2015 Annual Election Period (AEP) Results. Gorman Health Group Sales Marketing and Strategy Division

Transcription

1 2015 Annual Election Period (AEP) Results Gorman Health Group Sales Marketing and Strategy Division Issued: March 2015

2 TABLE OF CONTENTS 2015 ANNUAL ELECTION PERIOD RESULTS... 3 NATIONAL ENROLLMENT TREND... 3 THE BIG PICTURE AEP AEP... 7 ORGANIZATIONS AEP AEP PRODUCTS SUMMARY PAGE 2 March 2015

3 2015 ANNUAL ELECTION PERIOD RESULTS NATIONAL ENROLLMENT TREND Gorman Health Group, LLC (GHG) has run a high-level and detailed analysis of the Annual Election Period (AEP) results for the 2014 AEP and the 2015 AEP. The goal of this AEP results analysis is to help Medicare Advantage (MA) health plans and industry professionals understand the MA market. The AEP is the only time the majority of Medicare beneficiaries can change their MA health plan. The analysis of the national enrollment trend for AEP provides the industry with information on which states, plans, and plan types are experiencing the most growth/loss in enrollment. For the purposes of this analysis, GHG analyzes AEP results utilizing February 1, 2015, numbers. Utilizing the February numbers provides a more accurate depiction of AEP results since the January enrollment numbers released by the Centers for Medicare & Medicaid Services (CMS) are not inclusive of all AEP enrollments/disenrollments. Instead of placing footers or notations on each table, we have noted an asterisk (*) in the data tables field where those numbers are February numbers. THE BIG PICTURE Table 2 shows the total number of enrollees nearing 14 million across the nation from 12/1/2014 to 2/1/2015. This equates to a 4 percent AEP growth in membership. Table AEP Growth 2014 AEP 12/1/2013 2/1/2014 * Total 12,289,107 12,732,265 Table AEP Growth 2015 AEP 12/1/2014 2/1/2015 * Total 13,382,310 13,913,880 The 2015 AEP saw an overall growth of 531,570 beneficiaries enrolled in MA health plans, while the 2014 AEP saw an overall growth of 443,158 beneficiaries enrolled in MA health plans. Overall, the 2015 AEP showed more growth in sheer numbers in MA individual enrollment than the 2014 AEP (Chart 1), however, both reflect about a 4 percent overall gain. It is important to note that the Medicare-Medicaid Plan (MMP) product type saw a growth of about 128,427 members, with an overall count of 309,902 members. Being a new product to the market, the larger raw numbers of enrollees in the 2015 AEP may be accounted for by this product. PAGE 3 March 2015

4 Chart 1 - AEP Overall Growth 2014 & , , , , , , , ,570 AEP Overall Growth Table 3 shows the annual enrollment trend from 2011 to February Table 3 - Trend /1/ /1/ /1/ /1/2014 2/1/2015 * Total 10,189,151 11,239,785 12,289,107 13,382,310 13,913,880 In addition to understanding AEP growth, it is important to look at the enrollment growth/loss annually, by year, since not all enrollments occur during AEP. Medicare beneficiaries who qualify for a Special Election Period (SEP), Group MA enrollment, and those aging into Medicare are only a few of the reasons that would affect the annual enrollment of Medicare beneficiaries. PAGE 4 March 2015

