How a 26-year-old wants to transform Medicare Advantage plans

Few young adults spend significant time thinking about health insurance—especially as the Affordable Care Act allows them to remain on a parent or guardian’s coverage through age 26.

But at just 24, health insurance was at the top of Pooja Ika’s mind. Shortly after graduating from Babson College, Ika founded eternalHealth, a Boston-based Medicare Advantage (MA) health plan, in late 2020.

EternalHealth now works with 20,000 providers to serve almost 200 members in Massachusetts and Arizona—a number that’s expected to rise to 3,000 individuals come January. And Ika, now 26, has no plans to slow down.

Ika spoke with Healthcare Brew about why she founded eternalHealth and her hopes for the health plan’s future.

This interview has been lightly edited for length and clarity.

Why did you decide to enter the insurance market and focus on MA plans?

I grew up in Massachusetts with two parents who are in the healthcare industry, but on very different sides: My mother is a primary care physician at the University of Massachusetts and my father is a healthcare technology entrepreneur.

With starting eternalHealth, I had this unique ability to touch a lot more lives than I would have been able to if I was just a primary care physician. In addition to that, I would actually be able to make a lasting impact in a space that, I think, often sees people as just another number instead of a unique individual.

Medicare Advantage is a super interesting landscape just because of the aging population right now—all the baby boomers aging into Medicare. There’s about 10,000 people that age into Medicare daily. That population is looking to grow from a little over 60–80 million by 2030.

How did you navigate starting a MA plan?

The first step was onboarding our consulting company. We submitted our application in December 2020 to the state Division of Insurance, and part of that application process was also getting healthcare providers—your primary care physicians, hospitals, specialists—to buy in.

The next step was to build trust in the Division of Insurance. They had a lot of doubt in my intent, whether I was going to stay in the space, and my lack of experience. I promised them I would spend every single day doing my very best to learn about the space so that when they talk to me—in a year, two years, three years—they would talk to someone who knows just as much about the MA space as a seasoned, 50-year executive.

After we got some of our approvals, we started to grow our team and bring on experienced executives. We have a team of about 35 people, and collectively, the C-suite directors and director-level and up all have easily over 100 years of healthcare experience.

How is eternalHealth innovating in the MA plan space?

When you think about a health plan, you think about 15–20 really siloed departments—and each department embraces about five to 10 different technology vendors to be able to do their day-to-day operations. There’s obviously huge costs associated with all those vendors. But in addition to that, there’s also a huge cost associated with all the integrations that need to happen and the resources that are needed to maintain and manage those integrations.

We embrace one platform across all 15–20 of those departments. We are also able to bring more efficiency to the system to then create a much better experience for the providers, the brokers, and the members while taking those cost savings received from the platform and actually pushing them down to then create an even better experience by enriching our product design.

We are currently rolling out a flex card that is a dental benefit on a prepaid Mastercard, which will allow members to have access to up to $4,500 to use at any dentist of their choice. That card also is populated with over-the-counter dollars and grocery dollars. Ultimately my goal is to be able to move as much onto this one card as possible so members have ultimate flexibility. Oftentimes, networks end up being a barrier—there are so many hurdles as to why someone can’t access the care they need.

What’s next for eternalHealth?

The idea is to continue to grow organically and through acquisitions. Ultimately to create a showcase of how to run a really profitable organization, but also to run an organization that’s very focused on delivering value to its stakeholders.

There are lots of opportunities and potential acquisition strategies. But for me, I want to be in a lot of markets serving over 100,000 lives and be able to continue to take this model that drives value to the people that need it most.