Humana Continues Digging Out Of Its Financial Troubles
Medicare Advantage (MA)-dominant Humana told investors today that it was prioritizing efficiency as it continues to dig out from financial woes due to the MA rate and regulatory landscape. Due to uncertainty, including on rates, it is not yet able to give guidance going into 2026 but affirmed its guidance for the current year. Humana is also suing the Centers for Medicare and Medicaid Services (CMS) over its 2025 Star ratings, accusing the agency of gross regulatory violations and incompetence in administering the quality bonus program.
Humana posted a $693 million loss in Q4, an increase from a Q3 loss of $541 million. The company also halved its profits for the full year 2024 compared to 2023, posting $1.2 billion. Humana earned $2.5 billion in profit for 2023.
Humana expects to lose up to 550,000 MA members this year. It lost 445,000 during the recent open enrollment. Medicaid struggled as well from a cost and enrollment standpoint. In MA, Humana has lost a great number of high-revenue and usually highly profitable Dual Eligible Special Needs Plan (D-SNP) members. Overall medical loss ratio (MLR) was 91.9% in Q4.
Overall, the financial performance was better than expected and investors seem to think Humana is turning a corner financially. Humana appears to be shedding unprofitable products and enrollment around the country to improve margins. It is also expanding in Medicaid, which could boost its attractiveness in SNPs in the future.
Additional articles: https://www.modernhealthcare.com/finance/humana-medicare-advantage-investment-2025 and https://www.modernhealthcare.com/insurance/humana-medicare-earnings-outlook and https://www.healthcaredive.com/news/humanas-2024-profit-halved-medicare-advantage-losses/739761/ and https://www.beckerspayer.com/payer/humanas-no-1-medicare-advantage-priority-5-notes.html and https://www.beckerspayer.com/payer/humana-posts-693m-loss-in-q4.html
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#humana #medicareadvantage #medicaid #margins
MA Plans Want Rate Relief
The Better Medicare Alliance (BMA) and other lobbies for Medicare Advantage (MA) are urging the Trump administration to tweak the Advance Notice proposed net rate hike of just over 2%. This small increase would come after two years of cuts. BMA says that medical costs are significantly outpacing the proposed payment benchmarks. It notes that 2023 and 2024 rate cuts led to reduced benefits and increased costs for seniors. BMA says that could happen again if the remaining phase-in of medical education reductions and the proposed rate are not addressed, among other proposals.
#medicareadvantage #rates
Medicaid Cuts In The Headlines
Medicaid is dominating the headlines. In one case, National Public Radio discusses why some Republicans think smaller Medicaid would be better and discusses some of the proposed cuts.
In other news, House GOP leaders sought to downplay the magnitude of Medicaid cuts, saying they would be focused on waste, fraud, and abuse as well as work requirements. Although some Republicans want what they call modernization and deeper cuts and changes.
Check out my predictions on Medicaid cuts: https://www.healthcarelabyrinth.com/will-medicaid-and-the-affordable-care-act-see-huge-cuts/ .
Additional article: https://www.npr.org/sections/shots-health-news/2025/02/10/nx-s1-5289001/trump-republicans-medicaid-proposals
#medicaid #coverage #congress #budgetreconciliation
https://thehill.com/policy/healthcare/5139533-house-republicans-medicaid-cuts/?tbref=hp
Health Affairs On Medicaid And VBID
Health Affairs Forefront Blog published two blogs of interest today. First, authors look at the budget reconciliation process and potential impacts on Medicaid. It discusses possible cuts, from restructuring the program to lowering reimbursement for expansion populations to changing matching funding. Second, authors look at the history of the Value Based Insurance Design (VBID) in Medicare Advantage (MA). It addresses some of the reasons given for the sunset.
Check out my VBID blog here: https://www.healthcarelabyrinth.com/if-vbid-is-to-go-ensure-flexibilities-remain-for-plans/ .
Check out my predictions on Medicaid cuts: https://www.healthcarelabyrinth.com/will-medicaid-and-the-affordable-care-act-see-huge-cuts/ .
Additional article: https://www.healthaffairs.org/content/forefront/lies-ahead-medicaid-budget-reconciliation
(Articles may require a subscription.)
#medicareadvantage #vbid #medicaid
https://www.healthaffairs.org/content/forefront/end-ma-value-based-insurance-design-model-next
— Marc S. Ryan
