Trends in Medigap Coverage and Enrollment, 2011

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1 Trends in Medigap Coverage and Enrollment, 2011 May 2012 SUMMARY This report presents trends in enrollment in Medicare Supplement (Medigap) insurance coverage, using data on the number of policies in force as of December 2011 from the National Association of Insurance Commissioners (NAIC) and an America s Health Insurance Plans (AHIP) survey of newly purchased cost-sharing policies issued by Medigap carriers in The NAIC dataset contains information on most Medigap policies in force in the U.S., representing approximately 9.8 million covered lives, with policies from 254 carriers. 1 Respondents to the AHIP survey of newly purchased cost-sharing policies included large nationwide carriers and carriers selling in a single state; the survey represents about 45 percent of Medigap enrollment for In December 2011, enrollment in Medigap coverage increased by about 100,000 policies to 9.8 million, up from 9.7 million Medigap policies in force in December Most Medicare beneficiaries obtain supplemental coverage, through Medigap, Medicaid, and employerbased retiree plans or comprehensive coverage through Medicare Advantage. In 2011, most Medicare beneficiaries with a standardized Medigap policy had Plan F (51 percent). Plan C, the second most popular plan, had 14 percent of the Medigap standardized plan market. Plans F and C cover 100 percent of the deductibles and coinsurance not covered by Medicare.3 However, the Affordable Care Act of 2010 (ACA) requires that the NAIC review the benefit designs for Plans F and C policies for potential inclusion of nominal cost-sharing. To the extent practicable new Plans F and C must be available in the market by January 1, Some Medigap carriers may not report enrollment to the NAIC. However, we believe that the number of Medigap enrollees among these non-reporting carriers is relatively small and that the NAIC dataset includes most Medigap enrollment. 2 AHIP Center for Policy and Research. Trends in Medigap Coverage and Enrollment, (July 2011) See: Medigap-2011.aspx. 3 A high-deductible version of Plan F is also on the market; however, based on our survey of newly purchased policies, we estimate that it has relatively few policyholders. America s Health Insurance Plans, Center for Policy and Research 1

2 High-deductible Plan F, and newer standardized Medigap plans K, L, M, and N which contain enrollee cost-sharing requirements (copayments, coinsurance and/or deductibles) made up 23 percent of new Medigap purchases in Plan N, which includes costsharing of up to $20 for physician office visits and up to $50 for certain emergency room visits (waived in certain circumstances), represented 18 percent of newly purchased Medigap policies in 2011 and was by far the most popular of the newer standardized plans. BACKGROUND Medigap is a key source of supplemental coverage for Medicare beneficiaries. Seniors purchase Medigap coverage to protect themselves from high out-of-pocket costs not covered by Medicare, to budget for medical expenses, and to avoid the confusion and inconvenience of handling complex bills from health care providers. In 2012, the Medicare program has a $1,156 deductible per benefit period for inpatient hospital care (Part A) and 20 percent coinsurance for outpatient and physician care (Part B) after an annual deductible of $ In addition, the Medicare program does not have a limit on beneficiaries potential out-of-pocket costs. Most Medigap plans cover beneficiaries Part A deductible and Part B deductible as well as the Part B coinsurance. Only two plans currently offer full coverage for the Part B deductible. Some Medigap plans also cover certain benefits not covered by Medicare. In addition, under most Medigap policies, 4 United States Department of Health and Human Services. What are the Medicare premiums and coinsurance rates for 2012? See: policyholders can assign their benefits directly to providers and thereby avoid the need to decipher bills and file claims. Plans. Medigap policies sold after July 1992 were required to conform to one of 10 uniform benefit packages, Plans A through J, based on provisions in the Omnibus Budget Reconciliation Act of 1990 (OBRA 1990). In recent years, Congress has allowed new versions of the original standardized plans, authorized several new plans, and discontinued some of the original or modified plans. 5 The newer standardized plans require some cost-sharing (deductibles, coinsurance, and/or copayments) to be paid by beneficiaries. For example, Plan F is now authorized to be sold as a high-deductible plan. Plans K and L, which entered the market in 2006, do not cover the Medicare Part B deductible and only cover a portion of beneficiaries Part B coinsurance. However, there is a limit on beneficiaries annual out-of-pocket costs for Medicare eligible expenses of $4,660 for Plan K and $2,330 for Plan L (in 2012). 6 New Plans M and N entered the market in June of Plan M only covers half of the Part A deductible and does not cover the Part B deductible. Plan N covers the Part A deductible and does not cover the Part B deductible. Plan N also includes cost-sharing amounts of up to $20 for certain physician visits and up to $50 for certain emergency room visits. 5 Original Plans E, H, I, and J, and high-deductible Plan J are no longer available for new purchase. 6 Centers for Medicare and Medicaid Services. Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.(2012). See: America s Health Insurance Plans, Center for Policy and Research 2

