Big box behemoth Walmart is getting into the U.S. market for health insurance with a pilot effort in Georgia. If successful, it could offer coverage to millions of American seniors and would represent the latest example of a chimeric healthcare offering covering payment, provision and distribution. Clarivate market access analysts Parvathy Menon and Sayantani Biswas discuss key trends.
In October 2020, Walmart announced its insurance arm, Walmart Insurance Services, will begin to sell Medicare Advantage, Medicare Supplemental and Part D plans in 2021. Walmart plans to market its Medicare health plans, called LiveHealthy, with Clover Health in eight Georgia counties initially. The two plans offered by Walmart have no copay on Part D deductibles, include $100 every quarter to spend on over-the-counter items at Walmart, and offer savings on dental benefits and hearing aids. Although the plan has broad network, members will not have to pay extra to go out-of-network.
With the youngest baby boomers turning 65 by 2030 and enrollment peaking by then, entering Medicare seems like a safe bet for Walmart. As most established insurers gear up for the enrollment peak, Walmart is stepping into a potentially lucrative segment. Medicare also remains the rare sector which has seen few enrollment shifts during the COVID-19 pandemic. Walmart has chosen Georgia to pilot its Medicare plans because it has six Walmart Health centers and plans to expand retail care. In addition, Walmart has partnered with a long list of providers to create a broad network for its PPO plan.
Walmart’s partnerships give them a substantial footprint
Walmart’s association with Clover Health, a startup that showed a substantial enrollment increase, matches the retailer’s vision of expanding its footprint. Clover Health’s successful presence in eight states should offer Walmart a foothold. The partnership will utilize Clover Health’s technology to monitor patients using Walmart’s health clinics. Clover Health’s PPO provider networks are broad, with low out-of-pocket cost.
Together with Walmart’s partnership with Oak Street Health, a network of 60 value-based primary care centers, its expansion of Walmart Health centers in 2021 and its establishment of primary care clinics point to big expansion plans.
When Walmart starts to market its Medicare plans in 2021, Georgia seniors will have access to Walmart’s Health centers much like Aetna’s Connected plan in Kansas City, which allows free access to CVS MinuteClinics and HealthHUBs. Also, Walmart has worked with Anthem’s Medicare plan in the past and the retailer has decided to use similar benefits for its LiveHealthy plan.
- A new model of vertically-integrated healthcare provision and payment
While healthcare stakeholders like payers and PBMs are pushing boundaries through consolidation and integration, Walmart seems to be paving its own path through diversification. CVS is a retail pharmacy giant that now owns a large health insurer. Walmart is building on its retail pharmacy foundation to grow retail care services and venture into private health insurance.
- Walmart is entering a crowded market and will need to differentiate
Clover Health and Walmart are moving into a space dominated by well-established payers. As such, they will need to differentiate their offerings in order to persuade seniors to change plans. As Walmart pilots its Medicare plan in Georgia, the future and scale of success will depend on how Walmart derives benefit from its retail pharmacy and care service web to guide its growth. Dallas, Jacksonville and Chicago could develop as fertile markets that help the retailer gain further traction in the business.
Insights provided in this article were developed by Clarivate analysts, using data and analysis of the managed care landscape in the United States. Clarivate explores health insurer dynamics as part of its profiles of national and regional health plans. Clarivate analysts will continue to keep a close eye on the evolving U.S. market access environment.
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