Earn­ings re­port may re­veal Unit­edHealth’s ex­change plans

Modern Healthcare - - THE WEEK AHEAD - —Paul Demko

When Unit­edHealth Group kicks off the third-quar­ter earn­ings sea­son for in­sur­ers Thurs­day, re­form watch­ers will be ea­ger to hear more from its ex­ec­u­tives about their in­ten­tions for the 2015 Oba­macare open en­roll­ment. The Min­netonka, Minn.-based in­surer has in­di­cated it in­tends to more than dou­ble its ex­change foot­print, com­pet­ing for cus­tomers in 24 states after its cau­tious en­try into the ex­change business this year. A re­cent anal­y­sis by J.P. Mor­gan es­ti­mated Unit­edHealth will at­tract 450,000 ex­change en­rollees.

Aetna, Cigna and Hu­mana are mod­estly ex­pand­ing their ex­change par­tic­i­pa­tion for 2015. Those in­sur­ers will follow with third-quar­ter earn­ings re­ports in the com­ing weeks.

Another area to watch in the in­sur­ers’ re­ports is Medi­care Ad­van­tage, as Medi­care’s open en­roll­ment starts Wed­nes­day. Plans face pres­sure to achieve at least four stars un­der the CMS’ five-star qual­ity rat­ing sys­tem, or for­feit their bonus pay­ments. Those ex­tra bucks are cru­cial at a time of thin­ning prof­its for Ad­van­tage plans.

Hu­mana is set­ting the pace in star rat­ings, with 91% of its Medi­care ben­e­fi­cia­ries en­rolled in plans earn­ing four stars or bet­ter, ac­cord­ing to J.P. Mor­gan. Unit­edHealth boosted its share of mem­bers in plans with at least four stars from 22% to 33%, while Wel­lPoint had only 9% of Ad­van­tage mem­bers en­rolled in plans that qual­ify for bonuses.

The Ad­van­tage mar­ket con­tin­ues to grow, hav­ing signed up 4.6 mil­lion more ben­e­fi­cia­ries since 2010. In­sur­ers con­tinue to push back against Ad­van­tage rate cuts. The pro­gram “is too large and too im­por­tant for it to be weak­ened by in­suf­fi­cient fund­ing,” United Health Group CEO Stephen Hem­s­ley cau­tioned at a Wash­ing­ton event last week.

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