3 The ACA requires the NAIC to revise the standards for Plans C and F to include nominal cost-sharing for Part B physicians services. The new plans must be made available in the market, to the extent practicable, in January This requirement means that the current benefit designs for Plans C and F, which are the most popular Medigap plans and generally provide first-dollar coverage, will no longer be available to new purchasers after the changes are implemented. 7 Waiver State Standard Plans. Three states (Massachusetts, Minnesota, and Wisconsin) offer standard Medigap plans, but are exempt from the OBRA 1990 standardized plan provisions (and subsequent revisions). Individuals who purchase Medigap plans in one of these three states may keep their plans if they move to other states. Plans. Medigap changes are usually phased in for new purchasers, and allow existing policyholders to retain their policies. Although OBRA 1990 prohibited the sale of new prestandardized plans, some beneficiaries still have the pre-standardized policies. CARRIERS OFFERING COVERAGE, DECEMBER 2011 In 2011, 19 percent of carriers covered individuals with standardized Medigap plans in 41 to 51 states (including the District of Columbia); 11 percent of carriers covered individuals in 26 to 40 states; 9 percent covered individuals in 11 to 25 states; and 15 percent of carriers covered individuals with standardized Medigap plans in 2 to 10 states. Over half (54 percent) of all Medigap carriers had 7 Under the ACA, Medicare now covers certain preventive services on a first-dollar (no beneficiary cost-sharing at the point of service) basis. Table 1. Distribution of Medigap Carriers with Medigap Policies in Force, by Market Size, 2011 Number of States to 51 states 19% 26 to 40 states 11% 11 to 25 states 9% 2 to 10 states 15% 1 state 46% 100% Notes: Data in this table depicting the number of states are based on companies with standardized Medigap policies in force; data do not include companies with only prestandardized policies in force. The data for standardized policies include Medicare SELECT plans, and those issued in three states (MA, MN, WI) that received waivers from the standardized product provisions of OBRA The number of carriers with standardized Medigap policies in force reporting to the NAIC for 2011 was 254. For this report the District of Columbia is counted as a "state. policyholders in multiple states, and 46 percent had Medigap standardized policies in force in a single state only (see Table 1). Table 2. Number of Carriers with Medicare Select Policies in Force and Number of Individuals with Medicare Select Plans, 2011 Number of Carriers with Medicare 95 SELECT Policies in Force Number of Individuals with Medicare 739,167 SELECT Policies NAIC Medicare Supplement Insurance Experience Exhibit, for Medicare SELECT plans are identical to standardized Medigap plans but require policyholders to use provider networks to receive the full insurance America s Health Insurance Plans, Center for Policy and Research 3

