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October 9, 2024

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

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October 8, 2024

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

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