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March 20, 2023 06:00 AM

Medicare Advantage marketing was different in 2023. That's no accident.

Nona Tepper
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    Revamped marketing strategies separated the lions from the house cats during 2023 Medicare Advantage open enrollment.

    Industry giants UnitedHealthcare and Humana dominated the private Medicare market for the current plan year, capturing more than 70% of new enrollees and far outpacing the average industry growth rate of 7%. These leading insurers strengthened their positions by adapting to new regulatory and marketplace realities.

    In addition to offering popular supplementary benefits such as dental care, over-the-counter allowances and healthy food assistance, top insurance companies fine-tuned their marketing tactics to stand out in the increasingly crowded, commoditized and regulated market, said Brad Ellis, senior director at Fitch Ratings.

    The average beneficiary had 43 Medicare Advantage plans from which to choose, and a record 66% of Medicare Advantage plans with prescription drug coverage charged no premiums, according to the Kaiser Family Foundation. “There's been some commoditization of the Medicare Advantage benefits, so it really comes down to price and to marketing,” Ellis said. “There’s only so many bells and whistles you can add.”

    Insurers’ heightened focus on consumer outreach strategies coincided with a fedreral crackdown on Medicare Advantage marketing led by the Centers for Medicare and Medicaid Services.

    “CMS really pushed through several different regulatory restrictions, or requirements, quite late into the annual enrollment period, and really required a lot of that content to end up not making it out into the marketplace,” said Scott Fidel, managing director at the financial services firm Stephens Inc.. “CMS substantially slowed the direct-to-consumer via TV sales trend, relative to prior years, and that benefited certain carriers, and was negative for others.”

    In an effort to curb rising consumer complaints, CMS this year declared that insurers are responsible for the conduct of every entity that interacts with customers before, during and after enrollment—even if a carrier is not contracted with a marketer that breaks the rules.

    CMS also increased how much member satisfaction counts toward insurers’ star ratings, which provide Medicare Advantage insurers with the extra funds they need to offer generous benefits and that brokers use as a marker of quality. A heightened focus on the shopping experience led insurers to rethink relationships with direct-to-consumer call centers and slowed Medicare Advantage growth.

    “The Joe Namaths were a lot less present on the TV this year because those large sales aggregating organizations, they dropped their TV advertising by somewhere close to 70%,” said George Renaudin, Humana's president of Medicare and Medicaid. “When you add that up, I think having the growth rate slow isn't necessarily a shock,” he said. (Namath is a retired professional football player who was a spokesperson for Medicare Coverage Helpline, a brokerage.)

    Humana reasserted itself after missing enrollment targets for the 2022 plan year spurred a $1 billion investment into Medicare Advantage and expanded distribution channels. The effort paid off: Humana, the second-largest Medicare Advantage carrier with 5.5 million enrollees, and signed up 463,100 new members, nearly 23% of the total for this year, according to federal data released last month.

    The insurer raised compensation to third-party marketers such as GoHealth to equal what rivals offer, Renaudin said. But there was a caveat. Humana, like other insurers, asked brokers to pitch patients on the overall value of its benefits packages rather than merely emphasizing a specific feature, such as dental coverage. The insurer also gave bonuses to sellers who reduced the number of customers switching in and out of plans over the course of open enrollment.

    “We weren't just matching the competitors. We targeted how we were doing so in a way to improve the quality of the sale, which translates to better retention,” Renaudin said.

    UnitedHealthcare enrollment rose 11.9% to 8.9 million members for the 2023 Medicare Advantage plan year. UnitedHealth Group did not make an executive available for an interview.

    Highmark Health Plan likewise grew ahead of the industry at 12.3%, amounting to 29,000 new members. The company credited high star ratings, strong provider partnerships and a strategy to offer products at different price points in each market. “That definitely hit a chord,” Highmark Health Plan President Tom Doran said during a call with investors Monday.

