Centene Medicare Advantage Plans 2025

Are Centene Medicare Advantage plans the right fit for you? Get a clear view of how Centene’s options enhance traditional Medicare. With plans designed to meet a range of health preferences, these offerings include not just comprehensive medical coverage but also benefits like prescription drug coverage, vision, and dental care.

Discover Centene’s place in the Medicare landscape, including quality ratings and enrollment growth.

 

Key Takeaways

  • Centene’s Medicare Advantage plans offer a diverse portfolio, including HMO, PPO, SNPs, and PFFS options, focusing on supplemental benefits such as prescription drug coverage, vision, dental, and wellness programs.

 

  • Centene has achieved significant enrollment growth in Medicare Advantage beneficiaries, with an 8% increase from 2023 to 2024, and has actively integrated telehealth services for improved access to healthcare.

 

  • While Centene is investing efforts to enhance the quality and star ratings of its Medicare Advantage plans, it faces challenges in compliance and competitive pressures from companies like Humana with high customer satisfaction and UnitedHealthcare with significant market share.

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Centene’s Medicare Advantage Offerings

 

Centene Medicare Advantage Plans 2025, Centene's Medicare Advantage Offerings

 

Medicare Advantage plans, Centene has established a strong foothold in the industry through its subsidiaries, including:

  • WellCare

 

  • Allwell

 

  • Fidelis Care

 

  • Health Net

 

  • Ascension Complete

 

Each of these subsidiaries is designed to encapsulate the benefits of Original Medicare (Part A and Part B), while also extending additional benefits to subscribers.

This integration of services not only covers the fundamental health needs of beneficiaries but also supplements their healthcare journey with added advantages.

 

Plan Variety

Centene’s Medicare Advantage plan portfolio includes:

  • Health Maintenance Organization (HMO)

 

  • Preferred Provider Organization (PPO)

 

  • Special Needs Plans (SNPs)

 

  • Private Fee-for-Service (PFFS) plans

 

These plans cater to a wide array of healthcare needs and extend beyond the traditional scope of Medicare, covering essential services such as vision, hearing, fitness, and dental care.

Furthermore, Centene’s Wellcare brand extends its reach to enrollees in 37 states, offering standalone Medicare Prescription Drug Plans nationwide, a testament to its expansive coverage.

 

Extra Benefits

One of the key differentiators of Centene’s Medicare Advantage plans lies in the provision of extra benefits not covered by Original Medicare. By expanding the scope of services available to beneficiaries, Centene ensures an enhanced healthcare experience.

The additional benefits provided by Centene’s plans include:

  • Prescription drug coverage

 

  • Routine vision and dental care

 

  • Hearing aids

 

  • Access to wellness programs

 

These benefits are designed to ensure comprehensive health insurance coverage.

Centene’s D-SNPs even go a step further, offering extras like:

  • Over-the-counter benefits

 

  • Meal benefits

 

  • In-home support services

 

  • Bathroom safety devices

 

These benefits enhance support for those with dual eligibility and target the unique needs of seniors to ensure their safety and well-being.

Enrollment and Access

 

Centene Medicare Advantage Plans 2025, Enrollment and Access

 

Centene’s steady ascent in the Medicare Advantage landscape is reflected in its remarkable growth in enrollment. From representing just 3% of total Medicare beneficiaries in 2010, Centene’s Medicare Advantage enrollment rose to a staggering 31% in 2024.

This growth of 2.3 million beneficiaries between 2023 and 2024, a rise of 8%, underscores Centene’s expanding influence in the Medicare Advantage market.

Moreover, Centene’s implementation of telehealth services has further enhanced access to healthcare for its Medicare Advantage and Medicaid members, underscoring its commitment to improved healthcare outcomes.

 

Five States with Highest Enrollment

Centene’s Medicare Advantage growth story is particularly impressive in certain states. Here are some key statistics:

  • Florida has the highest average Medicare Advantage enrollment at 58%

 

  • Ohio follows closely behind with an average enrollment of 54%

 

  • Puerto Rico has an exceptionally high Medicare Advantage penetration rate, surpassing all other states

 

Other states that have shown significant growth in enrollment include:

 

  • Michigan

 

  • New Jersey

 

  • Maryland

 

  • West Virginia

 

This highlights the widespread appeal of Centene’s Medicare Advantage plans.