4 benefits. For this reason, Medicare SELECT plans generally cost less than other Medigap plans. Table 2 shows the number of carriers with Medicare SELECT policies in force, and the number of Medicare beneficiaries having a Medicare SELECT policy in Carriers with Medicare SELECT policies in force are located across the country in 45 states. Table 3. Percent of Carriers with Medigap Policies in Force, by Plan Type, 2011 Plan Type 2011 A 87% B 64% C 78% D 45% E 33% F 83% G 48% H 26% I 24% J 29% K 17% L 15% M 8% N 36% Waiver State Plans 29% Notes: The data for standardized policies include Medicare SELECT plans, and those issued in three states (MA, MN, WI) that received waivers from the standardized product provisions of OBRA The number of carriers with standardized Medigap policies in force for 2011 was 254. All plans offering new coverage must offer Plan A. Table 3 displays the percentage of reporting carriers with standardized Medigap policies in force by each product type. In 2011, the percentages of carriers offering the newer Plans K and L, which were authorized beginning in 2006, are 17 percent and 15 percent, respectively. In June 2010, new Plans M and N were authorized for sale. Eight (8) percent of carriers offered Plan M in 2011 and 36 percent of reporting carriers offered Plan N. POLICIES IN FORCE, DECEMBER 2011 According to the NAIC data, roughly 93 percent of Medigap policies in force in December 2011 were standardized plans. standardized plans, which were no longer sold after July 1992, account for only 7 percent of all Medigap policies (see Table 4). Table 4. Number of Policies, and Medigap Plans, 2011 Policies Percent Plans 9,061,762 93% Plans 705,627 7% All Medigap Plans 9,767, % Note: This data includes U.S. territories and the District of Columbia. Among people with Medigap standardized plans, Plan F continues to be the most popular, covering 51 percent of policyholders in 2011; Plan C had the second highest share, with 14 percent of the market, and Plan J had 8 percent of the Medigap standardized plan market in 2011 (see Table 5). Traditionally, the most popular Medigap plans have covered all or most of Medicare s deductibles and coinsurance. Table 6 shows the number of standardized Medigap policies in force in December 2010 and December 2011, by type of policy. America s Health Insurance Plans, Center for Policy and Research 4

5 Table 5. Distribution of Individuals with Medigap Plans, by Type of Plan, December 2011 Plan Type 2011 A 2% B 5% C 14% D 3% E 1% F 51% G 4% H 1% I 1% J 8% K * L 1% M * N 3% Wavier State Plans 5% 100% * Less than 0.5 percent. Notes: The data for standardized policies include Medicare SELECT plans and those issued in three states (MA, MN, WI) that received waivers from the standardized product provisions of OBRA Percentages may not sum to 100 percent due to rounding. TRENDS IN NEWLY PURCHASED POLICIES According to an AHIP survey of Medigap carriers conducted in 2011 at the request of NAIC, and updated the following year (February 2012), newer standardized plans requiring some enrollee costsharing are becoming a larger share of new policies Table 6. Change in Medigap Enrollment, Policies, December 2010 to December 2011, by Plan Type Plan Type Percent Change A 192, , % B 451, , % C 1,400,045 1,307, % D 332, , % E 151, , % F 4,201,883 4,604, % G 331, , % H 66,968 58, % I 148, , % J 867, , % K 29,497 40, % L 39,929 69, % M % N 148, , % O 547, , % 8,910,110 9,061, % Sources: AHIP Center for Policy and Research analysis of the AHIP Center for Policy and Research. Trends in Medigap Coverage and Enrollment, (July 2011) See: Notes: The data for standardized policies include Medicare SELECT plans and those issued in three states (MA, MN, WI) that received waivers from the standardized product provisions of OBRA purchased. 8 In particular, new Plan N with predictable cost-sharing amounts (instead of high deductibles or unpredictable coinsurance amounts), has rapidly become the most popular new plan, 8 This 2011 survey was discussed in: AHIP Center for Policy and Research. Trends in Medigap Coverage and Enrollment, (July 2011) See: America s Health Insurance Plans, Center for Policy and Research 5

