The AIS Data Team has posted new data to the subscriber dashboard Online Search Tool and In-App Download Enrollment Data Spreadsheets. This data primarily reflects fourth-quarter 2021 status but includes some first-quarter 2022 data for Medicare Advantage (MA), dual-eligibles and Medicaid membership.

Most related in-app downloads and special reports now reflect the most recent data available. Keep an eye out in the coming weeks for a detailed analysis of changes from the third quarter.

Note: Due to timing issues involving the auditing of quarterly data, the data in the monthly Public-Sector Plan Enrollment report will be more current in many cases than the membership figures in the quarterly reports. For the most updated and granular public-sector membership figures, always consult the monthly public-sector report.

For this update, we added several new MCOs, all of which are Medicare or dual-eligible plans that launched in 2022:
• Reid Health PACE (#2023)
• PACE of Northeast Indiana (#2024)
• Alterwood Advantage (#2025)
• Florida Complete Care (#2026)
• HopeWest (PACE) (#2027)
• LEON Health (#2028)
• Mass Advantage (#2029)
• Ochsner Clinic Foundation (#2030)

We discontinued the following MCOs:
• Affinity Health Plan (#210), consolidated into Molina Healthcare (#1545) after its acquisition in 4Q21;
• BlueCross BlueShield of Western New York and BlueShield of Northeastern New York (#277), consolidated into Highmark Health (#286) post-merger;
• Florida True Health, Inc., dba Prestige Health Choice (#1407), a Medicaid plan now operating under the AmeriHealth Caritas (#1007) brand;
• Gateway Health Plan (#317), consolidated into Highmark after all Gateway-branded plans changed to Highmark;
• PreferredOne, (#186), consolidated into UnitedHealthcare (#1263) following their 2021 merger; and
• Total Health Care, Inc. (#193), consolidated into Priority Health (#545) post-merger.

To reflect its new branding, we updated the MCO name for Scott & White Health Plan (#235) to Baylor Scott & White Health Plan.

Parent changes include moving Triple-S Management Corporation (#1196) under the GuideWell Mutual Holding Company (#97); the merger closed since our last update. We will communicate with our sources at both companies to determine whether to combine Triple-S with any other GuideWell entities.

We continue to track the consolidation of Centene Corporation (#1543) and WellCare Health Plans (#206). We have not made any changes to the parent-MCO structure for this update, but Centene has transitioned the bulk of its Medicare plans to the WellCare brand, so expect to see a substantial shift for both payers in duals and Medicare Advantage.

Medicaid continued to increase, gaining over 1.3M managed Medicaid lives from last quarter, while state Medicaid gained nearly 595K members.

Notable gains in the Medicaid space since the last update include the following:

• Highmark Health’s aforementioned contract pick-ups in Pennsylvania (Gateway Health Plan) and New York (BlueCross BlueShield of Western New York and BlueShield of Northeastern New York), netted the insurer an additional 376K members.
• Molina Healthcare gained 305K Medicaid members after its acquisition of Affinity Health Plan in New York and its picking up Cigna Corporation’s Texas contract.
• Medicaid behemoth Centene gained over 265K members due to expansions in multiple high-population states, nearly doubling its membership in Nevada alone.

Meanwhile, UnitedHealthcare (#1263) and Anthem, Inc. (#1264) both lost considerable Medicaid market share in Nevada – 100K and 80K members, respectively.

The public health insurance exchange market edged up slightly; we expect to see much more robust changes in this market for the first-quarter release in late June, by which point we’ll have updated figures from this time period.

Commercial risk group enrollment increased slightly once again, gaining nearly 170K new members from the third quarter. Most gains and decreases in commercial group risk were modest, aside from increases due to the mergers and acquisitions outlined above.

Medicare Advantage (MA) plans gained a little over 1M members, while dual-eligibles increased 385K, thanks to open enrollment. Please note that MA and duals membership is current as of March 2022. In addition, to WellCare’s aforementioned MA gains (nearly 370K members), other big winners include UnitedHealthcare (356K new members) and Aetna (151K).

Administrative services only/self-funded membership decreased by more than 236K, mainly due to attrition in foreign enrollment, as well as DHP’s removal of Seton Health Plan (#236)’s ASO membership; additional research indicates that Seton no longer offers a self-funded option.

Need more help? Contact support@aishealth.com with questions about how to use or interpret the information provided to you in AIS’s Directory of Health Plans. A member of AIS Health’s support staff would be happy to provide a free demonstration of the website for clients needing more guidance on how to best use this tool.