Medicare Part D s competitive design: Do Part D enrollees switch plans? Shinobu Suzuki June 23, 2013
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1 Medicare Part D s competitive design: Do Part D enrollees switch plans? Shinobu Suzuki June 23, 2013
2 Part D s competitive design Intended to provide sponsors incentives to offer attractive coverage while controlling spending Plans Compete for enrollees based on premium, formulary, quality of services, and network of pharmacies Manage drug spending and bid competitively to retain/gain enrollment Beneficiaries Choose a plan that provides access to the drugs they need at premiums and cost sharing they are willing to pay Beneficiaries willingness to reevaluate their plan choices from time to time is important for plan incentives 2
3 Why does switching matter? If too little switching Less of an incentive for plans to compete on premiums and control drug spending? If widespread and frequent switching If enough beneficiaries switched plans to maximize coverage of their medications, it could increase plan costs (and Medicare s spending for Part D) 3
4 Do Part D enrollees switch plans? Part D s annual open enrollment period provides an opportunity to reevaluate plan choice each year During the first few years, according to CMS, about 6% of Part D enrollees voluntarily switched plans each year Does not include plan switches resulting from CMS annual reassignment for low-income subsidy (LIS) enrollees A low rate of switching could mean: Beneficiaries are satisfied with their plans, Annual open enrollment process is confusing / difficult for beneficiaries to navigate, and/or Beneficiaries perceive cost of switching to be high (e.g., new formulary) 4
5 Data CMS administrative data Common Medicare Environment (CME) Part D denominator file CMS s plan crosswalk files Sample exclusions Individuals receiving Part D s low-income subsidy (LIS) Individuals enrolled in employer group plans Final sample included 14.6 million and 15.1 million enrollees, for and cohorts, respectively 5
6 Analytical method Compare Part D enrollee s plan choice before and after the 2010 and 2011 annual open enrollment periods (AEP) Voluntary switching defined as a plan switch where an individual: Chooses a different plan during the AEP; and The change in plan was not due to a plan termination or a service area reduction Rate of switching = % of non-lis enrollees who voluntarily switched plans during AEP 6
7 Part D enrollees who voluntarily switched plans, 2010 and AEP 2011 AEP All non-lis enrollees 13.6% 13.0% By Age 64 or younger 14% 14% or older By Race White 14% 13% African American Asian/Other Hispanic By urbanicity Metropolitan 13% 12% Non-metropolitan Note: AEP (annual open enrollment period), LIS (low-income subsidy). Figures exclude individuals enrolled in employer group plans and those enrolled in terminated plans or plans that experienced service area reductions. Source: MedPAC analysis of Medicare enrollment and Part D denominator files. 7
8 Choice of plan types among voluntary switchers, 2010 and AEP 2011 AEP Voluntary switchers, in PDPs before AEP Rate of switching 13% 13% % of switchers to PDP 81% 80% % of switchers to MA-PD 19% 20% Voluntary switchers, in MA-PDs before AEP Rate of switching 15% 13% % of switchers to MA-PD 91% 88% % of switchers to PDP 9% 12% Note: AEP (annual open enrollment period), PDP (prescription drug plan), MA-PD (Medicare Advantage-Prescription Drug [plan]). Figures exclude individuals enrolled in employer group plans and those enrolled in terminated plans or plans that experienced service area reductions. Components may not sum to totals due to rounding. Source: MedPAC analysis of Medicare enrollment and Part D denominator files. 8
![enrollment period), PDP (prescription drug plan), MA-PD (Medicare Advantage-Prescription Drug [plan]).](/docs-images/54/9741641/images/page_8.jpg "Figures exclude individuals enrolled in employer group plans and those enrolled in terminated plans or plans that experienced service area reductions.")
9 Variation in voluntary switching across PDP regions, 2010 and 2011 The share of PDP enrollees who voluntarily switched plans varied across PDP regions Not always consistent across years In 2010, the shares ranged from 7% in region 26 (New Mexico) to 23% in region 17 (Illinois) and in region 25 (states in the upper NW) In 2011, the shares ranged from 8% in region 4 (New Jersey) and region 26 (New Mexico) to 18 percent in region 16 (Wisconsin), region 18 (Missouri) and region 33 (Hawaii) Many factors likely affect the rate of voluntary switching (e.g., new plan entry, change in premiums, change in healthcare needs, etc.) 9
10 Are voluntary switchers more likely to switch plans again? Slightly less than 4% of enrollees in our sample* switched plans during 2010 and 2011 AEPs 1 in 4 among those who switched during 2010 AEP The majority chose plans of the same type in both years Over ¾ of MA-PD switchers chose MA-PDs Nearly 80% of PDP switchers chose PDPs *The sample for this analysis is a subset of cohort who had Part D enrollment record through January of
11 Other (non-voluntary) switchers Enrollees affected by plan turnovers and service area changes must choose a new plan 3-4% of enrollees were affected during 2010 and 2011 AEPs For plans, non-voluntary switchers are potential new enrollees (not distinguishable from voluntary switchers) In both 2010 and 2011, MA-PD enrollees were more likely to be affected by plan exits: About 6% of MA-PD enrollees vs. 3-4% of PDP enrollees 11
12 Summary of the findings Rate of (voluntary) switching varied by demographic characteristics Lowest among the oldest (80+) enrollees Lowest among Hispanic enrollees Most voluntary switchers chose the same plan type (MA-PD vs. PDP) Rate of (voluntary) switching among PDP enrollees varied across PDP regions; patterns not always consistent across years 1 out of 4 voluntary switchers who switched plans in 2010 switched again in
13 Policy implications A higher share than the observed rate of switching (13%) are likely to have reevaluated their plan choices Findings from MedPAC s focus groups indicate that enrollees who research plans do not always switch plans Non-voluntary switchers must also reevaluate their choice of plans Lower rate of switching observed among subgroups of enrollees may indicate difficulty navigating the annual open enrollment process Many factors likely affect the plan switching behavior and implications for policy would depend on those factors 13
14 Thank you! 14
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