6 Table 7. Percent of Newly Purchased Medigap Policies with Cost-Sharing Features Sold/Issued in, Categories, 2007 to Plan F (High-Deductible) 1% 1% 3% 3% 2% Plan K 1% 1% 2% 1% 2% Plan L 1% 3% 2% 1% 1% Plan M ** ** ** * * Plan N ** ** ** 6% 18% New Medigap Cost-Sharing Policies Issued/Sold 3% 5% 7% 12% 23% Source: AHIP Center for Policy and Research. * Less than 0.5 percent. ** Plans authorized for sale beginning June representing 18 percent of new policies issued in 2011 (see Table 7). Enrollment in high-deductible Plan F is not reported separately in the NAIC data. However, based on AHIP s survey of newly purchased cost-sharing policies, we believe that the overall number of highdeductible Plan F policies is likely quite small. Our survey showed, for companies who responded, that high-deductible Plan F comprised between 1 and 3 percent of newly purchased plans in the period. ACKNOWLEDGMENTS Jessica Collins, Research Analyst for AHIP s Center for Policy and Research, was responsible for the analysis of NAIC data in this report. The survey of newly purchased cost-sharing Medigap policies in 2011 was conducted by Dan LaVallee. For more information please contact Jeff Lemieux, Senior Vice President for AHIP s Center for Policy and Research, at (202) or visit MEDIGAP POLICIES BY STATE Table 8 shows enrollment in Medigap by state (including the District of Columbia, but not including the U.S. territories) and plan type in December Thus, the total number of policyholders in Table 8 is slightly lower than the overall total reported in Table 4, which includes the U.S. territories. America s Health Insurance Plans, Center for Policy and Research 6

7 Table 8. Medigap Enrollment by Plan Type and State, as Reported to the NAIC, December 2011 Plan Type AK AL AR AZ CA CO CT DC DE A 284 1, ,583 16,171 1,686 2, ,746 B , ,403 4,116 1,472 3, , ,989 C ,382 2,845 10,270 20,037 4,718 15, ,593 1,295,796 D ,502 3,914 1,451 2, , ,129 E , , , ,728 F 4,981 27,841 31, , ,775 78,256 52,079 3,469 11,177 4,601,784 G 106 3,181 2,369 6,895 7,287 4,369 2, , ,323 H , ,172 I ,657 6,971 1,702 2, , ,074 J 1,425 1,669 5,628 13,206 69,811 11,493 28,527 1,775 5, ,031 K , ,798 L , ,878 M N 162 2,718 2,422 4,614 7,509 2,456 2, , ,796 Waiver , , ,032 6,502 24,580 4,985 29, , ,388 8, , , , , , ,690 7,485 34,915 9,749,504 Plan Type FL GA HI IA ID IL IN KS KY A 14,022 2, , ,070 4,676 1,750 1, ,746 B 57,590 5, ,840 4, , ,989 C 98,414 25, ,413 2,548 29,843 19,573 20,546 28,040 1,295,796 D 76,676 4, , ,642 6,447 2,667 2, ,129 E 19,474 13, , ,415 5,017 1,167 6, ,728 F 207, ,682 2, ,520 40, , , ,762 87,452 4,601,784 G 13,927 13, ,812 3,974 18,853 23,045 3,620 8, ,323 H 1, ,577 58,172 I 8,762 2, ,342 2, , ,074 J 97,251 15, ,822 4,384 19,514 15,397 4,881 5, ,031 K 3,228 1, , ,798 L 3,535 1, , ,461 2,980 1, ,878 M N 14,080 7, ,268 1,390 16,457 14,209 3,313 6, ,796 Waiver , ,276 39,959 12, ,069 1,193 33,113 14,279 6,859 9, , , ,049 4, ,916 56, , , , ,297 9,749,504 (Continued) America s Health Insurance Plans, Center for Policy and Research 7

