Marc Ryan

Despite Star Problems, United And Humana Expected To Stay On Top Analysts say that United Healthcare and Humana will likely maintain their top positions in Medicare Advantage (MA), do well on enrollment, and weather current fiscal storms despite lower Star ratings, slimmer benefits, and financial headwinds. At the same time, analysts say lower Star scores are a real risk for the industry. Other large plans will do well as well. CVS Aetna has told investors it expects to shed about 10% of lives. Humana told investors it would lose about 5%. Large plans did very poorly in Star in 2025, with limited exceptions. Becker’s also ranks some of the largest MA plans by Star score for 2025. Jenn Kerfoot had a great LinkedIn post discussing the plight of 223,952 MA members facing plan terminations or service area reductions in areas with the highest levels of socioeconomic need. They will need

Winners And Losers From 2025 Medicare Advantage Star Year Announcement I reported yesterday that there was overall bad news for the Medicare Advantage (MA) industry when 2025 Star Years came out. The percentage of contracts obtaining a 4 Star or greater rating dropped to about 40%. Just 62% of all Medicare Advantage Part D (MA-PD) enrollees will be in a 4 Star or greater contract. These are big drops from even a sluggish 2024 Star year. There is always good news and bad news. Insurtechs Alignment Healthcare and Clover Health are celebrating their high-performing ratings. The big plans have a mix of stories: Humana, Elevance Health, and United Healthcare saw declines. Aetna and Cigna held steady. Centene’s performance was still sub par. Kaiser Permanente now has all of its members to 4 Star or greater. There were just seven 5-Star MA-PD contracts. There were 24 contracts that scored below 3

Bad News On Medicare Advantage Star Ratings The Centers for Medicare and Medicaid Services (CMS) announced 2025 Star ratings and the news was not good. The percentage of contracts obtaining a 4 Star or greater rating dropped to about 40%. Just 62% of all Medicare Advantage Part D (MA-PD) enrollees will be in a 4 Star or greater plan. These are big drops from even a sluggish 2024 Star year. Humana saw the biggest drops among large national plans, with United and Elevance having some reductions and Centene continuing to score low. Aetna was roughly flat in terms of achievement. The poor Big Plan results drove the estimated enrollment in high-performing plans down. Big Plans have about three-quarters of the MA market. Humana and United are challenging their ratings. United has filed a lawsuit against CMS. My new company, Lilac Software, will have a blog and an infographic on all

Despite Some Cutbacks, MA Plans Are Going Big For Special Needs Plans Given their potential for greater margin, Medicare Advantage (MA) plans appear to be making heavy investments in Special Needs Plans (SNPs) in 2025, even as they contract other products in certain areas. Done right, SNPs can generate 6.4% margins, compared with 2.8% for MA generally. This comes from 2021 data. As well, the plans are reacting to the Centers for Medicare and Medicaid Services (CMS) making the integration of Medicare and Medicaid funding streams a huge priority. The growth continues a trend. SNP enrollment is about 6.6 million people this year, up 255% from 10 years ago, 125% from five years ago and 16% from 2023. SNP enrollment is projected to hit 7.2 million in 2025. UnitedHealth Group, Humana, Elevance Health, CVS Health, Centene and Molina are all investing heavily. Some plans are contracting base benefits even in

Harris Announces Medicare At Home, Expands Healthcare Agenda Democratic presidential candidate Kamala Harris announced a new Medicare at Home initiative. She would provide home health aide and other in-home supports for seniors and the disabled in Medicare. This would extend the current scope of benefits officially from short-term home care to chronic home care. I have proposed a comprehensive long-term care program paid through Medicaid and with buy-ins by seniors. As well, Harris wants to have hearing and vision coverage added to the traditional program. She would pay for most of the initiatives by expanding Medicare drug price negotiations and instituting pharmacy benefit manager (PBM) reforms. On other news, Harris is turning up the heat on Trump with a healthcare agenda. The Harris campaign thinks healthcare can be a swing issue and move undecideds to her side. In addition, a new study in Health Affairs has found that, while Medicare