Despite Formidable Resources, The Medicare Advantage “Big Five” Are Not Winning Everywhere

Published on January 7, 2019

With 8.6 million Medicare Advantage enrollees, UnitedHealth, Humana, Aetna, Kaiser, and Anthem control 60% of the market, and they’re getting bigger: almost all the net enrollment gains in 2017 and 2018 went to the Big Five. In that timeframe, they added almost 1.4 million net new members while the rest of the industry – 240 different companies – added just 61,600.

However, even though the Big Five have more personnel, technology, marketing dollars, national brand recognition, and contract negotiating leverage, they are not winning everywhere.

Using Carrot MarketView we can identify the markets where mid-sized health plans are more than holding their own. Examples include the Baltimore (MD), San Diego (CA), Rochester (NY), Lafayette (LA), and Columbia (SC) MSAs. More importantly, since few health plans can migrate to those areas, Carrot MarketView also points to a number of winning strategies mid-sized plans can deploy in their own Medicare Advantage markets based on insights from like-markets.

How Regional Health Plans Are Beating the “Big Five” on Medicare Advantage Benefits

1. Medicare Advantage Dental Benefits

In highly mature, competitive markets like the Miami (FL) and Cincinnati (OH) MSAs, regional health plans are winning with HMOs offering dental benefits in a larger percentage of plans than the national players (70% vs. 46%). In up and coming markets, such as the Chicago (IL) and Omaha (NE) MSAs, the difference is more pronounced: 94% of regional HMO plans offer dental benefits vs. 57% of national plans.

2. Medicare Advantage Prescription Drug Deductibles

In highly mature, competitive markets, regional health plans are winning with LPPOs that offer lower prescription drug deductibles ($138) than national plans ($198).

3. Medicare Advantage Specialist Co-Pays

In up and coming markets, reduced specialist co-pays are also factors in mid-sized health plans’ successes: regional plans’ LPPO specialist co-pays average $11, while the specialist co-pays for national plans average $38.

We described the use of data points like these as a competitive advantage for health plans in a recent edition of Carrot Health Insights called “Medicare Advantage Moneyball.” The baseball-inspired post detailed how, in the early 2000s, the Oakland A’s figured out how to analyze information in new and innovative ways to beat far richer and more prominent Major League baseball teams: the A’s couldn’t outspend the large-market teams, so they outsmarted them. In this same way, mid-sized health plans can use Carrot MarketView to leverage data and analytics to identify and act upon unique and dynamic opportunities in their local markets.

We’d love to help you uncover opportunities in a Medicare Advantage market that matters to you! Ready to chat? Please contact us today. Want a little more inspiration first? This case study details how Medica used Carrot MarketView for a level of segmentation that reinvented how it engaged with consumers.

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