    Nonprofit Blue Cross and Blue Shield insurers collectively increased market share for the first time in recent years. For example, Blue Cross Blue Shield of Michigan credited its 9% Medicare Advantage growth to more robust marketing. The company’s internal numbers differ from CMS' report. Several insurers noted discrepancies and said CMS fell behind on cataloging enrollment data. CMS said its files lag by a month but reflect what insurers submit.

    The COVID-19 pandemic heightened the importance of TV advertising but, rather than rely on outside marketers to promote its products, the Blues carrier’s in-house marketers debuted a 30-minute infomercial highlighting plan benefits, said Rick Notter, vice president of individual business. The nonprofit insurer also boosted digital ad spending and placed spots on platforms such as Spotify, he said. Blue Cross Blue Shield of Michigan monitored how many leads each digital channel generated weekly and used those data to adjust marketing spending in real-time, he said.

    “Each year, it’s test and learn. The nice thing about digital marketing is that you can make changes almost on the fly,” Notter said. “You can almost change on a week-by-week or a day-by-day basis, depending on the results you're getting.”

    Not every insurer’s marketing strategy resulted in enrollment growth.

    Centene, for example, blamed the marketing landscape for slower-than-expected sign-ups. The company decreased its use of direct-to-consumer call centers to focus on its exclusive sales relationships and its star ratings, CEO Sarah London said during a call with investors last month. Centene, which declined to make an executive available for an interview, was the only large, for-profit insurer to lose Medicare Advantage members this plan year.

    “We made the decision to change our distribution strategy and focus more on proprietary channels,” London said at the time. “Near-term sales and retention were more significantly impacted by our distribution strategy than expected, particularly in light of competitor investments in channels we deprioritized.”

    Centene and CVS Health subsidiary Aetna had relied heavily on direct-to-consumer call centers to generate leads, and were disadvantaged when third-party marketers pulled back from TV, Fidel said. SelectQuote, for example, cut marketing spending by 54%, or $29.5 million, during Medicare enrollment, according to a filing the online broker submitted to the Securities and Exchange Commission last month. By contrast, Humana and UnitedHealthcare maintain a more omnichannel approach, Fidel said.

    Increased competition slowed Aetna’s growth, Christopher Ciano, president of Medicare operations, wrote in an email.

    A decline in star ratings also disproportionately impacted Centene and Aetna, Fidel said. Research has shown consumers generally don’t shop for plans based on star ratings, but brokers rely on quality scores to narrow down the products they pitch, he said.

    These factors, along with young health insurance companies scaling back operations, caused Medicare Advantage enrollment to grow at its slowest rate in at least five years, Fidel said. Clover Health, Bright Health Group and Oscar Health each suffered membership declines, while Alignment Healthcare grew below market rates.

    “These are companies that were all growing very quickly,” Fidel said. “Suddenly going from growing very quickly to shrinking at the margin, when you're thinking about what can drive a percentage point or so of change in the market, that's an influence.”

    Among the insurtechs, Devoted Health remained the exception as enrollment increased 73.7% to 124,419 members. The company declined to make an executive available for an interview, but news releases credit its integrated care model and high star ratings. Devoted Health also began selling policies in eight additional states this plan year.

    Alignment Healthcare rejected the characterization that it grew at a slower rate than the overall industry. CMS enrollment data are incorrect, and Alignment Healthcare grew membership 17% to 108,300 policyholders, said Dawn Maroney, president of markets at Alignment and CEO of its health insurance arm.

    The company doubled its internal Medicare Advantage sales staff and certified external brokers selling Alignment Healthcare plans, Maroney said. Training brokers to understand Alignment’s integrated insurance and care delivery model helped the insurer comply with new federal marketing regulations, she said. Alignment representatives review CMS’ Medicare Advantage complaint database to track consumer complaints about misleading brokers. The insurer suspends or terminates relationship with outside salespeople with poor track records, she said.

    Related Articles
    Medicare Advantage insurers face high marketing stakes
    Humana to cut costs, invest $1B in Medicare Advantage
    Medicare Advantage enrollment growth slowed for 2023
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