CVS Struggling with costs of Medicare Advantage plans

[Yipper]

After a big push into the Medicare Advantage business, CVS is apparently struggling wtih making it profitable. Gee, I wonder if this will drive up premiums and cause additional hurdles for getting access to specialists, advanced procedures, etc.?

Anyone on the CVS MA plans care to comment on your experience? To be clear, these are Aetna branded plans.

CVS Health chops 2024 forecast as cost struggles with Medicare Advantage persist | AP News

 

[Gotadimple]

This is to be expected. I can only speak for MA in Washington state. Aetna has been in the business of MA for a very long time. But what the article doesn't say is that CVS took a strategy to go directly after United Health Care for market share. They offer a $0 premium point of sale product. That means it is not an HMO and their list of providers is broad. They also offer HMO products. But the one thing all their products have is $0 premium, $0 deductible, drugs in tier 1 with $0 copay.

Like many other carriers there are two debit cards associated with the account: A flex card to pay for copays - funded quarterly. And a card to buy over the counter items. The catch is that you can only buy OTC items through CVS. Also funded quarterly. If you are healthy you won't be seeing the doctor so there are few co-pays, and you won't need a lot of OTC health items.

What does that mean? It means they are giving the coverage away. What does that mean for 2025? Premiums next year, for sure.

But the other issue is that CVS is having problems making a profit in its drug store business and has announced it will be closing stores, or stores in Target locations later in the year.

So overall, CVS just hasn't managed itself well.

 

[Retired Expat]

CVS is trying to be all things to all people. A pharmacy. A walk in medical clinic Doc in a Box, beauty supply store, a grocery store and deli. And doing most of those things poorly

 

[jazz4cash]

I noticed CVS decided the optical services cubby at the back of the store wasn’t such a great idea after all. They apparently closed on short notice with no plans for what to do with that space. The ones around here look like half empty storage area.

 

[Koolau]

I noticed CVS decided the optical services cubby at the back of the store wasn’t such a great idea after all. They apparently closed on short notice with no plans for what to do with that space. The ones around here look like half empty storage area.

Our CVS's are doing all kinds of shots as well as a minute clinic. Kind of handy as our PCPs never have the time for routine shots and they may not have the vaccine on site. SO, off to CVS every time we need to get vaxed for something (most recently RSV, Flu and Covid booster.) I like it.

While CVS may have MA set up, I've never seen anything about it at their local stores but YMMV.

 

[jazz4cash]

They have too many locations near me. The location I was using kept entering scripts with 0 refills so I don’t trust them. I woudn’t dream of getting a jab there. I get jabs at Walgreen’s but they are shaky too.

 

[audreyh1]

I was very underwhelmed with my experience in a Target CVS for a vaccine - my only choice at the time. It was bad compared to a regular CVS. I guess they are going to close a bunch of them?

They had planned to close “dozens” of Target CVS pharmacies this spring already. That’s out of 1800 so not a large chunk.

 

[FIREd_2015]

Article in WSJ - The Medicare Bubble Has Burst

"..For years, the privately run Medicare Advantage business generated outsize profit growth for health-insurance giants...But the gold rush is over...To gain market share, CVS-Aetna offered generous plans this year...CVS added more than 700,000 Medicare Advantage members...the company underestimated what it would cost to insure them...helped drive medical costs $900 million higher than the company had expected...CVS isn’t the only one in trouble...“The goal for next year is margin over membership,” CVS Chief Financial Officer Thomas Cowhey said at a recent conference...For well over a decade, Medicare Advantage plans have been making extremely high profits. What’s going on now are long overdue policy changes to bring their pricing and coding practices back into line...

https://www.wsj.com/health/healthcare/the-medicare-bubble-has-burst-141ae3bf?st=9ab0yoazxd7rhng&reflink=desktopwebshare_permalink

 

[Koolau]

They have too many locations near me. The location I was using kept entering scripts with 0 refills so I don’t trust them. I woudn’t dream of getting a jab there. I get jabs at Walgreen’s but they are shaky too.

Interesting. Just never had such an issue with CVS. I've had to tell them how much eye drop I need for a refill. They always have fixed it when they calculated wrong.

 

[Out of Steam]

CVS is trying to be all things to all people. A pharmacy. A walk in medical clinic Doc in a Box, beauty supply store, a grocery store and deli. And doing most of those things poorly

I'm in the process of leaving my local CVS Pharmacy for Wegman's (supermarket) right now. Got tired of searching elsewhere for a drug that was out-of-stock at CVS long term.

Ironically, a CVS location near me (not my regular one) with a dedicated vaccination room has worked well for that and I can see myself continuing to get them there.

 

[Koolau]

I'm in the process of leaving my local CVS Pharmacy for Wegman's (supermarket) right now. Got tired of searching elsewhere for a drug that was out-of-stock at CVS long term.

Ironically, a CVS location near me (not my regular one) with a dedicated vaccination room has worked well for that and I can see myself continuing to get them there.

Yeah, our CVS has the dedicated injection room AND a minute clinic. Longest we've had to wait for a vax was about 15 minutes. Fill out the paper work, wait for someone to come give the shot. Out the door in 15 minutes or less. MUCH quicker than going to PCP. Friendly, efficient cheap (covered by MC in most cases.) YMMV