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 to select new plans and are among 2 million facing similar situations nationwide.
Jared Strock tells us on LinkedIn that most MA plan terminations were in local PPOs (1.2M or about 13% of the total L-PPO market), with HMOs at (600K or 3% of the HMO market). PFFS and regional PPOs, which have much smaller footprints, were massively downsized. The PPO downsizing is a sign that the popular product can be more costly than HMOs.
Brooks Conway tells us on LinkedIn that MA-Part D and standalone Part D benefits had numerous changes given cost pressures and the Part D changes in the Inflation Reduction Act (IRA). Many Part D deductibles were moved from $0. Brooks says, that of non-SNP MAPD plans that offered a $0 Part D deductible in 2024, a little over half will retain the $0 deductible moving into 2025. However, the majority are excluding generics from the deductible. The rest of the plans introduced a deductible. On the PDP side, there are more $0 deductible plans – likely due to the new premium stabilization program. Brooks also sees many new Chronic Care Special Needs Plans (C-SNPs) being introduced.
Adam Fein tells us on LinkedIn that, after he dove into a recent Kaiser Family Foundation analysis, he sees coincidental premium hikes of $35 – matching the subsidy in the new premium stabilization program. He also sees vanishing PDP plans — 709 in 2024 to 524 in 2025 (-26%).
Additional articles: https://www.beckerspayer.com/payer/payers-ranked-by-average-medicare-advantage-star-ratings-2025.html and https://www.linkedin.com/feed/update/urn:li:activity:7251593804967747584/ and https://www.linkedin.com/posts/jkerfoot_aep-medicareadvantage-activity-7251610254453440514-1zyu?utm_source=share&utm_medium=member_desktop and https://www.linkedin.com/feed/update/urn:li:activity:7248848305042984960/ .
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#medicareadvantage #partd #pdp
https://www.modernhealthcare.com/insurance/2025-medicare-advantage-star-ratings-enrollment
FDA To Reconsider Barring Compounding Of Certain GLP-1s
The Food and Drug Administration (FDA) told a court that it will reconsider the decision to bar compounding pharmacies from fulfilling drugs with the active ingredients of Monjouro and Zepbound after a compounding interest filed a federal lawsuit. The group argues that the drugs are not really out of shortage and that patients will not be able to maintain therapy. While compounders charge far less than brand drug makers for GLP-1s, it is still extremely lucrative for them.
#weightlossdrugs #glp1s #branddrugmakers
Study Looks At Healthcare Disparities Across U.S.
A study by Forbes Advisor compared the 50 U.S. states across 14 key health metrics. Included in the metrics were relative numbers of hospital beds, doctors, nurses, community health centers, and percentage of residents who lack health insurance. Metrics were weighted based on importance and each state was then given a score. Heavily weighted measures included accessing primary care. The rankings can be seen at the article link. Not surprisingly, many low scores were in southern states, some of which have not expanded Medicaid.
The article also notes that a recent survey from Gallup and West Health found that just 55% of U.S. adults can access and afford quality healthcare and over 100 million Americans (about one-third) do not have access to a usual source of primary care.
#healthcare #healthcarereform #primarycare #coverage
https://www.newsweek.com/map-healthcare-america-accessible-affordable-1965624
— Marc S. Ryan