🧐 ProPicks AI October update is out now! See which stocks made the listPick Stocks with AI

Humana slumps as data shows membership in high-rating Medicare plans declined

Published 10/02/2024, 07:32 AM
Updated 10/02/2024, 11:13 AM
HUM
-

Investing.com -- Shares in insurer Humana (NYSE:HUM) slipped in early US trading on Wednesday after data showed that the proportion of its membership enrolled in four-star Medicare plans and above for next year fell sharply.

Humana is a major seller of government-backed Medicare Advantage plans, which are designed for adults aged 65 and older.

Preliminary figures from the Medicare Advantage Star Ratings, a measure of the performance of health and prescription drug plans carried out by the Centers for Medicare and Medicaid Services, found that 25% of Humana's members had signed up for plans that had ratings of 4 stars or above in 2025 -- down from 94% in the prior year.

Much of this decrease was due to the rating of Humana's H5216 contract being lowered to 3.5 stars from 4.5 stars, the company said in a regulatory filing on Wednesday. The plan contains roughly 45% of Humana's Medicare Advantage customers, including more than 90% of its employer group waiver plan members, it added.

"The decline in Stars performance for 2025 will impact Humana’s quality bonus payments in 2026," the firm flagged. The Centers for Medicare and Medicaid typically awards a quality bonus to health plans that achieve 4 stars or higher.

Humana noted that details on the 2025 star ratings are expected to be formally released by the Centers for Medicare and Medicaid Services, or CMS, "on or around" Oct. 10. It said the downgrade stemmed from its plans "narrowly missing higher industry cut points on a small number of measures," adding that it believes the CMS committed possible calculation errors.

The group has outstanding appeals related to some of the results and has requested additional information to ensure the accuracy of the threshold calculations, it said.

However, Humana said it was "disappointed with its performance and has initiatives underway focused on improving its operating discipline and returning to an industry leading Stars position as quickly as possible." The drive is projected by Humana to improve bonus payments "in 2027 and beyond."

The ratings decline are not expected to impact Humana's financial resutls or outlook for this year or 2025, but the company said it is taking steps to "mitigate" an anticipated headwind to its 2026 revenue should its appeals prove unsuccessful.

In July, Humana said demand for medical care was higher than projected in the second quarter, stoking investors' fears that a recent spike in medical costs for health insurers may not soon abate.

Medical costs have been jumping industry-wide since late 2023, when older adults began to catch up on health procedures delayed by the COVID-19 pandemic. Payments from the government for managing healthcare for Medicare members have been sluggish as well.

In a note to clients, analysts at Stephens downgraded their outlook for Humana to "Equal-Weight" from "Overweight", saying the results represent "a worst-case scenario" for the stock.

Latest comments

Risk Disclosure: Trading in financial instruments and/or cryptocurrencies involves high risks including the risk of losing some, or all, of your investment amount, and may not be suitable for all investors. Prices of cryptocurrencies are extremely volatile and may be affected by external factors such as financial, regulatory or political events. Trading on margin increases the financial risks.
Before deciding to trade in financial instrument or cryptocurrencies you should be fully informed of the risks and costs associated with trading the financial markets, carefully consider your investment objectives, level of experience, and risk appetite, and seek professional advice where needed.
Fusion Media would like to remind you that the data contained in this website is not necessarily real-time nor accurate. The data and prices on the website are not necessarily provided by any market or exchange, but may be provided by market makers, and so prices may not be accurate and may differ from the actual price at any given market, meaning prices are indicative and not appropriate for trading purposes. Fusion Media and any provider of the data contained in this website will not accept liability for any loss or damage as a result of your trading, or your reliance on the information contained within this website.
It is prohibited to use, store, reproduce, display, modify, transmit or distribute the data contained in this website without the explicit prior written permission of Fusion Media and/or the data provider. All intellectual property rights are reserved by the providers and/or the exchange providing the data contained in this website.
Fusion Media may be compensated by the advertisers that appear on the website, based on your interaction with the advertisements or advertisers.
© 2007-2024 - Fusion Media Limited. All Rights Reserved.