5 Chart 2 shows the overall yearly growth in enrollment since From 2011 to 2012 and 2012 to 2013, the industry saw an increase in MA membership in the individual market of 1,050,634 and 1,049,322 enrollees respectively, both at an overall growth of 9 percent. The enrollment gain percentage decreased slightly (but not significantly) from 2013 to 2014 at 9 percent (an increase of 1,093,203). Chart 2 Growth Trends Growth AEP 2014 to , to to to ,093,203 1,049,322 1,050, , , , ,000 1,000,000 1,200,000 AT THE STATE LEVEL The following tables and graphs show the five states with the most enrollment and the five states which saw the most growth in the 2014 and 2015 AEPs AEP As seen in Table 4, the five states with the most enrollment in the 2014 AEP are California (2,054,372 total enrollees), Florida (1,431,639 total enrollees), New York (1,148,067 total enrollees), Texas (987,289 total enrollees), and Pennsylvania (969,541 total enrollees). These states also have the most number of Medicare eligibles, so it is no surprise that they have the most number of MA enrollees. However, the five states which saw the most growth in the 2014 AEP (see Chart 4 and Chart 5) were North Carolina (growth of 132,935 enrollees), Illinois (growth of 103,899 enrollees), Texas (growth of 61,955 enrollees), Florida (growth of 60,653 enrollees), and Michigan (growth of 42,795 enrollees). PAGE 5 March 2015

6 Table 4 Top 5 States with Most 2014 AEP State 12/1/2013 2/1/2014* Gain/Loss Gain/Loss % CA 2,014,409 2,054,372 39,963 2% FL 1,370,986 1,431,639 60,653 4% NY 1,108,409 1,148,067 39,658 4% TX 925, ,289 61,955 7% PA 953, ,541 16,447 2% Chart 3 Top 5 States with Highest 2014 AEP Growth 1,600,000 1,400,000 1,200,000 1,000, , , , ,000-1,370,986 1,431, , , , , , , , ,853 Total 12/1/2013 Total 2/1/2014 NC IL TX FL MI Chart 4 - Top 5 States with Highest 2014 AEP Growth (Total Gains) 140, , ,000 80,000 60,000 40,000 20, , ,899 61,955 60,653 Gain/Loss 42,795 NC IL TX FL MI PAGE 6 March 2015

7 2015 AEP As seen in Table 5, the five states with the most enrollment as of February 2015 are California (1,772,760 total enrollees), Florida (1,460,632 total enrollees), New York (996,216 total enrollees), Texas (907,921 total enrollees), and Pennsylvania (798,630 total enrollees). However, the five states which saw the most growth in the 2015 AEP (see Chart 5 and Chart 6) are California (growth of 57,646 enrollees), Ohio (growth of 57,201 enrollees), Texas (growth of 54,561 enrollees), Florida (growth of 52,228 enrollees), and Illinois (growth of 26,079 enrollees). Overall, we see that California, New York, and Pennsylvania represent the most enrollments across the 2014 and 2015 AEPs. We also see that those states which saw the most growth in 2014 experienced more growth overall as compared to those states with the most growth in the 2015 AEP. Table 5 - Top 5 States with Most 2015 AEP State 12/1/2014 2/1/2015* Trend 2014 to 2015 % CA 1,715,114 1,772,760 57,646 3% FL 1,408,404 1,460,632 52,228 4% NY 979, ,216 16,441 2% TX 853, ,921 54,561 6% PA 782, ,630 15,655 2% Chart 5 - Top 5 States with Highest 2015 AEP Growth Total 2,000,000 1,800,000 1,600,000 1,400,000 1,200,000 1,000, , , , , ,715,114 1,408,404 1,772,760 1,460, , , , , , ,605 Total 12/1/2014 Total 2/1/2015 CA OH TX FL IL PAGE 7 March 2015

8 Chart 6 - Top 5 States with Highest 2014 AEP Growth (Total Gains) Total 70,000 60,000 50,000 40,000 30,000 20,000 10, ,646 57,201 54,561 52,228 Growth 2014 to 2015 CA OH TX FL IL 26,079 PAGE 8 March 2015

