MEDIGAP: Spotlight on Enrollment, Premiums, and Recent Trends. Jennifer Huang Policy Analyst, Program on Medicare Policy Kaiser Family Foundation

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1 MEDIGAP: Spotlight on Enrollment, Premiums, and Recent Trends Jennifer Huang Policy Analyst, Program on Medicare Policy Kaiser Family Foundation AcademyHealth 2013 Annual Research Meeting Tuesday, June 25, 2013

2 EXHIBIT 1 Co authors for this study Kaiser Family Foundation Gretchen Jacobson Tricia Neuman University of California, Los Angeles Katherine Desmond Thomas Rice

3 EXHIBIT 2 Research Objectives and Data Sources Objectives: describe trends in Medigap enrollment and premiums, and analyze variations across plan type, states, and across years assess how premiums vary by beneficiary characteristics examine whether policyholders enroll in lowest cost plans Data sources: National Association of Insurance Commissioners (NAIC), State Medigap premium comparison guides Medicare Current Beneficiary Survey (MCBS) 2009 Cost and Use file

4 EXHIBIT 3 An Overview of Medigap Research objectives and data sources used for this analysis What is Medigap? What does Medigap cover? How does Medigap enrollment vary by state, plan type, and over time? How do Medigap premiums vary by plan type, state, over time? How do Medigap premiums vary by beneficiary characteristics? Are beneficiaries choosing the lowest premium policies? Conclusion

5 EXHIBIT 4 Sources of Supplemental Coverage Among Medicare Beneficiaries, 2009 Other Public/Private Coverage only 1% Multiple Sources of Coverage (without Medigap) 10% Multiple No Supplemental Coverage 12% Employer Sponsored only 25% Supplemental Coverage 88% Medicaid only 14% Medicare Advantage only 14% Medigap 24% 15% Medigap only 5% Medigap + Employer 2% Medigap + Medicare Advantage 2% Other coverage combinations (including Medigap) Total Medicare Beneficiaries, 2009 = 47.2 Million NOTES: Numbers do not sum due to rounding. SOURCE: Kaiser Family Foundation analysis of the CMS Medicare Current Beneficiary Survey Cost and Use File, 2009.

6 EXHIBIT 5 Standard Medigap Plan Benefits BENEFITS Medicare Part A Coinsurance and all costs after hospital benefits are exhausted Medicare Part B Coinsurance or Copayment for other than preventive services MEDIGAP POLICY A B C D E 1 F G 2 H 1 I 1 J 1 K 3 L 3 M 4 N 4 50% 75% * Blood (first 3 pints) 50% 75% Hospice Care Coinsurance or Copayment (added to Plans A, B, C, D, F, and G in June 2010) 50% 75% Skilled Nursing Facility Care Coinsurance 50% 75% Medicare Part A Deductible 50% 75% 50% Medicare Part B Deductible Medicare Part B Excess Charges Foreign Travel Emergency (Up to Plan Limits)* Out of Pocket Limit $4,620 $2,310 NOTES: Check marks indicate 100 percent benefit coverage. Amount in table is the plan s coinsurance amount for each covered benefit after beneficiary pays deductibles or cost sharing amounts, where applicable. The Affordable Care Act eliminated cost sharing for preventive benefits rated A or B by the U.S. Preventive Services Task Force, effective After June 1, 2010, Medigap Plans E, H, I, and J are no longer available for purchase by new policyholders; existing policyholders may remain in these plans. 2 Benefits for Plan G reflect the standard benefit after June 1, 2010 (Part B excess charges changed from 80% to 100%). 3 Medigap Plans K and L available for purchase in Medigap Plans M and N available for purchase after June 1, *Plan N pays 100% of the Part B coinsurance except up to $20 copayment for office visits and up to $50 for emergency department visits. SOURCE: Centers for Medicare & Medicaid Services, 2011 Guide to Health Insurance, March 2011.

