Payments for paddleball racquets and golf clubs could disappear
If youre a Medicare Advantage plan holder, your advantages could be a little less the next time you renew because insurers are planning to cut back on their plan offerings in 2025.
All about money and less about the customer? Of course it is. Despite lower reimbursement rates from Centers for Medicare & Medicaid Services (CMS) and higher medical costs, many Advantage (aka Part C) plan leaders said they will focus on margins over membership growth.
Aetnas investors were told just last week that the company will do exactly that. Brian Kane, CEO of Aetna, told investors that the company will also pull out of counties where it believes it can't be profitable.
"It's hard to say right now that we won't have a meaningful decrease in membership," Mr. Kane said. "It's certainly possible."
Humana executives are threatening to do the same and expectcompetitors to take similar measures to avoid losing money in Medicare Advantage.
"We acknowledge that the industry is experiencing a dynamic and challenging time that we must navigate," CEO Bruce Broussard told investment analysts on the company's recent quarterly call.
CVS Health CEO Karen Lynch said that rather than exit a county, its move will probably be to adjust plan-level benefits in 2025. Those benefits could well be its outpatient services section -- mental health, pharmacy, dental --all things it says its paying more for these days.
And CVS is one to watch as this topic unfolds, too. A Wall Street Journal report says the company led the industry in 2024 in terms of growth but was a "notable outlier" in adding supplemental benefits for members.
United Healthcare the largest Medicare Advantage insurer in most states has yet to comment on the matter.
Whats likely to go?
Anyone who has a Medicare Advantage plan is probably smitten with the perks they get. Theres prescription drug coverage (Part D), dental, vision, hearing, gym memberships, sometimes meal delivery after a hospital stay and in-home support like light housekeeping. Losing those might not be devastating, but for a senior, little things can go a long way.
According to The Wall Street Journal, some Aetna plans offer fitness reimbursements. Pickleball paddles, golf clubs, and other sports equipment could be purchased with the benefit - but these extras could become obsolete if rates rise.
But, its a little too early to pull out a crystal ball and get more than that. Advantage members arent likely to find out any more than these could bes until plan specifics are released this fall.
In the meantime, you may want to set up a nudge in your calendar to check with the Medicare Plan Finder in early November. This is where updated 2025 plan details will be released.
Photo Credit: Consumer Affairs News Department Images
Posted: 2024-05-07 14:59:34