8 Table 8 (Continued). Plan Type LA MA MD ME MI MN MO MS MT A ,675 1,507 14,132 2,216 3,046 1, ,746 B 3, ,465 1,441 1,384 4,537 3,892 1, ,989 C 4,708 3,111 26,814 16, , ,557 5,590 7,173 1,295,796 D , , ,295 1, ,129 E ,560 1, , ,728 F 84,713 1,243 79,893 35,034 83,947 1, ,338 81,988 36,354 4,601,784 G 7, ,902 1,955 17, ,393 6,445 2, ,323 H , , ,172 I ,098 2,802 1, , ,074 J 1, ,049 6,037 10,209 2,824 18,196 7,085 4, ,031 K 1, , ,798 L 742-1, , , ,878 M N 4,835-5,572 1,158 12, ,650 6,656 1, ,796 Waiver - 221, , ,276 6,782 2,523 11,145 1,092 27,063 5,854 17,043 4,798 2, , , , ,969 71, ,831 37, , ,615 57,618 9,749,504 Plan Type NC ND NE NH NJ NM NV NY OH A 3, ,369 11,252 1,008 1,223 20,850 4, ,746 B 5, , ,774 1, ,559 5, ,989 C 21,408 1,303 5,226 4,733 99,756 2,838 2,559 48,125 87,194 1,295,796 D 4, , , ,028 17, ,129 E 2, , ,677 5, ,728 F 240,344 48,529 99,035 27,945 89,365 25,284 36, , ,246 4,601,784 G 14, ,276 2,293 16,147 1,448 2,627 10,041 22, ,323 H , ,548 1,381 58,172 I 3, ,329 1, ,014 5, ,074 J 43,795 1,495 8,446 19,842 57,676 5,878 5,572 10,176 21, ,031 K , ,924 1,055 40,798 L 3, ,337 4, ,801 10,547 69,878 M N 11, ,842 2,902 10,595 1,321 2,322 12,529 15, ,796 Waiver ,276 16, ,182 4,864 31,488 2,007 1,611 16,070 20, , ,160 53, ,182 70, ,603 43,469 56, , ,918 9,749,504 (Continued) America s Health Insurance Plans, Center for Policy and Research 8

9 Table 8 (Continued). Plan Type OK OR PA RI SC SD TN TX UT (All States) A 3,118 1,661 7, , ,111 11, ,746 B 1, , , ,795 6, ,989 C 5,932 5, ,214 25,434 8,988 1,033 17,290 34,467 4,324 1,295,796 D 4,037 1,141 18, , ,860 15,815 1, ,129 E , ,515 2, ,728 F 102,158 75,581 80,299 6, ,815 56,833 90, ,078 24,881 4,601,784 G 5,383 3,178 11, ,684 1,055 7,465 51,873 2, ,323 H , , ,172 I 832 1,153 17, , , ,074 J 7,626 5,858 28,978 1,203 12,868 1,726 7,747 51,497 4, ,031 K 1, , , ,798 L 1, , , ,074 5, ,878 M N 5,006 5,290 14, , ,298 20,809 1, ,796 Waiver ,276 7,361 5,454 55, ,602 4,054 23,100 23,291 2, , , , ,073 35, ,968 66, , ,168 45,766 9,749,504 Plan Type VA VT WA WI WV WY A 3,463 1,306 4,132 7,543 1, ,746 B 5,629 1,326 1,453 19,392 1, ,989 C 14,691 13,666 17,439 1,107 10,079 2,469 1,295,796 D 2,943 6,230 1, ,129 E 3,148 2, ,728 F 167,312 2, , ,808 22,345 4,601,784 G 6, , , ,323 H 1, ,172 I 8, , , ,074 J 33,980 6,383 14,818 3,134 4,857 2, ,031 K , ,798 L 1, , ,878 M N 5, ,802-2, ,796 Waiver , ,276 20,993 3,149 28,172 19,417 9,319 1, , ,703 38, , ,550 88,443 32,336 9,749,504 National Association of Insurance Commissioners' (NAIC) Medicare Supplement Insurance Experience Exhibit, for Notes: The data for standard policies include Medicare SELECT plans, and those issued in three states (MA, MN, WI) that received waivers from the standard product provisions of OBRA America s Health Insurance Plans, Center for Policy and Research 9

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