In 2022, “Medicare households spent an average of $7,000 on health care, accounting for 13.6% of their total household spending ($51,800).” This is twice as much as a non-Medicare household. “Health care expenses include health insurance premiums, medical services (e.g., hospital and physician services), prescription drugs, and medical supplies (e.g., crutches, eyeglasses, hearing aids).” Because of their fixed income and healthcare utilization, Medicare beneficiaries are acutely impacted by Medicare and healthcare cost changes.
Agent tip:
“Plan reviews will be the action every Medicare beneficiary must take this fall. That is, if they don’t want to be caught without a plan, overpaying, or not getting the benefits they rely on.“
Major disruptions are coming to Medicare this fall. The storm has begun to brew, but Medicare beneficiaries won’t see the tangible impact until October and November. How can beneficiaries, who are already under inflation-related financial pressure, weather the storm? Plan reviews will be the action every Medicare beneficiary must take this fall. That is, if they don’t want to be caught without a plan, overpaying, or not getting the benefits they rely on. Here’s why.
Major Medicare insurance carriers are already talking about exiting markets due to a lack of profitability or, at minimum, significantly reducing benefits. For example, CVS Health Aetna is preparing to make such significant changes to its 2025 Medicare Advantage plans that it anticipates losing 10% of its membership. And it’s okay with that because “[they] need to get [their] business back on track.”
Similarly, because of CVS Health Aetna’s moves, Humana now feels secure with losing 5% of its Medicare Advantage plan enrollees after it exits unprofitable markets, primarily in the Southeastern states of Florida, North Carolina, Georgia, Texas, and Illinois. If the plan isn’t discontinued, you may see trims in plan options, eliminating unprofitable Medicare Advantage plans.
Where will Aetna and Humana’s members turn to? UnitedHealthcare hopes that it will be them. The largest Medicare Advantage plan carrier in the United States expects around 2% growth during the Annual Enrollment Period, primarily due to its strong product positioning, exits of other carriers from markets, and competitor’s poorer Medicare Advantage plan offerings.
Medicare Advantage insurers’ 2025 contract bids are due to the Centers for Medicare and Medicaid Services on June 3, 2024, but plans are not announced to the public until October 1, 2024.
All Medicare Advantage plan enrollees will require a plan review this fall. However, anyone enrolled in Medicare Part D prescription drug coverage should also schedule a time to review their plan options. According to the Centers for Medicare and Medicaid Services, the average Medicare Part D monthly premium in 2024 is $55.50. But premium rate hikes could be on the way for 2025, 2026, and beyond – for three reasons.
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Local, licensed insurance agents with 25+ years of experienceThese Medicare Advantage and Medicare Part D shake-ups are all coming during an election year. Three major players are currently biding for the Presidential seat: Joe Biden, Donald Trump, and Robert F. Kennedy Jr. (RFK).
According to a KFF poll, Biden has more trust in various healthcare policy measures, but voters are split on addressing healthcare costs. Most voters are unaware of the Medicare drug pricing provisions in the Inflation Reduction Act that President Biden signed into law. “When Trump was President, his administration’s budget proposals included spending cuts to Social Security, primarily by targeting disability benefits, and Medicare, largely by reducing provider payments.”
In contrast to Biden and Trump, RFK thinks “politicians in both parties have allowed America’s health to deteriorate.” He states that “they debate about who will bear healthcare costs, which is like rearranging chairs on the Titanic. America’s catastrophic health is bankrupting our country. Approximately 90% of U.S. health care costs are for people with chronic and mental health conditions.” RFK plans to investigate and root out the cause of chronic disease.
No matter who wins the presidential election, Medicare and healthcare is a topic that is at the front of all Medicare beneficiaries’ minds. With more than 14% of their household income going to healthcare expenses, this fall’s shakeup will be an opportunity for individuals and caregivers to schedule a plan review to ensure that themselves and their loved ones have the coverage they need going into 2025 – and aren’t left in the wake of market departures, benefits cuts, and rising costs of healthcare.
Everyone on Medicare can schedule a plan review during the Medicare Annual Enrollment Period between October 15th – December 7th. You can schedule your annual review appointment starting October 1st. Call to speak with a local licensed Connie Health agent in your area.
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Aetna is a leading health insurance company offering various health benefits, including medical, dental, pharmacy, and disability plans. Founded in 1853, Aetna provides insurance policies and services to millions of Americans, focusing on enhancing their health and wellness.
Aetna offers Medicare plans, including Medicare Advantage plans (Part C), Medicare Prescription Drug plans (Part D), and Medicare Supplement plans (Medigap). These plans are designed to provide seniors and Medicare-eligible individuals with comprehensive healthcare coverage tailored to their needs.
Yes, Humana Gold Plus is a Medicare Advantage plan. This plan combines Original Medicare Part A (hospital insurance) and Part B (medical insurance) into a single plan, offering additional benefits such as prescription drug coverage and dental, vision, and wellness programs, which Original Medicare does not typically cover.
Humana is not Medicare but offers various Medicare plans, including Medicare Advantage plans (Part C), Medicare Prescription Drug plans (Part D), and Medicare Supplement plans (Medigap). Humana’s Medicare plans provide enhanced coverage options for seniors and Medicare-eligible individuals.
Humana is a health insurance company that offers multiple Medicare Advantage plans. These plans provide comprehensive healthcare coverage by combining Original Medicare Part A and Part B into a single, convenient plan. They often include additional benefits such as prescription drug coverage and dental, vision, and wellness programs.
Aetna has decided to stop 2025 coverage for certain Medicare Advantage plans in various regions due to several factors.
Firstly, shifts in regulatory frameworks can have profound implications on the viability and sustainability of these plans. Adapting to new regulations may require significant adjustments that are only sometimes feasible for all regions.
Additionally, the company continuously reviews its market presence to align with federal and state healthcare policy changes, ensuring compliance and optimal service delivery. Market dynamics, such as fluctuating demand and intensified competition, also drive Aetna’s decision-making, guiding them to concentrate on areas where they can provide maximum value and maintain healthy membership levels.
Lastly, strategic business considerations, including optimizing operational efficiencies and effective resource allocation, are crucial in deciding where to discontinue or sustain coverage.
Humana has announced the 2025 discontinuation of certain Medicare Advantage plans in select areas, citing many contributory factors.
One significant reason is the evolving landscape of healthcare regulations and policies necessitating ongoing adjustments and adaptations. These changes can sometimes make it challenging to sustain certain plans comprehensively.
Furthermore, Humana continually assesses its market engagement to ensure its services align with federal and state requirements and enhance overall service efficiency.
Another pivotal aspect influencing this decision is market conditions, including variability in demand and increased competition, which prompt Humana to reassess and focus its resources strategically on regions where it can deliver the most robust value and maintain strong membership support.
If you find yourself in a situation where your Medicare Advantage plan is stopping coverage, it is pivotal to act swiftly and thoughtfully.
Firstly, you will receive a notice from your plan provider detailing the discontinuation. Review this notice thoroughly to understand the timeline and specific details. Next, compare alternative plans available in your area. A local licensed Connie Health agent can help you review your plan options – to find a plan tailored to your health and budget.
These steps can help you transition smoothly and maintain uninterrupted access to necessary healthcare services.
Read more by Renee van Staveren
Since 2009, I've been writing about complicated, technical issues, with the goal of making topics like Medicare and healthcare easier to understand. I've been writing about Medicare since 2021 and healthcare since 2019. I am an AmeriCorps alumni. I enjoy gardening, reading, and DIYing.
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