As other major insurance companies drift away from Medicare Advantage (MA), Elevance is jumping into the deep end.
The insurer projects it will end 2025 with an increase of 7%–9% in MA membership, President and CEO Gail Boudreaux said in a Jan. 23 earnings call. Most of that growth already happened during open enrollment for the for-profit carrier, which had just over 2 million MA enrollees out of its 45.7 million total members as of Dec. 2024.
The prediction comes as some other insurers want to lose MA members in 2025 amid a difficult market.
Boudreaux insisted during the earnings call that the chain wasn’t taking on more than it could handle.
“We remain confident in our ability to balance growth and margin performance in 2025,” Boudreaux said.
Two sides of a coin
In contrast, CVS CEO David Joyner said during the company’s Feb. 12 Q4 earnings call that the chain plans to shrink insurance arm Aetna’s MA membership “by high single digits percentage” compared to 2024, in the aim of improving profits for 2025.
In a report detailing Q4 and year-end results, CVS Health pointed to MA market pressures like sky-high utilization, a high-acuity Medicaid membership, and low star ratings—a quality metric tied to perks like bonus payments.
Aetna had rapidly grown in membership but was then saddled with more medical costs from those extra members than it could handle, tanking margins, Healthcare Dive previously reported.
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Humana, too, expects individual MA membership to decline by 550,000 or 10% from 2024 as a result of exiting “certain unprofitable plans and counties,” according to its Q4 earnings report released Feb. 11.
“For a while it was how quickly could you grow Medicare because the business was trending favorably. And now, because the trends are so unfavorable, you’ve got half of this sector making a conscious effort to lose members. We haven’t seen this in a very long time,” Jared Holz, a healthcare sector strategist with investment firm Mizuho Securities, told Stat News in September.
One plan’s loss, another’s gain
Elevance executives have previously said that one part of their growth strategy was to snatch up members exiting other MA plans.
“If everyone is talking about membership losses, those members are going somewhere,” Elevance’s CFO of government health benefits Stephen Tanal said during the 45th annual Goldman Sachs Global Healthcare Conference in June, as Modern Healthcare reported at the time.
In the Jan. 23 earnings call, however, Boudreaux said many of the plan sign-ups during open enrollment were renewals from existing members. But that’s good, she said, because it gives the insurer confidence in predicting its future medical expenses and margins.
Elevance EVP and CFO Mark Kaye said during the call that though Elevance has seen high MA costs, they are “manageable,” and that the insurer priced its plans in 2025 appropriately to deal with those costs.