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Aetna Continues to Shun Traditional Major Medical

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Aetna Inc. is turning away from the upheaval in the U.S. major medical insurance market and focusing on other product lines.

Mark Bertolini, Aetna’s chairman, and other executives talked often about Medicare plans, care coordination efforts for Medicare plan members, and efforts to help small employers self-insure today during a conference call with securities analysts.

They showed little interest in trying to return to major medical under today’s tumultuous conditions.

(Related: Aetna to Stay Out of Individual Health Market in 2018)

“Our whole view is that the best thing to do when you’re going through hell is to just keep going,” Bertolini said, in response to an analyst’s question about uncertainty about federal policy. “We just keep plowing through it.”

For now, Bertolini said, Aetna is mostly out of the commercial insurance markets affected by the Affordable Care Act. “When that rights right and stable, we’ll look at considering how to get back in,” Bertolini said.


Aetna held the conference to go over its earnings release for the third quarter.

The company is reporting $848 million in net income for the third quarter on $15 billion in revenue, compared with $597 million in net income on $16 billion in revenue for the third quarter of 2016.

The company ended the quarter providing or administering major medical coverage for 22 million people, down from 23 million people a year earlier.

Medicare Advantage plan enrollment increased to 1.5 million, from 1.4 million, and the number of Medicare supplement insureds increased to 733,000, from 667,000.

But the company’s Medicaid plan enrollment fell to 1.3 million, from 2.4 million.

The number of people the company covered through ordinary insured individual or group health plans fell to 4.6 million, from 5.6 million.


The Wall Street Journal has been reporting on rumors of CVS offering to acquire Aetna for $66 billion.

CVS (Photo: M. Spencer Green/AP)

(Photo: M. Spencer Green/AP)

Bertolini headed off questions about that topic by repeating the generic statement a company representative makes before Aetna starts any earnings call: “It is our policy not to comment on rumors or speculation.”

The Future

Under current U.S. rules, Medicaid pays for nursing home care for the poor.

Medicare pays for medical care, and home health care, for disabled people and older people at all income levels, but it is not supposed to pay for long-term care.

Medicare plan issuers have been looking for ways to fill the long-term care void.

Bertolini appeared to imply that a new alliance Aetna has formed with Meals on Wheels could help the company get closer to providing light supportive care for people who are still in the community. Working with the meal delivery service will be a way for Aetna to check in on enrollees, give the enrollees social support, and help the enrollees get medical care when that appears to be necessary, Bertolini said.

Bertolini also talked about Aetna’s hopes of expanding its Medicare Advantage enrollment by expanding its geographic reach in that market.

The company can now reach about 62% of Medicare Advantage users, up from 56% a year ago, Bertolini said.

Eventually, he said, Aetna would like to have the ability to serve 80% of Medicare Advantage users.

“We have really good same-store growth,’ Bertolini said. “Now we need more stores.”

Bertolini also talked, in passing, about the possibility that Aetna could bring back some kind of “skinny plan,” or limited-benefit medical plan offering, if the Trump administration makes that possible.

Aetna is already considering the possibility of offering a skinny plan that would stay in effect for one year and serve as a transition to getting a consumer fully insured, Bertolini said.

Aetna needs more information about the future rules will be before it can flesh out that idea, Bertolini said.

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