HUM appeared at #JPM22 to, what people in politics often refer to as "correcting the record." That usually happens when the response you thought you would get is not the one you have. They continue to put the blame for enrollment guidance change on aggressive telephone sales by competitors who focus less on value and more on price. Price was not to their advantage this year as they took a conservative approach in light of COVID.
That could be true.
CMS released a rule last week providing guidance, in response to customer complaints, about third party marketing organization. OHS is the subject of a Department of Justice inquiry on their use of TPMOs. There could be no better opportunity for unscrupulous telephone salespeople than during a pandemic, with products targeted at the shut-in elderly.
The question not asked though, is why competing plans would assume the cost and risk associated with TMPOs when everyone knows plan switching is very rare in Medicare Advantage - less that 10% of enrollees change plans during the annual enrollment period.
We have pointed since last summer that Medicare Advantage faces significant political, competitive and demographic headwinds. Notwithstanding HUM's comments today, while the Medicare Advantage program has bipartisan support, that comes with caveats and qualifiers. Some Democrats see it as privatization and many Republicans think the program is too fat. CMS delivered their own headwind last week when they proposed a change to DIR fees. Finally, as the growth in eligible seniors has slowed, the competition has gotten stiffer and yes, COVID mortality is having an effect.
To put it succinctly, there are more plans and other options chasing fewer eligible beneficiaries.
Call with questions.
Emily Evans
Managing Director – Health Policy
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