Anthem to buy Medicare Advantage insurer HealthSun

Insurance giant Anthem has announced it will acquire Florida Medicare Advantage plan HealthSun, which could add 40,000 members from the Miami metropolitan area to Anthem’s affiliated Medicare and Medicaid plans in the state.

If the deal, expected to close by the end of the year, receives regulatory approval, Anthem would boost its total plan membership in Florida to 650,000.

“The acquisition of HealthSun, which offers a unique integrated care delivery model serving mainly dual-eligible (Medicare and Medicaid) members, fits well with our plans for continued growth in the Medicare Advantage and dual-eligible populations,” Anthem President and CEO Joseph Swedish said in a statement. “In addition, the HealthSun acquisition will further the industry leading commitment of Anthem’s affiliated health plans in offering a wide variety of value based care models that benefit our members through high quality care and improved outcomes.”

HealthSun’s care delivery model involves serving members at 19 “wholly owned primary care and specialty centers,” as well as a network of unaffiliated clinics. The plan has been given a 4.5 star rating by CMS for the 2017 and 2018 reimbursement years.

Anthem’s mergers and acquisition activity has been tripped up in the regulatory approval stage before, most notably in the successful antitrust lawsuit against its proposed merger with Cigna.

According to the Kaiser Family Foundation, Anthem is entering an area with some of the highest market penetration for Medicare Advantage. 65 percent of Medicare beneficiaries in Miami-Dade County are enrolled in Medicare Advantage plans for 2017. Anthem itself covers about 3 percent of the MA enrollees nationwide, below national rivals UnitedHealthcare (24 percent), Humana (17 percent) and Aetna (7 percent).