For some companies, it’s not the number of plans that receive a high rating, but the size of their membership.
Nearly 38% of Aetna policies received at least four stars, down from 55.6%. But the rating for CVS Health subsidiary Aetna National PPO’s largest plan, Aetna National PPO, has dropped to 3.5 stars, putting the product well below the four-star bonus threshold. More than 1.9 million individuals are enrolled in the Aetna National PPO, representing 59% of the company’s Medicare Advantage membership.
Aetna attributed the drop to poor scores on the Health Care Providers and Systems (CAHPS) survey. According to a Securities and Exchange Commission filing filed on Wednesday, the company identifies the loss of revenue as a headwind to 2024 earnings and plans to mitigate some of the downside through “several downsides.” Contract diversification efforts are ongoing.”
The health insurance trade association AHIP attributed the industry-wide decline to the ongoing COVID-19 pandemic, as well as to CMS’s revised rating calculation this year. CMS has made some changes, such as doubling the weight that CAHPS scores have in star ratings.
CMS also evaluates Medicare Advantage plans using its pre-pandemic standards. The agency has relaxed how it calculates Medicare Advantage star ratings for 2021 and 2022 as part of its COVID-19 relief, resulting in a record number of insurers winning high scores and an increase in corresponding increase in federal spending on bonuses.
“We look forward to working with CMS to address methodological and other issues to ensure accurate, reliable indicators of plan performance,” said President and CEO. implementation of AHIP, Matt Eyles said in a statement.
The majority of Medicare Advantage members are still enrolled in high-performing plans, Eyles said. According to CMS, about 72% of all Medicare Advantage members with Part D benefits are covered by plans that score at least four stars.
Fifty-seven Medicare Advantage plans with prescription drug coverage earned five out of five stars, down from 74 in 2022, CMS said. Plans with five-star ratings are allowed to market their products for an entire year, giving them a leg up on competitors who are restricted from promoting products during a six-week open enrollment period.
Among for-profit insurers, Humana had the smallest change, with more than 73% of their 41 plans receiving at least four stars, down from 78%. Humana did not immediately respond to a request for an interview.
All seven plans operated by the Kaiser Foundation Health Plan received at least four stars, unchanged from year to year. Non-profit insurers tend to score higher than for-profit companies in the star program, CMS said.
Tim Broderick contributed to this story.
