CVS expects $1B hit from Medicare Advantage superstar scores dip

CVS Health anticipates insurance coverage income will decline as much as $1 billion subsequent yr after its greatest Medicare Advantage plan reported a large drop in superstar scores, the corporate disclosed in a Securities and Exchange Commission submitting Thursday.

The Aetna insurance coverage subsidiary will join 21% of its Medicare Advantage contributors in plans rated no less than 4 stars in 2023, down from 87% the prior yr. Medicare Advantage plans will have to reach 40 or five-star ratings to earn most payout bonuses. Health insurance coverage corporations depend on those further bills to supply supplemental advantages or to rate no premiums.

Aetna attributed the decline to a one-star lower in its greatest contract, the Aetna National PPO, which covers 59% of the insurer’s 3.2 million enrollees. The corporate has been running to unfold its contributors amongst a couple of plans, with approval from the Centers for Medicare and Medicaid Services, CVS Health wrote within the SEC submitting. The corporate declined an interview request.

The corporate reported an 8.7% drop in internet source of revenue to $2.1 billion right through the primary quarter, pushed by means of prices associated with its acquisitions of generation corporate Signify Health and Chicago-based number one care chain Oak Street Health, CVS Health due to this fact diminished benefit projections for this yr. CEO Karen Lynch advised traders this month that interior metrics recommend superstar scores will make stronger subsequent yr.

Aetna reported the second-largest drop Among huge insurers in contributors enrolled in four- and five-star plans this yr. Centene skilled the biggest decline, with fewer than 2% of its Medicare Advantage contributors enrolled in extremely rated insurance policies this yr. Insurance corporations attributed the industrywide scores slide to CMS resuming extra stringent opinions after enjoyable them right through the COVID-19 pandemic and to the larger significance of shopper revel in in calculating ratings.

CMS plans to halve the load put on member revel in sooner or later and to interchange the “reward factor,” which supplies further bonuses to plans with persistently top scores, with a well being fairness index to advertise efforts to deal with disparities.