 

Three Consecutive Years of Growth

Centene’s Medicare Advantage enrollment growth trajectory showcases a sustained upward trend. Total Medicare Advantage enrollment experienced significant growth between 2023 and 2024, with an increase of approximately 2.3 million beneficiaries.

This reflects an 8% rise from the previous year. This growth is largely attributed to the increasing number of enrollees in individual plans, which saw a rise of 0.9 million enrollees since 2023.

Despite a reported decrease in Medicare Advantage membership from 1,511,100 in 2023 to 1,284,200 in 2024.

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Quality and Star Ratings

 

Centene Medicare Advantage Plans 2025, Quality and Star Ratings

 

While growth and expansion are pivotal, Centene places an equal emphasis on quality, as indicated by its active efforts to improve its Medicare Advantage star ratings. However, questions have been raised about the quality measurements for D-SNPs coordinated with Medicaid, indicating a need for improved evaluation systems.

In 2023, only 3 percent of Centene members were in four-star or higher plans, signifying an area for potential improvement.

 

Part D Contract Performance

Centene’s approach to improving plan quality is multi-faceted. The company is focused on enhancing its provider network, transitioning more lives into higher-risk arrangements, and improving customer service.

This effort is reflected in the fact that a significant 26 percent of Centene Medicare Advantage enrollees benefit from a rebate towards their Part B premium, an extra feature that can influence the perceived value and choice of plan.

Despite these concerted efforts, specific information regarding the performance of Centene’s Medicare Part D contracts remains elusive, and determination is needed to uncover the details.

 

Addressing Deficiencies

In the realm of quality ratings, Centene has experienced setbacks. The company saw a decrease in its Medicare Advantage federal quality ratings in the previous year. However, Centene remains undeterred and is actively working to elevate their Medicare Advantage plan quality ratings.

Despite the decline, only one of Centene’s Medicare Advantage plans achieved a four-star rating in the recent CMS evaluations for 2025, pointing to a clear opportunity for improvement.


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Medicaid Services Integration

 

Centene Medicare Advantage Plans 2025, Medicaid Services Integration

 

Centene’s commitment to providing comprehensive healthcare solutions extends beyond Medicare Advantage offerings to include Medicaid services integration. In 2023, Dual-Eligible Special Needs Plans (D-SNPs) played a pivotal role in providing specialized care for the 5.2 million dual-eligible individuals enrolled in these Medicare Advantage plans.

Despite most D-SNP enrollees (57%) being in coordination-only plans, the need for improved integration between Medicare and Medicaid services is apparent.

Centene’s subsidiary, Absolute Total Care, exemplifies this integrated care ethos by participating in South Carolina’s Healthy Connections Prime pilot program aimed at dual-eligible individuals.

Through clinical data exchanges, Centene enhances health outcomes by facilitating critical information sharing among providers, crucial for the care coordination of dual-eligible members.

 

Dual Eligible Special Needs Plans (D-SNPs)

Special needs plans, including D-SNPs, have significantly impacted the Medicare Advantage landscape. In 2023, these plans covered more than 5.7 million beneficiaries, making up 19% of total Medicare Advantage enrollment. D-SNPs cater to individual needs by providing benefits not available in traditional Medicare, often without charging a premium.

As of 2023, an average of 10 plans were available for dual-eligible individuals to choose from. The growth of D-SNPs has been significant, with 29% of dual-eligible individuals enrolled in 2021 compared to 11% in 2010, and the number of D-SNPs has more than doubled since 2011.

Centene’s commitment to integrated care for dual-eligible beneficiaries is evident through programs like Healthy Connections Prime and the use of technology to ensure high-quality, locally based healthcare.

However, despite their growth, Centene’s Medicare business, including D-SNPs, reported a financial challenge with a premium deficiency reserve of $250 million for the 2024 Medicare Advantage business.

 

Coordination of Care

Centene’s subsidiary Absolute Total Care stands as a beacon of integrated care. It received a Commendable rating from the National Committee for Quality Assurance (NCQA) for its integrated care model tailored to dual-eligible individuals in South Carolina. This model aims to improve outcomes for dual-eligible individuals by leveraging expertise in coordinating care for Medicaid members with complex conditions.

Through strategic partnerships, Centene addresses both the health and social needs of dual-eligible members, highlighting the company’s commitment to providing comprehensive, coordinated care.