7 EXHIBIT 6 An Overview of Medigap Research objectives and data sources used for this analysis What is Medigap? What does Medigap cover? How does Medigap enrollment vary by state, plan type, and over time? How do Medigap premiums vary by plan type, state, over time? How do Medigap premiums vary by beneficiary characteristics? Are beneficiaries choosing the lowest premium policies? Conclusion

8 EXHIBIT 7 Percent of Medicare Beneficiaries with Medigap by State, All Plans, 2010 National Average = 23% 12% 21% 35% 30% 51% 21% 16% 26% 12% 24% 50% 22% 38% 49% 27% 47% 19% 13% 33% 15% 29% 17% 17% 24% N/A 46% 27% 22% 25% 16% 19% 13% 24% 29% 22% 25% 25% 20% 17% 19% 2% 19% 28% 30% 20% 19% 27% 26% 22% 21% DC 9% 0% 15% (6 states, DC) 16% 20% (12 states) 21% 25% (13 states) 26% 30% (10 states) 31% 40% (3 states) More than 40% (5 states) NOTE: Analysis excludes California, as the majority of health insurers do not report their data to the NAIC. Analysis includes standardized plans A N, policies existing prior to federal standardization, plans in Massachusetts, Minnesota, and Wisconsin that are not part of the federal standardization program, and plans that identified as Medicare Select; excludes plans where number of covered lives was less than 20. Number of Medigap policyholders as of December 31, 2010, as reported in the NAIC data. SOURCE: K. Desmond, T. Rice, and Kaiser Family Foundation analysis of 2010 National Association of Insurance Commissioners (NAIC) Medicare Supplement data. Kaiser Family foundation and Mathematica Policy Research analysis of CMS State/County Market Penetration Files.

9 EXHIBIT 8 Share of Medigap Policyholders by All Plan Types, 2010 MA, MN, and WI 4% Plan A 2% Plan B 3% PreStandardization 8% Plans H, I, K, L, M Each 1% or less Plan N 2% Plan J 8% SELECT 9% Plan C 13% Plan C 13% Plan D 3% Plan E 1% 54% of policyholders are in plans with first dollar coverage Plan G 3% Plan F 40% Plan F 40% Total Number of Medigap Policyholders, 2010= 9.3 million NOTE: Analysis excludes California, as the majority of health insurers do not report their data to the NAIC. Analysis includes standardized plans A N, policies existing prior to federal standardization (PreStandardization), and plans in Massachusetts, Minnesota, and Wisconsin that are not part of the federal standardization program; includes plans that identified as Medicare Select; excludes plans where number of covered lives was less than 20. Number of Medigap policyholders as of December 31, 2010, as reported in the NAIC data. SOURCE: K. Desmond, T. Rice, and Kaiser Family Foundation analysis of 2010 National Association of Insurance Commissioners (NAIC) Medicare Supplement data.

10 EXHIBIT 9 Share of Medigap Policyholders with Medigap Plans C and F, % National Average = 54% 59% 38% 68% 91% 1% 75% 52% 77% 72% <1% 0% 74% 77% 75% 56% 73% 58% 64% 57% 63% 58% 59% 69% 62% N/A 85% 66% 44% 43% 61% 64% 75% 64% 22% 57% 73% 12% 67% 58% 59% 55% 39% 69% 27% 1% 90% 43% 51% 34% 64% DC 51% 0% 50% (12 states) 51% 60% (12 states, DC) 61% 70% (13 states) 71% 80% (9 states) 81% 90% (2 states) 91% 100% (1 state) NOTE: Analysis excludes California, as the majority of health insurers do not report their data to the NAIC. Analysis includes standardized plans A N, policies existing prior to federal standardization (PreStandardization), and plans in Massachusetts, Minnesota, and Wisconsin that are not part of the federal standardization program; excludes plans that identified as Medicare Select, and excludes plans where number of covered lives was less than 20. Number of Medigap policyholders as of December 31, 2010, as reported in the NAIC data. SOURCE: K. Desmond, T. Rice, and Kaiser Family Foundation analysis of 2010 National Association of Insurance Commissioners (NAIC) Medicare Supplement data.

