Will Medicare Advantage Work in 2025? UnitedHealth Hopes So

News July 16, 2024 at 03:56 PM
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What You Need To Know

  • UnitedHealth wants to hold profit margins steady.
  • Executives are hazy about what competitors will do.
  • The company posted $4.4 billion in net income in spite of the Change ransomware attack.
A Medicare card with 2025 on it

UnitedHealth Group executives were vague Tuesday about what the Medicare Advantage program might look like in 2025.

UnitedHealth is the biggest Medicare Advantage player, with plans covering 7.8 million of the 32 million enrollees. The company also covers about 4.3 million of the 14 million people who own another type of supplemental coverage, Medicare supplement insurance.

The Centers for Medicare and Medicaid Services, the agency that oversees Medicare, has announced what issuers see as a funding cut.

What will that mean for UnitedHealth?

UnitedHealth is trying to hold Medicare Advantage plan profit margins steady, Tim Noel, the head of the company's Medicare and retirement unit, said during a conference call the company held to go over second-quarter earnings with securities analysts.

"We've priced the products so that we'll be comfortable with whatever growth is the outcome of what we bring to the marketplace," Noel said.

Andrew Witty, UnitedHealth's CEO, declined to predict how UnitedHealth's Medicare Advantage plan market share might change.

"Ultimately, the way growth plays out in the marketplace depends on how everybody bids, not just on how you bid," Witty said. "It only takes one bid to be kind of out of expectation to completely distort how things could play out."

What it means: Clients with Medicare coverage might find that it ends up being about the same in 2025, but they could also end up seeing big, confusing changes, given that even top executives at a top issuer aren't sure what to think.

The backdrop: The Medicare Advantage program gives private insurers a chance to use a combination of federal money and enrollee premiums to provide an alternative to traditional Medicare coverage.

The annual enrollment period for the coming year starts Oct. 15 and runs through Nov. 7.

In addition to tightening plan funding formulas, CMS has tried to change the way that issuers pay agents. Agency officials want to stop issuers from paying for agent support services but increase the maximum commission for an initial enrollment by $100. The cap is now $611.

A federal judge in Texas blocked implementation of the regulations.

The earnings: UnitedHealth reported $4.4 billion in net income for the second quarter on $99 billion in revenue, compared with $5.5 billion in net income on $93 billion in revenue for the second quarter of 2023.

Net results include a number of unusual items, including costs related to the ransomware attack on the company's Change Healthcare health data exchange unit. Adjusted operating earnings, which exclude the unusual items, increased to $8.7 billion, from $8.1 billion.

The number of people in major medical plans the company insures or administers fell to 50 million, from 53 million.

Credit: CMS

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