 2022, adding a potential 3.1 million members and reaching 94% of Medicare-eligible consumers in the U.S.
Currently, more than 7.3 million people are already enrolled in UnitedHealthcare's Medicare Advantage plans. The insurer said the expansion will focus on lowering prescription drug costs, and improving benefits and the member experience.
WHAT'S THE IMPACT?
On the prescription drug front, the company promised that more than 70% of current members and 90% of eligible consumers will have access to $0 tier 1 copays at a retail pharmacy – up from 30% and 59%, respectively, in 2021. Nearly 60% of members and nearly 80% of eligible consumers will have access to $0 Rx deductibles, up from 40% and 57% this year.
Most plans will offer $0 copays for tier 1 and tier 2 drugs ordered through the OptumRx home delivery pharmacy, and more than 20 generic drugs are slated to move to a lower tier, effectively resulting in a wider variety of drugs that will be available with the $0 copay.
About 5.5 million members will have access to Medicare Advantage and Part D plans that limit monthly out-of-pocket costs to $35 or less for all covered insulin, the insurer said.
In terms of plan design, UnitedHealthcare said members will have broad access to $0 copays on primary care, labs, virtual visits, diagnostic colonoscopies and mammograms, and cardiac rehab. They'll also see lower copays on specialist visits and physical, occupational and speech therapies, and $0 copays when the visit is virtual.
Routine eye exams will continue to be offered at no cost, and most plans will offer a no-cost hearing exam, with a hearing aid offered to most members.
In particular, UnitedHealthcare has touted its added benefits and features for 2022, including UCard, an integrated member ID card in select markets that is intended to consolidate separate benefits and program cards onto a single card, replacing the OTC and Healthy Food benefits cards.
Other new features include HouseCalls, which offers members a yearly visit with a licensed clinician from their home; the Renew Active Fitness Program, which will provide free gym memberships to facilities in the insurer's network; and a customer service model dubbed Advocate4Me, which will focus on personalized support.
People can make changes to their Medicare coverage during Medicare Annual Enrollment, which runs from Oct. 15 to Dec. 7.
THE LARGER TREND
While UnitedHealthcare has a massive foothold in the Medicare Advantage space, it underwent scrutiny from the federal government earlier this month, when the Centers for Medicare and Medicaid Services blocked four Medicare Advantage plans from enrolling new members in 2022 because they didn't spend the minimum threshold on medical benefits. Three UnitedHealthcare plans and one Anthem plan failed to hit the required 85% mark three years in a row.
Medicare Advantage plans are required to spend a minimum of 85% of premium dollars on medical expenses; failure to do so for three consecutive years triggers the sanctions.
For UHC, the penalties apply to its MA plans in Arkansas, New Mexico and the Midwest, which encompasses Missouri, Kansas, Nebraska and Iowa. UHC plans cover about 83,000 members, and the Anthem plan covers about 1,200 members. They cannot offer select plans to members until 2023, assuming they hit the 85% threshold next year – what's called the medical loss ratio (MLR). If they fail to hit the threshold for five years in a row, the government will terminate the contracts.
UHC representatives told Bloomberg that it missed the 85% benchmark in certain markets in part because of patients deferring medical care due to the COVID-19 pandemic.
More and more seniors have been enrolling in Medicare Advantage plans in recent years. In such plans, private insurers contract with the federal government to provide publicly funded medical benefits to those 65 years old and older. UnitedHealthcare is the nation's largest provider of such plans.
MA plans continued to increase their supplemental benefit offerings in 2021, including meals and transportation to physician visits and coverage of over-the-counter drugs and wellness, benefits not covered under Medicare Part A, Part B or Part D,
The drawback has always been the narrower networks of MA plans compared to traditional Medicare.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
