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Aetna reports rising utilization, high-cost claimants in Medicare Advantage block
Summary
Aetna told the Commission there are 9,132 Medicare Advantage members (avg. age 75.5) and reported increases in inpatient and non-acute admissions, growth in medical paid amounts, and 234 high-cost claimants in the review period; staff will research apparent skilled-nursing trends further.
Aetna presented utilization and cost data for the State of Maine Medicare Advantage book (9,132 members, average age 75.5), reporting a 25.3% increase in inpatient admissions per 1,000 and an 83.7% increase in non-acute admissions per 1,000 for the rolling 12 months ending June 30, 2024. Total pharmacy paid amount was $63K (up 9.7%) and total medical paid was $96M (up 14%). Aetna also reported 234 high-cost claimants (>$75K) and that catastrophic claims totaled $31.6M in the period.
Labor Member Jonathan French asked whether higher utilization trends in skilled nursing care appear to be continuing; Aetna said additional research is required because of a two-month data lag and offered to return with updated trend analysis. Aetna outlined near-term member outreach and education plans including a gout education launch (Oct. 29, 2025) and colorectal at-home screening kit campaigns starting Oct. 22, 2025.
