The Biden administration has suspended Medicare Advantage Part D new customer enrollment for three United Healthcare Group plans and one Anthem plan for failing to meet medical loss ratio requirements.
The Centers for Medicare & Medicaid Services (CMS) announced the suspensions in a series of enforcement notices Sept. 2. The plans are prohibited from signing up any new customers for the 2022 coverage year, and suspensions occur before open enrollment starts Jan. 1.
The Part D plans were dinged by CMS for not maintaining a medical loss ratio of 85%, meaning 85% of every premium dollar must go toward healthcare coverage and the rest to administration costs.
CMS is required under law to suspend enrollment in any Part D plan that doesn’t meet the medical loss ratio deadline of 85% for three years. The plans did not meet the requirement from 2018 through 2020, according to the enforcement letters.
The plans can resume sign-ups for the 2023 coverage year if they show they have a medical loss ratio of at least 85% for 2021.
CMS suspended enrollment for plans administered by United of the Midwest, United of New Mexico, United of Arkansas and Anthem’s MMM Healthcare.
UnitedHealthcare told Fierce Healthcare the reason the medical loss ratio dipped below 85% was “so many of our members deferred going to get care due to COVID-19.”
The insurer said existing members won’t be affected, and it will “offer alternative plan options for people who want to choose a New UnitedHealthcare plan in these select markets.”
Anthem told Fierce Healthcare that it will work with MMM Healthcare and CMS to address the agency’s concerns.
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