UPDATE: Humana Mulling '10 Medicare Advantage Plan Changes
April 27 2009 - 2:44PM
Dow Jones News
Humana Inc. (HUM) will have to raise Medicare Advantage
premiums, cut benefits in those health plans or do both as a result
of the government's move to cut reimbursement by 4% to 5% in 2010,
although the managed-care concern expects its plans to remain
appealing compared with industry rivals and traditional Medicare,
Chief Executive Michael McCallister said Monday.
"Since our 2010 bids are due the first Monday in June, work is
already underway to make strategic changes to...keep our plans
competitive," McCallister told analysts on a conference call after
the managed-care company posted first-quarter profit that more than
doubled from a year earlier, and raised its full-year earnings
guidance.
At the same time, Humana is working with U.S. senators from both
parties who seek to have the Centers for Medicare & Medicaid
Services revisit the unexpectedly low 2010 payment rates for the
Medicare plans offered by private-sector health insurers.
McCallister later told Dow Jones Newswires he sees a "reasonably
good" chance CMS will mitigate the cuts. The timing is difficult,
though, as insurers must submit their 2010 Medicare Advantage plan
designs in early June and Congress would have to override a planned
21% Medicare physician fee cut, as it is expected to do, before CMS
would reconsider the rates, he said.
Meanwhile, McCallister said, Humana is conducting a
market-by-market, product-by-product design review for 2010. for
its Medicare Advantage plans, which generate more than half the
company's revenue.
"We are cautiously optimistic that when we get done, our benefit
plans are going to be very, very competitive," Chief Operating
Officer Jim Murray said, adding that Humana also is cautiously
optimistic it will see growth in Medicare Advantage plans next
year.
Humana has the highest exposure to Medicare among the major,
diversified managed-care plans and attributed better-than-expected
first-quarter performance to the strength of its Medicare drug and
health businesses. The company expects to add some 50,000 Medicare
Advantage members this year.
In contrast, enrollment in Humana's commercial business
declined, with layoff-driven attrition in small-group health plans
far more severe than the company had expected. The company now
expects commercial enrollment to decline by 150,000 to 175,000 this
year, after previously forecasting little change from 2008.
McCallister said a new government subsidy for Cobra coverage for
those who have been laid off won't change industry dynamics,
although it will help some people maintain health insurance.
While Humana's Medicare businesses boosted the bottom line,
efforts in Washington to cut Medicare Advantage funding in 2010 and
beyond create some uncertainty for the Louisville company, just as
broader health-reform efforts in Washington cloud the outlook for
the managed-care group.
Health insurers sell private Medicare Advantage plans that offer
beneficiaries services not available through traditional Medicare.
President Barack Obama and other Democrats have targeted the plans
for payment cuts.
In addition to the 2010 cuts, the president proposed competitive
bidding for Medicare Advantage in an effort to save more than $175
billion over 10 years. Obama complains the government spends 14%
more on Medicare Advantage than it does on traditional Medicare
coverage.
The industry takes a different view, defending Medicare
Advantage as a program that lowers costs, improves health outcomes
and appeals to seniors. Managements, including Humana's, say they
will work with the administration.
"Original Medicare, which lacks any sort of cost controls and
functions as a claims paying factory, is headed rapidly for
insolvency," while Medicare Advantage offers care coordination,
disease management and other activities that reduce costs,
McCallister said.
In spite of efforts to target Medicare Advantage funding,
McCallister remained upbeat about the business, saying Humana aims
to keep the cost of care in its plans 15% below that of traditional
Medicare and to build large networks.
"We've always liked Medicare. We've been in the business for
more than 20 years," and plan to do well over the long term, he
told Dow Jones Newswires, noting the millions of Americans aging
into Medicare in coming years. "This is a real growth market."
As for broader health reform, McCallister said a government
health-plan option for individuals would destroy the competitive
landscape of the health insurance market. He compared the idea with
traditional Medicare, which McCallister said inadequately
compensates providers.
"It's just a slippery slope to a government-run system" and
could derail reform efforts, he said.
Humana recently traded up $1.97, or 7.2%, to $29.33.
-By Dinah Wisenberg Brin, Dow Jones Newswires
215-656-8285; dinah.brin@dowjones.com