11 EXHIBIT 10 Change in Number of Medigap Policyholders by State, All Plans, National Average = 1.8% 27% 7% 11% 4% 9.5 million 2% Medigap 19% policyholders in % 0% N/A 23% 9% 4% 12% 16% 15% 32% 2% 20% 1% 2% 3% 9% 31% 3% 9.3 6% million 9% 11% 1% 5% 11% 5% Medigap policyholders 6% in % 2% 7% 5% 11% 16% 1% 6% 5% 2% 13% 0% 2% 6% 19% 6% 19% 6% DC 16% Decrease more than 20% (2 states) Decrease 11% 20% (7 states) Decrease 0% 10% (12 states) Increase 0% 10% (19 states) Increase 11% 20% Increase more than 20% (7 states, DC) (2 states) NOTE: Analysis excludes California, as the majority of health insurers do not report their data to the NAIC. Analysis includes standardized plans A N, policies existing prior to federal standardization, plans in Massachusetts, Minnesota, and Wisconsin that are not part of the federal standardization program, and plans that identified as Medicare Select; excludes plans where number of covered lives was less than 20. Number of Medigap policyholders as of December 31, 2006 and December 31, 2010, as reported in the NAIC data. SOURCE: K. Desmond, T. Rice, and Kaiser Family Foundation analysis of National Association of Insurance Commissioners (NAIC) Medicare Supplement data. CMS Medicare and Medicaid Statistical Supplement: Medicare Enrollment 2009, released September 30, 2010.

12 EXHIBIT 11 An Overview of Medigap Research objectives and data sources used for this analysis What is Medigap? What does Medigap cover? How does Medigap enrollment vary by state, plan type, and over time? How do Medigap premiums vary by plan type, state, over time? How do Medigap premiums vary by beneficiary characteristics? Are beneficiaries choosing the lowest premium policies? Conclusion

13 EXHIBIT 12 Average Monthly Medigap Premiums, Plans A J, 2010 $169 $177 $187 $175 $181 $169 $186 $196 $195 $140 A B C D E F G H I J NOTE: Analysis excludes California, as the majority of health insurers do not report their data to the NAIC. Analysis includes standardized plans A J; excludes plans K L because of the small number of policyholders enrolled in these plans; excludes policies existing prior to federal standardization; excludes plans in Massachusetts, Minnesota, and Wisconsin; excludes plans that identified as Medicare Select; excludes plans where number of covered lives was less than 20. SOURCE: K. Desmond, T. Rice, and Kaiser Family Foundation analysis of National Association of Insurance Commissioners (NAIC) Medicare Supplement data.

14 EXHIBIT 13 Average Monthly Medigap Premiums for Plan F, by State, 2010 National Average = $181 $158 $172 $129 $172 $154 $155 $154 $174 $226 $176 $178 $175 $162 $163 $176 $189 $178 $181 $193 $186 $178 $171 $181 $158 N/A $174 $178 $177 $162 $168 $171 $166 $165 $163 $173 $177 $174 $173 $189 $190 $139 $209 $156 $183 $201 $171 $183 $220 $184 $209 DC $180 Less than $150 (2 states) $151 $160 (6 states) $161 $170 (7 states) $171 $180 (19 states, DC) $181 $190 (9 states) More than $190 (6 states) NOTE: Analysis excludes California, as the majority of health insurers do not report their data to the NAIC. Analysis includes standardized plan F; excludes plans that identified as Medicare Select; excludes plans where number of covered lives was less than 20. SOURCE: K. Desmond, T. Rice, and Kaiser Family Foundation analysis of National Association of Insurance Commissioners (NAIC) Medicare Supplement data.