9 ORGANIZATIONS 2014 AEP Table 6 shows the five MA organizations with the most enrollment at the completion of the 2014 AEP: United Health Group (3,140,452 total enrollees), Humana (2,748,447 total enrollees), Kaiser Foundation Health Plan (1,212,586 total enrollees), Aetna Group (1,070,681 total enrollees), and WellPoint (653,163 total enrollees). However, the five organizations which show the most enrollment gains in the 2014 AEP (see Chart 7 and Chart 8) were Humana, Aetna, Blue Cross Blue Shield of Michigan, Blue Cross and Blue Shield of North Carolina (BCBSNC), and Independence Blue Cross. Table 6 - Top 5 Organizations with Most 2014 AEP Organization Total 12/1/2013 Total 2/1/2014 Trend 2013 to 2014 % Gain/Loss UNITEDHEALTH GROUP 3,166,890 3,140,452 (26,438) -1% HUMANA 2,442,992 2,748, ,455 13% KAISER FOUNDATION HEALTH PLAN 1,200,240 1,212,586 12,346 1% AETNA 949,004 1,070, ,677 13% WELLPOINT 624, ,163 28,862 5% Chart 7 - Top 5 Organizations with Highest 2014 AEP Growth 3,000,000 2,000,000 1,000,000-2,442,992 12/1/2013 2/1/2014 2,748, ,004 1,070, , ,025 83, , , ,734 HUMANA AETNA BCBS MICHIGAN BCBS NORTH CAROLINA INDEPENDENCE BLUE CROSS PAGE 9 March 2015

10 Chart 8 - Top 5 Organizations with Highest 2014 AEP Growth (Total Gains) 350, , , , , ,000 50, , ,677 43,482 35,147 Growth 2013 to ,343 HUMANA AETNA BCBS MICHIGAN BCBS NORTH CAROLINA INDEPENDENCE BLUE CROSS 2015 AEP Those big players in the 2015 AEP are similar as those in 2014, with United Health Group and Humana owning the majority of the individual MA market with over 2.5 million members each. As seen in Table 7, the five organizations with the most enrollment at the 2015 AEP are United Health Group (2,756,188 total enrollees), Humana (2,679,634 total enrollees), Kaiser Foundation (814,265 total enrollees), Aetna (695,688 total enrollees), and Anthem (555,670 total enrollees). Table 7 - Top 5 Organizations with Most 2015 AEP Organization Total 12/1/2014 Total 2/1/2015 Trend 2014 to 2015 % Gain/Loss UNITEDHEALTH GRP 2,766,889 2,756,188-10,701 0% HUMANA GRP 2,421,349 2,679, ,285 11% KAISER FOUNDATION GRP 783, ,265 30,477 4% AETNA GRP 613, ,688 82,455 13% ANTHEM INC GRP 560, ,670-4,937-1% As seen in Chart 9 and Chart 10, Humana saw the most enrollment growth in the 2015 AEP with a growth of about 260,000 new members. It is important to note that nearly all organizations with the most Medicare enrollment also had the most enrollment gains in the 2015 AEP. PAGE 10 March 2015

11 Chart 9 - Top 5 Organizations with Highest 2015 AEP Growth 3,000,000 2,500,000 2,000,000 1,500,000 1,000, , ,421, ,233 12/1/2014 2/1/2015 2,679, , , , , ,276 29,373 57,676 HUMANA GRP AETNA GRP CIGNA HLTH GRP KAISER FOUNDATION GRP HCSC GRP Chart 10 - Top 5 Organizations with Highest 2015 AEP Growth (Total Gains) 300, , , , , ,000 50,000 82,455 32,206 30,477 28,303 - Growth 2014 to 2015 HUMANA GRP AETNA GRP CIGNA HLTH GRP KAISER FOUNDATION GRP HCSC GRP Although these organizations have been the big players in the individual MA market, the 2015 AEP saw a large number of acquisitions and mergers in the MA industry. Nearly all five organizations with the most enrollment growth in the 2015 AEP (with the exception of Kaiser) experienced major growth due, in part, to acquisition, mergers, or as in the case of Anthem and WellPoint, uniting the company and products offered under a single brand name. PAGE 11 March 2015

