2025-MAPD & PDP what does your Crystal Ball say?

[newbie2001]

You said the key words “ when they want to make a change “ . We’ve had rising mapd benefits the last 5 yrs .Everything’s been calm . Mark my words . All hell breaks loose in 2025 . I’ve been reading every article this earnings season on carriers .CO’s being pinched hard by rapidly rising claims . Cms basically gave no premium increase for 2025 . A perfect storm hitting . Humana which agents have written the most the last 4 yrs has been blindsided by heavy claims . In their earnings report there saying maintaining margins more important than adding members . That’s the key word for there going to slash benefits and increase copays . Means there could be a big division between plans in 2025 . Means agents are going to have to move there humana book . How much do benefits matter to members ? Look no further than Aetna. They crushed all carriers in the benefit dept . They added 500k members during aep more than the next 7 carrier combined . People jumped ship big for more benefits .

Weirdly enough in my area in FL. Aetna is not really that strong in the benefits in my area. They have great dental but beyond that most doc’s my clients work with don’t accept there HMO plans and they have 1 PPO plan that doc’s accept but then most will choose a UHC plan HMO-POS plan over Aetna’s PPO anyway.

Humana has them beat in the “giveback” department as well. I’d say if there doc accepts it 90% of my clients take the Humana giveback HMO if they’re healthy and little to no meds.

 

[sshafran]

I think I can say with some level of accuracy that my MAPD clients don't really take as much service work as my Med Supp + PDPs.

But I will also say that they take more time when they want to make a change. Gotta do provider lookups. Gotta compare non-standardized plans. Have to remember that Plan XYZ has $2,000 dental but XYZ2.0 has $2,800 dental but no OTC (or whatever - you get the point - there are a lot of moving parts and it's non-standard).

Point being when someone wants mapd it does take more time because if I think the OOP being low matters, but they (stupidly) think free toothpaste via OTC is the only thing that matters, I might lose them in 3 months because of OTC.

I could say oh well they aren't my kind of client since they changed over something dumb, but frankly I like $26/mo and I'd rather be smart enough to get that person in the plan that they'll stick with.

So... It takes more questions, more digging, more comparing...... More time.

Whereas med supp and pdp are more cut and dry as to which carrier to go with... Not saying there is no nuance but much less nuance.

Case in point moved 50+ Green company gold plus from old version to new during AEP because OOP on old went from $3600 to over $5000 but a new green company gold plus was still at around $3,600.

Easy call - new is better. Lower risk, better specialists copay ($10!).

I can't tell you how many dumb calls I got from these people mad because their OTC was now mail order only and they can't use at Walmart. At least 12 calls or texts.


...You're welcome for reducing your risk?

...Sorry about your stupid toothpaste at Walmart?

It's just dumb. We need to get back to actual health insurance.

 

[somarco]

We need to get back to actual health insurance.

No argument here . . .

 

[DonP]

Case in point moved 50+ Green company gold plus from old version to new during AEP because OOP on old went from $3600 to over $5000 but a new green company gold plus was still at around $3,600.

Easy call - new is better. Lower risk, better specialists copay ($10!).

I can't tell you how many dumb calls I got from these people mad because their OTC was now mail order only and they can't use at Walmart. At least 12 calls or texts.


...You're welcome for reducing your risk?

...Sorry about your stupid toothpaste at Walmart?

It's just dumb. We need to get back to actual health insurance.

I talked to my Humana rep today. He thinks things go back 10 yrs on benefits and copays next yr .If so there will be a lot of moving going on . He could be correct as you got to add in the effects of 2k troop on part D’S next yr . I expect med sup premiums up 12-20% and pdp’s 25-50% for 2025 . Nothing gets left untouched

 

[sshafran]

I talked to my Humana rep today. He thinks things go back 10 yrs on benefits and copays next yr .If so there will be a lot of moving going on . He could be correct as you got to add in the effects of 2k troop on part D’S next yr . I expect med sup premiums up 12-20% and pdp’s 25-50% for 2025 . Nothing gets left untouched

I wrote a T65 UHC Female G in NC for 3/1 - no discounts - $117/mo

Just noticed today on Jarvis they put a billing statement letter we can read. That might be new because I never saw it (?) unless I just didn't notice it. It shows her premium next year already - which is cool - but it's $132. $117 to $132!