15 EXHIBIT 14 Average Monthly Medigap Premiums, Monthly Medigap premium (rounded to the nearest dollar) $162 $170 $176 $ % increase from previous year +4.9% +3.5% +4.0% NOTE: Analysis excludes California, as the majority of health insurers do not report their data to the NAIC. Analysis includes standardized plans A N, policies existing prior to federal standardization, and plans in Massachusetts, Minnesota, and Wisconsin that are not part of the federal standardization program; excludes plans that identified as Medicare Select; excludes plans where number of covered lives was less than 20. SOURCE: K. Desmond, T. Rice, and Kaiser Family Foundation analysis of National Association of Insurance Commissioners (NAIC) Medicare Supplement data.

16 EXHIBIT 15 An Overview of Medigap Research objectives and data sources used for this analysis What is Medigap? What does Medigap cover? How does Medigap enrollment vary by state, plan type, and over time? How do Medigap premiums vary by plan type, state, over time? How do Medigap premiums vary by beneficiary characteristics? Are beneficiaries choosing the lowest premium policies? Conclusion

17 EXHIBIT 16 Variation in Plan F Premiums, by Beneficiary Characteristics, % higher 52% higher 8% higher 12% higher Standard beneficiary 65 year old, female non smoker Under 65, + 73% to your Medigap premium Age 80, + 52% to your Medigap premium If you are Male, + 8% to your Medigap premium Smoker, + 12% to your Medigap premium NOTE: OEP is open enrollment period; GI is guaranteed issue. Does not include premiums for high deductible Plan F plans, or Plan F SELECT plans. SOURCE: 2010 Medigap premium comparison guides for Alabama, California, Colorado, Florida, Iowa, Kentucky, Louisiana, Missouri, Montana, and North Dakota.

18 EXHIBIT 17 An Overview of Medigap Research objectives and data sources used for this analysis What is Medigap? What does Medigap cover? How does Medigap enrollment vary by state, plan type, and over time? How do Medigap premiums vary by plan type, state, over time? How do Medigap premiums vary by beneficiary characteristics? Are beneficiaries choosing the lowest premium policies? Conclusion

19 EXHIBIT 18 Are beneficiaries choosing the lowest premium plans? Notes on data analysis Only examines changes in Plan F (excluding SELECT and highdeductible plans) Among states that require community rating Among states with federally standardized plans, where Plan F is the most popular plan type Analysis uses 2009 data (due to changes in the Medigap market in 2010) Excludes companies with less than 1% marketshare Examines market share of each company within a state, and compares to premiums for each company within a state

20 EXHIBIT 19 Medigap Plan F policyholders in community rated states tend to be enrolled in the lowest premium plans available in their state State How many plans? Lowest Plan F premium? For AARP Largest plan in state? Percent of market Arkansas 14 No Yes 20% Connecticut 4 Yes Yes 64% Maine 2 Yes Yes 77% New York 6 Yes Yes 83% Washington 8 Yes Yes 52%

21 EXHIBIT 20 An Overview of Medigap Research objectives and data sources used for this analysis What is Medigap? What does Medigap cover? How does Medigap enrollment vary by state, plan type, and over time? How do Medigap premiums vary by plan type, state, over time? How do Medigap premiums vary by beneficiary characteristics? Are beneficiaries choosing the lowest premium policies? Conclusion

22 EXHIBIT 21 Conclusion Enrollment and premiums Variations by state and plan type Nationally, stable over time, with variations at state level Premiums vary by characteristic In 4 of 5 community rated states, Medicare beneficiaries with Medigap Plan F tend to be enrolled in one of the lowest premium plans available to them Not consistent with patterns in MA or Part D; potential reasons for this difference? Some changes to Medigap are being discussed in the context of deficit and debt reduction, with implications for beneficiaries

23 EXHIBIT 22 Medigap Resources on kff.org Medigap: Spotlight on Enrollment, Premiums, and Recent Trends Medigap Reforms: Potential Effects of Benefit Restrictions on Medicare Spending and Beneficiary Costs Medigap Reform: Setting the Context Medicare and the Federal Budget: Comparison of Medicare Provisions in Recent Federal Debt and Deficit Reduction Proposals Policy Options to Sustain Medicare for the Future For more information, visit kff.org/medicare

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