Tag Archives: Annie Man

How will the coronavirus affect health insurance enrollment?

In the United States, the COVID-19 pandemic has put millions of people out of work. A portion of the newly unemployed and their families are expected to seek health insurance coverage. Some have been furloughed, which allows them to keep their employer-sponsored health insurance while applying for unemployment benefits. Others may be able to find employer-sponsored health insurance coverage with parents or spouses.

Before the Patient Protection and Affordable Care Act (ACA), newly uninsured adults and families could purchase COBRA coverage, individual market plans, or short-term plans, enroll in Medicaid, or participate more fully in federal health options for which they were eligible. Today, newly unemployed adults and their families have the following additional options not available prior to the ACA:

  • Individual market plans through the state or federally run marketplaces with federal premium assistance for qualifying households
  • Expanded Medicaid coverage in 36 states
  • Young adults (under age 26) can enroll in their parents’ employer-sponsored insurance

In this brief, Milliman’s Annie Man and Barbara Dewey discuss the health insurance options available to the newly unemployed and how this may affect the ACA individual market.

Supplemental benefit considerations in a COVID-19 world

Medicare Advantage (MA) plans must cover all benefits offered by original Medicare. MA plans may offer extra benefits such as dental and vision, called “supplemental benefits,” that are tailored to improve the health of existing members, appeal to prospective members, or provide the benefit of group purchasing power.

With the widespread nature of COVID-19, social distancing measures have become a daily practice that affects most Americans right now and have the potential to affect seniors for a longer duration. Some supplemental benefits like a fitness benefit, which are intended to keep seniors active, may not achieve their intended goals when gyms are closed or discouraged for high-risk individuals.

In this brief, Milliman’s John Rogers, Annie Man, and Kyle Hutmaker examine how MA plans might think about offering supplemental benefits for 2021. While no one knows what will happen with COVID-19 in 2021, in the absence of a vaccine or other curative treatment, MA plans should consider the possible effects of the disease well into the future.

What was the impact of the Next Generation ACO Model on Medicare spending in 2016?

In September 2016, the Center for Medicare and Medicaid Innovation (CMMI) selected NORC at the University of Chicago to conduct an independent evaluation of the Next Generation Accountable Care Organization (NGACO) Model program. On August 27, 2018, CMMI released NORC’s first report on the findings of its evaluation, which included NORC’s estimate of the impact of the NGACO program on Medicare Part A and Part B spending (gross impact) in 2016. NORC defined the net impact of the program by combining this gross impact with the results of the NGACO program’s shared savings and losses. These results were published by CMMI in October 2017 (i.e., shared savings and losses).

In this paper, Milliman consultants combine the aggregate gross impact of each of the NGACOs shown in the NORC report with the shared savings/(loss) results of each NGACO to calculate the net impact of each individual NGACO.





Medicare Shared Savings Program 2016 Track 3 financial results

Under the Medicare Access and CHIP Reauthorization Act of 2015, healthcare providers that participate in a Medicare Shared Savings Program (MSSP) as Track 3 accountable care organizations may qualify for the advanced Alternative Payment Model 5% bonus. Track 3 was first offered in 2016. This paper by Milliman consultants discusses first-year MSSP Track 3 performance and possible drivers of success.





Individual stop-loss is now optional for Next Generation ACOs

Next Generation Accountable Care Organizations (NGACOs) now need to choose between whether they want to have their annual financial reconciliations based upon capped claims or uncapped claims. Previously, they didn’t have a choice and reconciliations were based upon capped claims. For some NGACOs, the choice between an annual financial reconciliation based upon capped claims or uncapped claims could have significant impact. Milliman consultants provide more perspective in this paper.





CMS proposed rules would impact Part D drug costs and plan designs

On November 16, 2017, the Centers for Medicare and Medicaid Services (CMS) released 713 pages of proposed changes to Medicare Advantage (MA) and the Medicare Part D prescription drug benefit. The proposed changes (file code CMS-4182-P) would take effect for contract year 2019 and are intended to manage utilization of opioids, reduce costs, and provide more plan choices. The updates present major changes to the way the programs operate. According to CMS, “the proposed changes would result in an estimated $195 million in savings a year for the Medicare program over 5 years (2019 through 2023).”

Some significant impacts on Part D that plans need to be aware of would include:

Midyear formulary changes: Plans would have more flexibility to immediately incorporate generic drugs as soon as they are available.

• Plans could assess the cost impact of each new generic drug based on member utilization to weigh against administration and disruption issues.
• This proposed rule could be significant, especially if the increases in generic approvals continue. According to Milliman’s internal research, there were about 14 and 31 significant first generic launches in 2015 and 2016, respectively. And this year the U.S. Food and Drug Administration (FDA) has continued to speed up the generic approval process.

Opioid treatment: Plans would be able to restrict access and manage opioid utilization. The proposed rules codify and expand upon the current Part D Opioid Drug Utilization Review Policy and Overutilizing Monitoring System.

Biosimilars: Plans would be able to categorize certain low-cost biosimilars as generics for low-income subsidy (LIS) cost sharing and non-LIS catastrophic cost sharing. Because the LIS copays in 2018 will be $3.35 for generics and $8.35 for brands, this is likely not to have a large impact on 1) lowering member costs, or 2) increasing biosimilar utilization.

Point-of-sale costs: The proposal includes a request for information (RFI) regarding applying price concessions and rebates at the point of sale, which could lower member cost sharing when taking brand medications that offer rebates, but may increase premiums and government cost.

Meaningful differences testing: With the elimination or modification of this testing, plans may be able to add more enhanced alternative Part D plans to their product portfolios in the same region.

A link to the Fact Sheet issued by CMS can be found here. CMS is accepting comments until January 16, 2018.