I know they're complicated in how it's calculated but in real life $132-117 = 15. 15/117 = 12.8%+

12.8%!

And this is UHC on a T65... Known for stability...

 

[sman]

I wrote a T65 UHC Female G in NC for 3/1 - no discounts - $117/mo

Just noticed today on Jarvis they put a billing statement letter we can read. That might be new because I never saw it (?) unless I just didn't notice it. It shows her premium next year already - which is cool - but it's $132. $117 to $132!

I know they're complicated in how it's calculated but in real life $132-117 = 15. 15/117 = 12.8%+

12.8%!

And this is UHC on a T65... Known for stability...

16% increase here in Georgia for UHC. Definitely the largest I’ve ever seen from them. They’ve always been single digits.

 

[Millwood]

³

I wrote a T65 UHC Female G in NC for 3/1 - no discounts - $117/mo

Just noticed today on Jarvis they put a billing statement letter we can read. That might be new because I never saw it (?) unless I just didn't notice it. It shows her premium next year already - which is cool - but it's $132. $117 to $132!

I know they're complicated in how it's calculated but in real life $132-117 = 15. 15/117 = 12.8%+

12.8%!

And this is UHC on a T65... Known for stability...

How could they know and have rates approved for next year? All supplements have a claim loss ratio. They have to submit claims paid and premiums received for a rate increase.
Would like to know what wizardry is going on? Hmmm

 

[newbie2001]

I wrote a T65 UHC Female G in NC for 3/1 - no discounts - $117/mo

Just noticed today on Jarvis they put a billing statement letter we can read. That might be new because I never saw it (?) unless I just didn't notice it. It shows her premium next year already - which is cool - but it's $132. $117 to $132!

I know they're complicated in how it's calculated but in real life $132-117 = 15. 15/117 = 12.8%+

12.8%!

And this is UHC on a T65... Known for stability...

The least expensive Plan G option for T65 in my area (female) went from $178 to $189.

 

[somarco]

They have to submit claims paid and premiums received for a rate increase.

Some states don't require renewal rate approvals. . . Georgia being one of them.

Regarding statements by @sshafran and @sman I believe they are referencing 2024 new business rates effective in April, May or later.

Carriers are required to provide annual audited financial reports so the state(s) will know if they are maintaining the statutory reserves. They are subject to audits every 3 years.

Medigap carriers have witnessed an increase in utilization similar to what MAPD carriers are experiencing. The result is higher rates for Medigap and cutbacks for MAPD.


Health insurers have been critical of weaker payment rates, as well as changes in the Star Rating program and risk adjustment model, which they say are increasing complexity in benefit offerings and pricing decisions. And an increase in utilization beginning in 2023, driven in large part by the return of elective procedures that were deferred during the pandemic, has placed upward pressure on medical loss ratios for the MA business. New rules around prior authorizations may further increase costs.

Increased Medicare Advantage utilization likely credit neutral, finds Fitch

Insurers generally have sufficient ratings headroom to withstand higher MA utilization rates, analysts found.

www.healthcarefinancenews.com

 

[sman]

³

How could they know and have rates approved for next year? All supplements have a claim loss ratio. They have to submit claims paid and premiums received for a rate increase.
Would like to know what wizardry is going on? Hmmm

Bob touched on it, but I'll dive in as well. In Georgia, UHC typically has their annual rate change in June. They have released the rates for June 2024 to May 2025 and they are jumping substantially. I'd imagine they will lose some business here in Georgia. When your T65 female rate jumps from $139 to $161.25 (both prior to any discounts and in Area 1), you just aren't going to get as many enrollments when there are much lower cost options. Area 2 rates have a slightly lower increase of 13.3% (from $136.75 to $155).

Of course, other carriers may very well have large increases at renewal time as well. I just checked Humana, and they are going from $126.09 to $136.06 in the same area as UHC's Area 2 rates for T65 female. That's a much smaller increase and separates them by nearly $20. For those who take advantage of the gym membership, it may still be worth going with UHC or Anthem. But for those who don't care about that benefit, it would be hard to justify paying an extra $20 per month.

One of the things we've been able to tout over the years with UHC is consistency in keeping rate increases to a minimum (usually single digits). We won't be able to say that any longer.