Molina Reels From Medical Expense
Molina Healthcare reported Q3 financials and cut its 2025 earnings guidance for the third time this year. It is citing high medical costs particularly in its Exchange line of business. Molina is not the first to report the Exchange medical trend concern. The impacts will only be worse in 2026 if Exchange credits expire, risk increases, and enrollment drops.
While Molina revenues beat analyst expectations, the plan missed on earnings. Molina is a Medicaid- and Exchange- dominant health plan with some Medicare Advantage (MA) lives. Molina posted a very-high medical loss ratio (MLR) of 92.6% in the quarter, up from 89.2% at the same time last year. Exchange plans hit a 95.6% MLR, up from 73% same time last year. Medicaid margins were strong but pressured from continued utilization. MA sees high utilization as well.
In other news, a mix of Exchange pullouts and some expansions (surprisingly). Aetna is fully exiting the Exchanges in 2026. Molina is pulling out of one-fifth of the counties where it sells health insurance exchange plans and also will not pay commissions in several states. Centene is contracting in some states but expanding counties in others. UnitedHealthcare, Cigna, Oscar, and Elevance Health are expanding in some existing states. Oscar is adding a few states. Other regional players are pulling out.
Additional articles: https://www.healthcaredive.com/news/molina-2025-guidance-cut-aca-woes-q3/803580/ and https://www.beckerspayer.com/financial/molina-cuts-earnings-outlook-a-third-time-amid-aca-challenges/ and https://www.modernhealthcare.com/insurance/mh-aca-plans-centene-cigna-oscar-2026/ and https://acasignups.net/25/10/20/which-carriers-are-bailing-aca-exchanges-altogether-2026 and https://www.modernhealthcare.com/insurance/mh-molina-healthcare-aca-markets-2026/
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#molina #exchanges #margins #coverage #healthcare
More MA Contraction And Marketing Changes
Centene is cutting commissions for more Medicare Advantage (MA) plans and further limiting marketers’ ability to sign up new members. Centene won’t compensate agents and brokers for new enrollments into 13 plans in Arizona, Connecticut, Kentucky, Michigan, Ohio, Oregon, and Washington. It is also removing 36 plans from the portals brokers and agents use to sign up beneficiaries. Numerous other major plans have curbed 2026 commissions or marketing.
Deft Research says up to 5% of current MA members, or about 1.8 million people, will need to change plans because their plan was terminated. As I suspected, the impact of the contraction would again be high. Up to 2 million had to do so in 2025.
While some regional plans left MA as well, some are viewing it as an opportunity to gain market share with big players pulling out. ATI Advisory says the average number of counties where regional insurers are offering MA grew by 6% while large national insurers’ footprint declined 3% and small insurers’ fell 5% for 2026.
More expansion and contraction news as well:
- AmeriHealth Caritas, Blue Cross Blue Shield of Wyoming, and Scan Health Plan are expanding in MA in 2026.
- AmeriHealth Caritas will add hundreds to thousands of new members after expanding into Louisiana and North Carolina, said Chris McDade, president of Medicare markets at the nonprofit insurer. They focus on dual eligible or D-SNPs and are in a joint venture with Blue Cross Blue Shield of Michigan and Independence Health Group.
- Medica will increase MA in enrollment after UCare left the program.
Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz said that the government shutdown is not affecting Medicare open enrollment. The agency is temporarily calling back all furloughed staff starting next week to aid in the process.
The American Hospital Association is urging CMS to delay its traditional Medicare prior authorization pilot, the Wasteful and Inappropriate Service Reduction (WISeR) program, by at least six months.
Additional articles: https://www.modernhealthcare.com/insurance/mh-centene-medicare-advantage-commissions-cuts/ and https://www.beckerspayer.com/payer/medicare-advantage/dr-oz-government-shutdown-not-hurting-medicare-open-enrollment/ and https://thehill.com/policy/healthcare/5569544-medicare-open-enrollment-cms-obamacare-aca-shutdown/ and https://www.beckershospitalreview.com/finance/aha-pushes-cms-to-delay-medicare-prior-authorization-pilot/
(Some articles may require a subscription.)
#medicareadvantage #marketing #enrollment
https://www.modernhealthcare.com/insurance/mh-scan-health-plan-bcbs-wyoming-medicare-advantage
Oz Speaks on Exchanges and Subsidies: A New Trump Exchange Replacement Plan?
Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz says that he does not favor extending the enhanced Exchange premium subsidies as they are and that President Donald Trump may have a full plan to overhaul and replace the program.
In related news, a Brooking Institution analysis points to the loss of one million on the Exchange rolls if minimum premiums were put in place. Studies suggest that reason is that paying a premium adds an additional administrative step to the process of enrolling and staying enrolled in coverage.
Additional articles: https://www.medpagetoday.com/washington-watch/repeal-and-replace/118120 and https://www.brookings.edu/articles/how-would-eliminating-0-marketplace-premiums-affect-insurance-coverage/
#exchanges #premiums #subsidies #healthcare #coverage
— Marc S. Ryan