12 Table 8 lists the organizations which saw the most loss in enrollment in the 2015 AEP: BCBSNC (41,796 total loss in enrollment), Wellcare (37,079 total loss in enrollment), Highmark (20,605 total loss in enrollment), Hawaii Medical (15,945 total loss in enrollment), and BCBS of NJ (12,514 total loss in enrollment). Table 8 Top 5 Organizations with Most Loss 2015 AEP Organization Total 12/1/2014 Total 2/1/2015 Trend 2014 to 2015 % Gain/Loss BCBS OF NC GRP 166, ,565-41,796-25% WELLCARE GRP 335, ,692-37,079-11% HIGHMARK GRP 252, ,188-20,605-8% HAWAII MEDICAL SERV ASSN 40,986 25,041-15,945-39% BCBS OF NJ GRP 35,537 23,023-12,514-35% PRODUCTS Table 9 shows the total enrollment trend by product type, 2011 through February The table shows that at the close of the 2015 AEP, Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and HMO SNP (Special Needs Plan) are the product types with the most enrollments, with HMO at over 7 million total enrollees as of 2/1/2015 more than all other product types combined. Table 9 Total by Product Type AEP Product Total 12/1/2011 Total 12/1/2012 Total 12/1/2013 Total 12/1/2014 Total 2/1/2015 HMO 4,792,986 5,337,595 6,087,450 6,644,122 7,024,469 PPO 1,400,725 1,644,455 1,774,901 1,896,264 1,957,740 HMO SNP 1,233,132 1,344,798 1,555,784 1,753,470 1,661,315 Regional PPO 793, , , , ,719 HMO-POS 900,344 1,017, , , ,811 Cost 308, , , , ,225 MMP 3, , ,902 PFFS 550, , , , ,224 Regional PPO 115, , , , ,535 SNP PPO SNP 43,627 63,779 83,248 67,142 67,429 HMO-POS SNP 23,142 36,347 44,425 49,633 48,511 PACE 21,517 24,183 26,910 29,674 29,818 MSA 1,396 2,831 6,062 11,466 12,182 PSO 3,942 PAGE 12 March 2015

13 It is not surprising that HMO is the largest product since HMO is the top performing product type across the five organizations with the most enrollments. Chart 11 shows the total HMO enrollment by the following organizations: UnitedHealth Grp (1,601,955 HMO enrollees), Humana Grp (1,300,678 HMO enrollees), Kaiser Foundation (692,063 HMO enrollees), Aetna (345,908 HMO enrollees), and Anthem, Inc. (272,387 HMO enrollees). Chart 2 Total HMO by Top 5 Organizations 2015 AEP 1,800,000 1,600,000 1,601,955 1,400,000 1,300,678 1,200,000 1,000, , , , , , , ,387 0 Total 2/1/2015 UNITEDHEALTH GRP HUMANA GRP KAISER FOUNDATION GRP AETNA GRP ANTHEM INC GRP PAGE 13 March 2015

14 2015 AEP Chart 12 shows not only the growth in the top three performing product types but also how large the HMO footprint is in the market to this day. The HMO product enrolls about 50 percent of the entire individual MA market. It is important to note that the large increase (71 percent growth) in the MMP type is due to this product s growth in 2014 after its introduction in the market in Thus, it is important to look at Chart 13 as well to get a representation of the growth in other products based upon the percentage of gains/losses. The top three plans, outside of Medicare-Medicaid, that saw the most enrollment growth are Cost, HMO, and MSA. Although the MSA product saw 6 percent growth this AEP, it only represents 0.01 percent of the market. Chart 3 Trend in Top Three Product Types AEP 8,000,000 6,000,000 6,644,122 12/1/2014 2/1/2015 7,024,469 4,000,000 2,000, ,896,264 1,957, , ,902 HMO Medicare-Medicaid Plan PPO + Products with the highest enrollment not based upon total gain or loss in 2015 AEP. It is also important to look at Chart 13 to get a representation of the growth in other products based upon the percentage of gains/losses. The top three plans, outside of Medicare-Medicaid, that saw the most enrollment growth are Cost, HMO, and MSA. Although the MSA product saw 6 percent growth this AEP, it only represents 0.01 percent of the market. PAGE 14 March 2015

