New Medicare Advantage Organizations (MAOs) in 2020

Over the weekend, I had the chance to review the CMS landscape file and discovered the new Medicare Advantage organizations, becoming effective on January 1, 2020.

Since there are no “parent organizations” in the landscape file, it’s a little tougher to weed through everything and determine which are truly new MA organizations, versus ones that are simply new organization names of existing parent organizations. It’s also difficult to determine the new organizations based on the CMS Contract ID. These can change from year to year, as plans can get cross-walked or new Contract ID’s get assigned to existing parent organizations. I only reviewed the “traditional MA” plans and did not look through the Special Needs Plans (SNP) or the Medicare-Medicaid Plans (MMPs).

I came up with 12 new organizations, but it’s possible I may have missed a few. Regardless, hopefully this will be helpful to those who are interested. Since the landscape file is public, I’m also sharing a list that explains what the CMS Landscape file shows, in terms of what counties and where each plan resides. To put the absolute number in context, in 2019 there were seven new parent organizations, and in 2018 there were four (again, not including SNP-only plans).

The following list is in alphabetical order by the organization’s name, which is not necessarily the parent name. (If I knew that, this whole process would be a lot easier!)

1. AMH Health — The plan name is Anthem MaineHealth Advantage, so I’m thinking this is a joint venture between Anthem and MaineHealth. They are in 16 counties throughout Maine and are accompanied with an HMO product.

2. ApexHealth, Inc. — This is a four-state entry, which is the most states of any plan. The states include NC (five counties), SC (eight counties), TN (four counties), and VA (six counties/cities). This company was founded by the Cotton family (Jon Cotton) who originally owned Meridian Health Plan, which was sold to WellCare and later acquired by Centene. Visit this link to learn more.

3. Ascension Complete — This is a three-state entry. The states include FL (six counties), IL (four counties), and KS (three counties). This appears to be a joint venture between Centene and Ascension. Read this article from Forbes to learn more.

4. Blue Cross Blue Shield of Kansas — BSBSKS has a PPO, so they are not a new CMS contract holder. However, since this is an MA product, I thought I’d put them on the list! They are introducing a PPO in 14 counties in Kansas.

5. Clarion Health — This is a Florida-only entry. They are offering an HMO in seven counties in Florida. (Full disclosure, Ritter is an FMO for Clarion.)

6. Mary Washington Medicare Advantage — This is a seven county and city, only launching in Virginia. Get more information regarding their launch with Lumeris.

7. MoreCare — This is a Cook County, IL-only launch. Based on some job postings I found for this company, it appears to be possibly owned by Medical Home Network, but I’m still unclear on this.

8. Oscar — This company is expanding its small group and ACA business product lines to add Medicare Advantage for 2020. They are opening up in two states including New York and Texas. Oscar will be available in four counties in New York and three counties in Texas. (Full disclosure, Ritter is an FMO for Oscar.)

9. PHP Medicare — This appears to be Physicians Health Plan out of Lansing, MI; a Michigan-only launch in 12 counties. This organization was a little tough to find. Get more info here.

10. Reliance Medicare Advantage — This is another Michigan entry in six counties. Check out their website, which is physician-based. This seems to be related to Detroit Medical Center, according to the addresses.

11. Troy Medicare — This start-up organization is more independent and pharmacy based, but it’s privately held ($5 million Class A funding). I read an article on this one a while ago, but here is a more recent one. They are starting out in four counties in North Carolina.

12. Zing Health — This is probably my favorite organization name. This is a Cook County, IL-only entry. Zing Health is backed in some way by Health 2047 and the American Medical Association (AMA). Get more info here.

It will be interesting to track how all of these new plans do! Quite a few will be covering Illinois (Chicago), Michigan, Virginia, and North Carolina. I didn’t find anything for the Western states, which was surprising (states such as CA, WA, OR, AZ, and NV) since these states are large and growing. The typical first-year enrollment is less than 1,000 members, as only about one in three new entrants get above that number (based on the 61 entries from 2013 through 2019).

In 2019, there were four out of seven new parent organizations, which exceeded 1,000. It will be interesting to see if that trend toward higher FY enrollment continues in 2020 and if these plans find early success (as many seem to have strong backing)!