For some corporations, it isn’t the variety of plans that obtained a excessive score that is important, however the measurement of the plans’ membership.
Almost 38% of Aetna’s insurance policies obtained no less than 4 stars, down from 55.6%. However scores for the CVS Well being subsidiary’s largest plan, the Aetna Nationwide PPO, fell to three.5 stars, dropping the product beneath the four-star bonus threshold. Greater than 1.9 million people are enrolled within the Aetna Nationwide PPO, which represents 59% of the corporate’s Medicare Benefit membership.
Aetna attributed the decline to poor scores within the Client Evaluation of Healthcare Suppliers and Techniques survey (CAHPS). The corporate recognized the lack of stars income as a headwind for 2024 earnings and plans to mitigate a few of the draw back by means of “ongoing contract diversification efforts,” in keeping with a Securities and Alternate Fee submitting submitted Wednesday.
“This yr scores declined {industry} large,” an Aetna spokesperson wrote in an electronic mail. “CMS elevated reliance on member surveys to 1 third of the full Star rating. With our largest nationwide PPO contract’s outcomes primarily based on lower than 1,000 member survey responses out of almost 2 million members – lower than one-tenth of 1% – we don’t imagine they precisely replicate the full expertise of our Medicare Benefit members.”
Medical insurance commerce affiliation AHIP attributed the industry-wide declines to the continuing COVID-19 pandemic, in addition to to CMS modifying the way it calculated scores this yr. CMS made a number of modifications, corresponding to doubling the burden that CAHPS scores have on star scores.
CMS additionally assessed Medicare Benefit plans utilizing its pre-pandemic requirements. The company relaxed the way it calculated Medicare Benefit star scores for 2021 and 2022 as a part of COVID-19 aid, which led a report variety of insurers to garner excessive scores and a corresponding improve in federal spending on bonuses.
“We stay up for partaking with CMS to deal with methodological and different points to make sure that there are correct, dependable indicators of plan efficiency,” AHIP President and CEO Matt Eyles stated in a press release.
The vast majority of Medicare Benefit members stay enrolled in high-performing plans, Eyles stated. Roughly 72% of all Medicare Benefit members with Half D advantages are coated by plans that scored no less than 4 stars, in keeping with CMS.
Fifty-seven Medicare Benefit plans with prescription drug protection earned 5 out of 5 stars, a decline from 74 in 2022, CMS stated. Plans with a five-star score are allowed to market their product all yr, giving them a leg up on rivals which can be restricted to selling merchandise through the six-week open enrollment interval.
Amongst for-profit insurers, Humana skilled the smallest change, with greater than 73% of its 41 plans receiving no less than 4 stars, down from 78%. Ninety-six p.c of Humana Medicare Benefit members are at present enrolled in plans rated 4 stars and above for 2023, a spokesperson wrote in an electronic mail.
The entire seven plans operated by Kaiser Basis Well being Plan obtained no less than 4 stars, representing no year-over-year change. Not-for-profit insurers tended to attain higher than for-profit corporations within the stars program, CMS stated.
Tim Broderick contributed to this story.