Here is what you’ll find in this week’s newsletter!

1. Important links 🔗 - the best articles we found this week about the Medicare Market along with links to Jared’s recent LinkedIn posts.

2. Deep Dive 📚 - Aetna → The Big Winner of AEP 2024

3. Compliance Chatter 📢 - Maryland’s Governor approved SB0219

4. Sponsor Snapshot 🚀 - brought to you by 2024 AEP Medicare Advantage State Deep Dives.

It’s only a 5 minute read, but it will make you 10x smarter.

DEEP DIVE 📚

Aetna → The Big Winner of AEP 2024

This week’s deep dive is Part 3 in our series on 2024 AEP enrollment results.

Part 1 looked at AEP results by Geography and Health Plan.

Part 2 looked at AEP results by Plan Type.

In this final installment we look at the big winner of AEP… Aetna! By winner, I simply mean, “they grew the most”.

(Aetna is part of CVS Health, but I’m going to refer to them as Aetna throughout the deep dive.)

Remember, “AEP growth” is the change in enrollment counts from December 2023 to February 2024.

Overall Growth

During AEP 2024 Aetna grew membership by ~585,000, outpacing their nearest competitor by ~440,000.

Aetna’s Growth by Geography

The first question to ask is: “Where did they grow?”

Answer: “Well, basically everywhere!”

Aetna had the most growth in 26 of the 52 “state” markets.

Aetna was in the top 3 (for most growth) in 39 of the 52 “state” markets.

In addition to being the top growing plan across state markets, they also dominated several of the state markets.

For example:

• In Missouri, Aetna grew by ~38,000, while the 2nd highest only grew ~2,300.

• In Kansas, Aetna was essentially the only plan that grew.

You get the point. In roughly half the states where they grew the most, they did so by a large margin!

Aetna’s Growth by Plan

While the overall 2024 AEP growth was driven by Local PPO plans, Aetna uniquely grew both Local PPO and HMO plan types.

• Aetna’s Local PPO plan enrollment grew ~327,000

  • The rest of the market grew ~600,000

  • In other words, everyone grew local PPO plans, and Aetna took a large portion

• Aetna’s HMO plan enrollment grew ~259,000

  • The rest of the market declined ~121,000

  • In other words, Aetna took HMO lives from their competitors

Additionally, 23% of Aetna’s AEP growth was driven by Special Needs Plans (SNPs). The majority being D-SNPs.

• Aetna’s D-SNP plan enrollment grew ~134,000

  • The rest of the market grew ~24,000

Plan Comparisons

One common theme I heard from agents (more on that later) is that part of what drove Aetna’s growth was that their benefits were richer than competitors.

In order to explore this theory, I decided to do a plan comparison in a few counties.

This is not meant to be a comprehensive review/comparison, but it provides at least a little evidence in a few markets.

Using the state list above (where Aetna dominated), I decided to complete a plan comparison in St. Louis County, Missouri (the largest county in MO) and Sedgwick County, Kansas (a rural-“ish” county).

In St. Louis County, I compared Aetna’s biggest growth plan to Humana and UnitedHealth Group’s largest plans. They are all HMO plans.

I used eHealth’s plan comparison tool (it’s what popped up when I googled, and I didn’t have to provide contact info!).

One Note: Essence also has a large HMO plan in St. Louis County, but the eHealth tool doesn’t include Essence.

Here are the results:

A few notable areas where Aetna looks to “win”:

• Higher Star Ranking

• Lower out of pocket max

• Higher flex benefit dollars

• Higher OTC Benefits

• Higher Eyewear Benefits

__

In Sedgwick County, KS I also compared Aetna’s biggest growth plan to Humana and UnitedHealth Group’s largest plans.

For this comparison I decided to only compare PPO plans (which is where Aetna saw their growth).

Here are the results:

A few notable areas where Aetna looks to “win”:

• Lower out of pocket max

• Higher flex benefit dollars

• Higher OTC Benefits

Again, by no means a complete review, but it does provide a bit of evidence of their benefit richness during AEP.

What did Agents say about Aetna’s AEP?

Okay, now one final bit of information.

A few months ago, after it was clear that Aetna “won” AEP, I asked this question to my followers across a few social media platforms:

"If you were explaining to an executive at a carrier why Aetna grew so much... what would you say?“

The discussion led to 160+ comments (across the multiple platforms). You can see the LinkedIn post here.

Most of the discussion and responses came from Medicare distributors, Agents, Agency owners, etc.

Here are the common themes that emerged.

1. Commitment to Local Markets

2. Quality Improvement and DSNP Growth

3. Product Offering

4. Vertical Integration and CVS Influence

5. Regional Improvements and New Plans

6. Market Expansion and $0 Premium Plans

7. Flexibility, Choices, and Simplicity

8. Dental Benefits and Ancillary Offerings

9. Focus on Dual Eligible Beneficiaries

10. Partnerships and Collaborations

11. Focus on Local Presence

Does this resonate? Anything that you would add? (Respond to this email and let me know.)

Final Thoughts

It will be very interesting to see how Aetna’s growth translates to Revenue, Medical Loss Ratio, and Profits during 2024, and into the future.

With all the changes coming in 2025, how will Aetna, and the other Health Plans in Medicare Advantage price and develop their plans for AEP 2025?

Will the benefit comparisons above look similar in 2025, or will there be notable changes?

If you’re ready, here are some ways we can help you:

• Newsletter Sponsorship opportunities: Promote your product or services to leaders in the Medicare space. Let’s discuss. (link)

• Market Research: Reports that help you wrap your arms around the Senior focused insurance markets. (link)

• Consulting: We can help you develop new insurance products for the Medicare market, appraise your books of business, and keep you compliant. Let’s discuss. (link)