America's Benefit Specialist August/September 2023

MEDICARE MATTERS

pre-COVID baseline, which could help inform future studies examining changes that took place during the pandemic. The Parkinson’s Foundation estimates that one million peo ple in the U.S. are living with PD, and this number is expected to rise to 1.2 million by 2030. Currently, there are only 660 MDS in the U.S., with a total of six practicing in rural areas. There aren’t enough expertly trained specialists today for the grow ing population of people living with the disease. A shortage of MDS can bring challenges in seeking care, including long

appointment wait times and unreasonable travel distances. There are opportunities to improve access to specialized care by expanding PD-specific training for healthcare professionals and pursuing strategies that improve access across all popu lation groups. These results will support policy development and future research that dives deeper into access issues faced by beneficiaries, especially those who may not live near the highest-trained specialists.

MEDICARE ADVANTAGE UTILIZATION UP IN SECOND QUARTER The two largest Medicare Advantage insurers have separately noted increased member utilization trends for the second quarter of 2023, signaling a potential trendline that could pressure the health insurance sector’s overall profitability going forward, according to a new AM Best commentary. UnitedHealth Group Inc. and Humana Inc. each comment ed about the increased MA utilization, which occurred after carriers in the MA program had already set rates for the 2024 calendar year. The Best’s Commentary, “Medicare Advantage Utilization up in Second Quarter 2023,” states that the MA line of business accounted one third of the health insurance sector’s profitability in 2022. by pent-up demand and not by an increase in severity or di agnosis. Claims were largely for hip, knee and cardio-related procedures. Humana issued a statement that it was seeing increased utilization in claims for emergency room, outpa tient surgeries and dental services, as well as inpatient claims that diverge from seasonal patterns. Both companies have indicated that they expect the high er level of utilization to persist over the near term and not be quickly resolved, according to the report. Furthermore, they expect full-year results to fall in within their previously stated guidance, but their loss ratios will likely be at the upper end of ranges.

“Given the growing share of MA earnings in the overall industry’s balance, a deterioration in MA profitability would negatively impact overall industry results,” said Sally Rosen, senior director, AM Best. “AM Best believes that the health in surance industry and the MA segment will remain profitable in 2023, although 2024 profitability may be pressured.” UnitedHealth Group had commented on the rise in utilization for outpatient services, particularly in MA, at an investor relations event. The increase appears to be driven

“Given that these two companies write MA throughout the country, these trends may be widespread, with some varia tion by state,” said Jason Hopper, associate director, AM Best. “MA expenses related to hospital and medical benefits, other professional services, emergency room visits, and prescrip tion drugs have all increased by double digits in the last two years, exceeding premium growth in 2021 and dampening profitability.” To access the full copy, visit www3.ambest.com.

CONFERENCES

July 22-23 Ms. Medicare 2024 Cleveland, OH www.msmedicare.org

March 11-13 Medicare and Margaritas Orange Beach, AL www.medicareandmargaritas.com

November 13-24 National Medicare Advantage Confeence Las Vegas, NV www.wcforum.com/conferences/medicare

42 ABS | benefitspecialistmagazine.com