Medicare Advantage Trends in 2019 to Watch

Friends, some hot intel from the field for Medicare Advantage (MA) in 2019:

  • Expect many new entrants to the MA market, especially provider-sponsored plans moving up the food chain.
  • We are seeing benefits improve by $20-40 PMPM, dependent on county revenue-to-cost ratios and plans’ Star ratings. Expect to see many more low-cost, narrow network products. Premiums will hold the line or fall, with $0 PCP copays going mainstream.
  • We are continuing to see new $0 or low cost plans this year – that is where enrollment is growing. Plans are adding new products to capture the New to Medicare market.
  • We are expecting to see many cobranded products this Annual Election Period (AEP) with regional and national players teaming with local health systems and physician groups.
  • We are seeing an increase in marketing budgets this year, plus more aggressive sales distribution strategies, since many Plans understand that this year and next are expected to be big growth years. The reinstatement of the new (old) Open Enrollment Period (OEP) fundamentally changes your sales and marketing strategy. For new plans, or those new to MA, who have never been through an OEP, there is even more to consider from a strategic perspective.
  • We are seeing dental and over-the-counter drug benefits being added to most products, as well as a widespread increase in travel benefits, which Boomers love.
  • Groundbreaking new supplemental benefits under the new CMS policy won’t be the norm in 2019. Most plans simply didn’t have time after the April announcement and the bid deadline. 2020 however will see an explosion, especially in at-home essential care benefits and palliative care, transportation, and telehealth.  An OTC benefit will be a game-changer in the new era of expanded supplemental benefits in MA in 2019 and beyond. Not only do OTC products delivered to the member provide tremendous value and loyalty, but when used as an incentive in chronic care management it changes behavior and improves member adherence. Our merger partners at Convey Health Solutions are the best at it. Learn more here.

MA members continue to tell us that their most important priorities are what Melissa Smith, our Senior Vice President of Sales, Marketing, Strategy & Stars refers to as “doctors, dollars and drugs” – essentially the construct of our provider network and formulary, and how easy and costly it is for members to understand and use them.  But we all know that it’s not enough to offer robust benefits: we have to communicate them effectively during and after enrollment, we have to pay claims and handle calls accurately and quickly, we have to coordinate clinical care and medication use the way we describe during the sales process, and (of course) we must comply with CMS regulations.  We know this isn’t easy.  We can help.  Please contact us at




Benefits are Submitted. What’s Top of Mind for 2019 Marketing and Sales? Learn more

Whether you need help establishing an effective member experience or member communication strategy, cataloging and evaluating existing member communications, or identifying opportunities to streamline and strengthen your member engagement tactics or interventions, we can help. Read more here

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John Gorman
John Gorman

Under John's leadership, Gorman Health Group has become the leading professional services and solutions firm for government-sponsored health care, providing thought leadership and expert strategic, operational, and technology-based solutions. Read more

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