Cavulus CEO Says Newly Proposed Rules May Boost Medicare Advantage Enrollment in Rural America

Medicare Advantage (MA) is an increasingly popular insurance option that accounts for more than 34% of all Medicare plan coverage types in the USA. State by state enrollment varies with penetration peaking at 60% in Minnesota, approximately 40% in places such as New York, Pennsylvania and California, and down to 20% in more rural locations like the Dakotas, Iowa, and Oklahoma.

According to Patrick Phillips, CEO of Cavulus, a leading technology firm serving the MA industry, many states with low MA enrollment are underserved because they have large expanses of rural areas. However, based on newly proposed rules published by Centers for Medicare & Medicaid Services (CMS) for 2021/2022, Phillips believes MA enrollment in these rural states should get a boost.

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Kaiser Family Foundation data shows MA enrollment in urban counties is 36% vs. 24% in rural counties. Phillips says this disparity is partly due to a CMS rule that requires MA Organizations to demonstrate that their networks don’t unduly burden beneficiaries in terms of travel time and distance to network providers and facilities. In rural regions it’s a hurdle that’s historically been difficult to overcome.

Enter telehealth and telemedicine. The new CMS proposed rules “encourage and account for telehealth providers in contracted networks, and propose that MA plans receive a 10% credit towards the percentage of beneficiaries that must reside within required time and distance standards when the plan contracts with telehealth providers for Dermatology, Psychiatry, Cardiology, Otolaryngology, and Neurology.”

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The Cavulus CEO explains “this integration of technology is an enormous benefit to patients, particularly in Medicare, who may have mobility constraints based on condition or age,” pointing out that patients will receive more direct, immediate, and accessible care through telehealth, and also have more coverage options as Medicare Advantage plans expand into rural America.

Phillips encourages all MA plans to re-evaluate service area expansions with this new rule in mind for 2021. He concludes, “it may even be a driver for rural provider groups and networks to consider launching their own MA plans.”

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