Medicare open enrollment starts this week. Here are 5 trends to watch

Medicare open enrollment begins Thursday, and experts say to keep an eye on how insurers are offering supplemental benefits and the growth of telehealth.

Medicare Advantage (MA) enrollment has climbed annually for the past several years, particularly as baby boomers continue to age into the program. And that's a trend that's not likely to slow down, Adam Finkelstein, counsel at Manatt Health, told Fierce Healthcare.

Features that attract beneficiaries to the program, such as out-of-pocket caps and access to tailored chronic care management options, aren't going away, he said. Plus, MA plans are growing their reach and becoming more available to members in more regions, also driving up enrollment, he said.

"I think the trends that have pushed beneficiaries toward Medicare Advantage plans are continuing and I don’t see any reason for them to stop," Finkelstein said.

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Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said at a Fierce Healthcare event hosted last month that the feds are expecting a strong enrollment period as well. CMS is projecting the lowest premiums since 2007.

Here are the biggest trends to watch during open enrollment this year:

Number of beneficiaries in high-ranking plans declines

CMS says that 77% of beneficiaries who enroll in an MA plan this year will sign up for a plan with four stars or more. That's down from the 2020 plan year, in which about 81% of beneficiaries enrolled in high-star plans.

CMS did tout improvement over time in the star ratings, however. In 2017, 69% of beneficiaries who enrolled in MA signed up for a plan with at least four stars. 

RELATED: Medicare Advantage open enrollment starts this week. Here are the health plans' star ratings for 2020

In addition, the overall number of plans earning four stars or more has increased over the past several years, CMS said. In 2017, 45% of MA plans with prescription drug coverage earned high marks, while about 49% of such plans will earn four or more stars for 2021.

The overall average star rating is 4.06 out of 5 for the 2021 plan year, compared to 4.02 in 2017.

“The historically low premiums for Medicare Advantage plans this year would mean little if they didn’t come paired with high-quality care,” said Verma in a statement.

Telehealth, virtual care boom continues

One of the biggest storylines to come out of the COVID-19 pandemic was the explosion in telehealth use, and executives at major health plans say that has been influential in driving their plans for 2021.

Christopher Ciano, president of Aetna Medicare, said that the insurer will continue to offer telehealth visits for primary and behavioral healthcare needs at no cost-sharing for MA members through the end of the year, with that program potentially seeing an extension in 2021 if the public emergency continues.

He added that Aetna was able to pivot many of its programs to a virtual or telephonic option and intends to continue making those available in the coming year. Experts conducted home risk assessments virtually, and the insurer adapted its partnership with Papa and pharmacist consults to work telephonically as well.

RELATED: Aetna says 2021 Medicare Advantage plans spotlight members' 'total health'

He said that pandemic marked a "huge momentum shift" in conversation around telehealth.

"I don’t think we’d be in the telehealth space we’re in if we didn’t have COVID," Ciano said.

Mike Polen, senior vice president and CEO of Medicare Solutions at Centene, said MA insurers are looking for various ways to allow consumers to engage in their own care, and telehealth and remote options are a key part of that.

Supplemental benefits continue to blossom

CMS allowed additional flexibilities for supplemental benefits that target beneficiaries' social needs beginning in the 2019 plan year, and interest in offering these solutions has only grown going into 2021.

For example, Ciano said Aetna began piloting a benefit in 2020 that offered members a stipend for tools to avoid falls, such as grab bars. Success with that program has led the insurer to expand it to more plans for 2021.

Polen said that Centene and other insurers in the MA market have invested heavily in piloting various initiatives, and the challenge is now communicating clearly which ones members have access to.

"The approach that we’re taking is to really focus on those benefits that are the most impactful for the members, and make those as easy as possible to access," he said.

RELATED: How the WellCare acquisition is driving Centene's approach to Medicare Advantage

A group of beneficiaries that will be of particular interest for these initiatives moving forward is people with end-stage renal disease, who will be eligible to enroll directly in MA plans for the first time beginning with this open enrollment period.

Finkelstein said that it's likely some end-stage renal disease patients will hold out to see how their plan offerings shape up, and that some insurers are planning for these members more quickly than others. Humana, for instance, announced last week that it will take its partnership with Fresenius Medical Care into 39 more states.

"My sense is that there are plans that are out there that are making a concerted effort to design their plans in a way to cater to these beneficiaries," Finkelstein said.

Insulin savings model draws plenty of interest

A program to watch going into 2021 is CMS' Senior Savings Model, in which standalone Part D plans and MA plans with prescription coverage agree to cap insulin costs for seniors. CMS said that 88 insurers have inked deals to participate, which Finkelstein said means there are options available in this program for beneficiaries nationwide.

CMS notes that a third of Medicare beneficiaries are diabetic, which means the model would reach a significant number of seniors. Finkelstein said it is one of the "absolute success stories of 2021," as the number of organizations signing on is high for a CMS demonstration.

"This level of participation is unprecedented," Finkelstein said.

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Big-name payers including UnitedHealthcare, Aetna, Cigna, WellCare and Humana have signed on to participate in the program across multiple states, as have a number of regional health plans.

Ciano said that Aetna is hoping to take lessons from participating in the program in Florida and go from there. Steve Warner, senior vice president of MA at UnitedHealthcare Medicare & Retirement, told Fierce Healthcare that insulin costs are a consistent challenge and that the model is a promising solution. 

"What we’re doing with insulin is big," Warner said. "I think we’ve pushed pretty far."