15 Chart 4 Growth All Product Types 2015 AEP 8,000,000 6,000,000 4,000,000 2,000, /1/2014 2/1/2015 Medicare-Medicaid Plan Cost HMO MSA HMO-POS PPO Regional PPO SNP Regional PPO PACE PPO SNP HMO-POS SNP HMO SNP PFFS Table 10 shows product types by total number of lost enrollees. HMO SNP (92,155 total lost enrollees), Private Fee-for-Service (PFFS) (34,567 total lost enrollees), and HMO- POS (Point of Service) SNP (1,122 total lost enrollees) lost the most sheer numbers of enrollees. These three plans also saw the most percentages lost; -5 percent, -12 percent, and -2 percent loss in enrollment, respectively. It is important to note that PFFS will continue to lose membership as this product type phases out. In addition, we must take into account the growth of the MMPs when analyzing the over 92,000 members leaving the HMO SNP product type. Most of the 92,000 HMO SNP enrollees may account for the 128,427 growth in MMPs. Table 10 Products by Total Lost Enrollees 2015 AEP Product Type 12/1/2014 2/1/2015 Trend 2014 to 2015 % Gain/Loss HMO SNP 1,753,470 1,661,315-92,155-5% PFFS 289, ,224-34,567-12% HMO-POS SNP 49,633 48,511-1,122-2% PSO 0 NA PACE 29,674 29, % PPO SNP 67,142 67, % MSA 11,466 12, % Regional PPO SNP 215, ,535 4,247 2% Regional PPO 975, ,719 15,498 2% HMO-POS 835, ,811 28,686 3% Cost 433, ,225 39,586 9% PPO 1,896,264 1,957,740 61,476 3% MMP 181, , ,427 71% HMO 6,644,122 7,024, ,347 6% PAGE 15 March 2015

16 Chart 5 Trend in Products with Most Loss in 2015 AEP 2,000,000 1,500,000 1,000,000 1,753,470 1,661, , , ,224 49,633 48,511 12/1/2014 2/1/2015 HMO SNP PFFS HMO-POS SNP Table 10 shows the total enrollment by product of the top five performing plans in the MA market as of 2/1/2015. This table reiterates our previous discovery that the HMO product was the top performing product across all organizations, previously identified as having the most enrollments at the end of the 2015 AEP. Table 6 Top 5 Performing Plans in MA by Product Product Type United Health Humana Kaiser Aetna Anthem HMO 1,601,955 1,300, , , ,387 Regional PPO 361, ,307 NA NA 103,063 Regional PPO SNP 219,535 NA NA NA NA HMO SNP 200, ,706 82,848 26,495 80,018 PPO 176, ,763 NA 287,493 81,497 PPO SNP 62,133 NA NA NA NA HMO-POS 58,294 5,901 NA 11,573 NA PFFS 47, ,274 NA NA NA HMO-POS SNP 14,137 NA NA NA NA MMP 14,072 20,005 NA 24,219 18,705 Cost 39,354 PAGE 16 March 2015

17 SUMMARY MA continues to show substantial growth in the Medicare market. The 2015 AEP saw an overall growth of 531,570 enrollees and a 4 percent overall gain. It is important to note that the MMP product type saw a growth of about 128,427 members with an overall count of 309,902 members. Being a new product to the market, the larger raw numbers of enrollees in the 2015 AEP may be accounted for by this product. The largest players in the market continue to reign, with United Health Group and Humana owning the majority of the individual MA market with over 2.5 million members each. The top five organizations with the most enrollment during the 2015 AEP are United Health Group (2,756,188 total enrollees), Humana (2,679,634 total enrollees), Kaiser Foundation (814,265 total enrollees), Aetna (695,688 total enrollees), and Anthem (555,670 total enrollees). The HMO, PPO, and HMO SNP are the product types with the most enrollments at the end of the 2015 AEP, with HMO at over 7 million total enrollees as of 2/1/2015 more than all other product types combined. This past year has shown the increase of the MMP type, with 71 percent growth in the 2015 AEP after its introduction in the market in PAGE 17 March 2015