Marketing Activities and Intermediate Sanctions

Centene Medicare Advantage Plans 2025, Marketing Activities and Intermediate Sanctions

Marketing activities are a crucial facet of Centene’s strategy to promote its Medicare Advantage plans to eligible beneficiaries. Centene has experienced compliance issues with CMS regulations regarding its Medicare Advantage plans, leading to sanctions.

 

Marketing Strategies

Centene’s marketing strategy is multi-channel in nature, leveraging the following channels to reach a broad audience:

  • Television

 

  • Radio

 

  • Print media

 

  • Online advertising

 

Specifically targeting eligible seniors, Centene’s marketing efforts emphasize the benefits and services of their Medicare Advantage plans, highlighting specific plan features that appeal to this demographic.

 

Compliance with Regulations

Compliance with CMS regulations is a critical aspect of Centene’s operations. The company actively works to maintain compliance with CMS regulations governing Medicare Advantage plans. However, non-compliance has led to sanctions, underscoring the importance of strict adherence to these regulations.

Centene’s WellCare Medicare Advantage prescription drug plans in Arizona and North Carolina were terminated due to star ratings falling below three stars for three consecutive years, which led to non-compliance issues.

Comparison with Competitors

 

Centene Medicare Advantage Plans 2025

 

In the competitive landscape of Medicare Advantage, Centene holds its own against industry giants like UnitedHealthcare and Humana, which accounted for 47% of the total Medicare Advantage enrollment in 2023

. However, Humana’s Medicare Advantage plans were recognized as the best overall for 2024, thanks to:

  • High-quality ratings

 

  • Strong customer satisfaction

 

  • Wide availability

 

  • Plethora of $0 monthly premium plan options.

 

Humana provides a range of Medicare Advantage plan types, including HMOs and PPOs, offering more flexibility at a higher cost. Additionally, approximately 58% of Humana’s Medicare Advantage plans offer drug coverage without a deductible, and the company’s mail-order pharmacy, CenterWell, is highly rated for customer satisfaction.

 

Benefit Offerings

While competitors like Humana offer similar benefits such as prescription drug coverage, telehealth services, and wellness programs, Centene differentiates itself with its specialized plans for those with chronic illnesses and its focus on integrating services for dual-eligibles through their D-SNPs.

 

Market Share and Growth

When it comes to market share and growth, Centene finds itself in a challenging landscape, having experienced a decline in Medicare Advantage enrollees by about 91,000 between March 2022 and March 2023. In comparison, the market share of other competitors is as follows:

  • UnitedHealthcare: 29% of all active plans

 

  • Humana: offers broad availability and extensive provider networks

 

  • Blue Cross Blue Shield: known for high customer satisfaction

 

  • Kaiser Permanente: offers extensive provider networks and affordability

 

  • Cigna: provides stiff competition for Centene

 

These competitors each offer unique advantages, making the market highly competitive for Centene.

Summary

In conclusion, Centene Corporation’s Medicare Advantage offerings stand out with their variety, extra benefits, impressive enrollment growth, focus on quality improvement, and integration of Medicaid services. Despite facing challenges in compliance and competition, Centene’s commitment to enhancing healthcare access and quality for its beneficiaries remains unwavering.

As the company continues to innovate and adapt, the future holds promising possibilities for further growth and success in the Medicare Advantage landscape.

 

Frequently Asked Questions

 

What is the most highly rated Medicare Advantage plan?

The most highly rated Medicare Advantage plan is offered by Humana, known for its good coverage, affordable costs, and plans with no monthly cost. Dec 5, 2023.

 

Who is the largest provider of Medicare Advantage plans?

The largest provider of Medicare Advantage plans is UnitedHealth Group, with 7.6 million people in its plans and $257 billion in premium revenues.

 

Is Centene part of Unitedhealthcare?

No, Centene is not part of UnitedHealthcare. They are two separate and different companies with distinct virtues and characteristics.

 

What are the 4 types of Medicare Advantage plans?

There are 4 types of Medicare Advantage plans: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans (PFFS), and Special Needs Plans (SNPs). Each type operates differently.

 

What are the extra benefits offered by Centene’s Medicare Advantage plans?

Centene’s Medicare Advantage plans offer extra benefits like prescription drug coverage, vision and dental care, hearing aids, and wellness programs to its members.

These additional benefits can help you save on out-of-pocket expenses and improve your overall well-being.

Centene Medicare Advantage Plans by State

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Mon-Fri : 8am-9pm ET