Highmark Health’s subsidiary, Endorsed LLC, is teaming up with three senior living operators to offer a specialized Medicare Advantage plan aimed at dual-eligible seniors. The plan, designed for those eligible for both Medicare and Medicaid and who are long-term nursing home residents, will be marketed in 12 Pennsylvania counties. Pending federal approval, the coverage is set to go live in January, marking a significant step in addressing the healthcare needs of one of the most complex and costly patient populations.
Tackling the High Costs of Dual-Eligible Care
The partnership targets a demographic known for its high healthcare costs. In 2018, dual-eligible seniors cost Medicare more than twice as much per capita as non-dual-eligible seniors. The new plan aims to improve coordination between Medicare and Medicaid benefits, which has traditionally been poor, leading to higher costs and fragmented care. By focusing on better care management, the partners hope to generate significant cost savings while improving patient outcomes.
Implications for the Long-Term Care Industry
This initiative comes at a critical time for the long-term care industry, which has been hit hard by rising labor costs and stagnant reimbursement rates. With 40 nursing home bankruptcies in Western Pennsylvania alone, there is cautious optimism that the new insurance plan could provide some financial relief. However, concerns remain about whether Medicare Advantage reimbursement rates will be sufficient to cover the true costs of care, as traditional Medicare rates often do.
Strategic Positioning in a Growing Market
For Highmark and its partners, this move represents a strategic expansion into the growing market of senior care insurance. The number of dual-eligible Medicare and Medicaid recipients has grown by more than 16% since 2016, making this a lucrative market for insurers. Successfully managing and marketing these specialized plans could position Highmark as a leader in this niche segment, setting a precedent for future innovations in the industry.
The Road Ahead: Regulatory Approval and Industry Impact
The success of this plan depends on federal approval and the specifics of the reimbursement structure. If approved, this partnership could signal a new era in how insurance companies and healthcare providers collaborate to manage the care of high-cost, complex patients. The long-term impact on the financial health of nursing homes and the broader insurance industry will be closely watched as the plan rolls out.