Fifteen years ago, aggressive federal government efforts to cut Medicare Advantage plan reimbursement rates were chasing carriers out of the market.
Issuer after issuer announced moves to leave the market or reduce participation.
Insurers were still recovering from the effects of major 1990s-era changes on the Medicare supplement insurance market.
Today, thanks in part to policymakers' awareness of Medicare enrollees' political clout, the climate has changed. Issuers are usually happy to talk about their Medicare Advantage, Medicare supplement insurance and Medicare Part D prescription drug plan programs, and Wall Street securities analysts are usually happy to hear about the results.
Analysts ask insurers tough questions about the effects of low interest rates and the regulatory rate review process on long-term care insurance operations, and about the effects of problems with big Affordable Care Act risk-management programs on individual major medical operations.
They ask insurers softer questions about whether mild flu seasons or patient decisions to avoid the emergency room could help the issuers' report pleasant earnings surprises.
Here's a look at what four insurers and one Web broker have been saying about Medicare plan operations in the past few weeks.
CNO and Anthem
Executives from Carmel, Indiana-based CNO Financial and Indianapolis-based Anthem had the luxury of not having to say much about their Medicare plan operations during their companies' third-quarter earnings calls.
CNO executives had to spend much of their call reassuring analysts about the company's open and closed blocks of LTCI business.
Anthem executives spent much of their call talking about the future of the ACA public exchange system.
At Anthem, Medicare major medical plan enrollment fell 0.3 percent from the total for the third quarter of 2015, to 1.4 million, and stand-alone Medicare drug plan enrollment fell 5.1 percent, to 353,000.
But Anthem said the benefits expense ratio improved for the Medicare business that stayed on the books.
At CNO, which sells only Medicare supplement insurance, both sales and premiums fell.
The company generated $16 million in new Medigap sales on $197 million in total collected Medigap premiums, down from $17 million in new sales on $210 million in Medigap premiums for the third quarter of 2015.
The ratio of benefits payments to premiums increased.
But the benefits ratio increased to 72.5 percent, from 71.5 percent at the Bankers Life unit, and to 69.5 percent, from 68.7 percent, at the Washington National unit. The higher figures were much lower than the 137.7 percent unadjusted benefit ratio at the LTCI unit.
Aetna and WellCare
Hartford-based Aetna and Tampa, Florida-based WellCare Health Plans talked more about their Medicare plan operations.
At Aetna, Medicare Advantage enrollment rose 12 percent from the figure for the third quarter of 2015, to 1.4 million.
The number of Medigap insureds increased to 667,000, from 534,000.
The number of people with Aetna stand-alone Medicare drug coverage jumped to 2 million, from 1.4 million.
Aetna says its ratio of benefits payments to revenue improved during the quarter and helped the company's overall performance.
At WellCare, enrollment in Medicare plans fell to 338,000, from 355,000,
The number of WellCare Medicare drug plan users fell 1.9 percent, to 1 million.
But WellCare changed its Medicare bidding strategy, and that helped cut the company's ratio of benefits payments to revenue to 83.6 percent, from 86.9 percent in the third quarter of 2015.
The company's Medicare drug plan benefit ratio improved to 58.8 percent, from 60 percent.
The Medicare Advantage and Medicare drug plan annual election period started Oct. 15 and is set to run until Dec. 7. Executives from Aetna and WellCare did not give early election period sales figures.
Shawn Guertin, Aetna's chief financial officer, said Aetna "continued above-industry growth" in individual Medicare Advantage plan sales, partly because the company's plans have high quality ratings.
WellCare executives said their company still needs to work on improving quality ratings.
A web broker
One company that sounded less happy about its Medicare business is eHealth, the Mountain View, California-based company that helped create the modern web-based health insurance sales industry.
The company has been looking to Medicare plan sales to help it compensate for the turmoil in the individual major medical market.
The total number of Medicare applications submitted increased 26 percent, to 24,100, and the total number of Medicare product holders the company serves increased 33 percent, to 242,500.
But commission revenue held steady at about $6.6 million.
One challenge is that, rather than paying a full year of sales commissions for policies sold outside the annual election period, some carriers prorated commission payments, according to Dave Francis, eHealth's chief financial officer.
Another challenge is that Medicare program marketing guideline changes hurt sales, Francis said.
"There is always a constant flow of new tweaking and rules around how one is able to market in that business," Francis said.
Francis said the third-quarter guideline change was more of a speed bump than a major problem. But the talk about the change was a reminder that policymakers in Washington have changed Medicare market rules in the past and could change them again.
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