Medicare Advantage: The Basics
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- Dwayne Henry
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1 : The Basics Gretchen Jacobson, Ph.D. Associate Director, Program on Policy Kaiser Family Foundation Monday, June 10, 2013 Exhibit 1 More than one quarter of beneficiaries are enrolled in a private plan in 2013 HMO 65% Fee for service 72% Fee for service 72% Local PPO 22% Total Beneficiaries, 2013 = 51 Million Regional PPO 7% PFFS 3% Other 3% NOTE: PFFS is Private Fee for Service plans, PPOs are preferred provider organizations, and HMOs are Health Maintenance Organizations. Other includes cost and demonstration plans. Includes enrollees in Special Needs Plans as well as other plans. SOURCE: MPR/Kaiser Family Foundation, 2013 Spotlight: Enrollment Market Update, June Analysis of the Centers for and Medicaid Services (CMS) enrollment files,
2 Exhibit 2 Characteristics of Enrollees, % 14% % 26% % Under 65 42% 13% 18% Age Race/Ethnicity Income Under 65 Other 4% Other 5% Hispanic 14% Black 11% White 71% Hispanic 6% Black 9% White 79% More than 21% $20,001 35% Under $20,000 32% 43% 40% More than $20,001 Under $20,000 SOURCE: Kaiser Family Foundation analysis of Current Beneficiary Survey (MCBS) Cost and Use File, Exhibit 3 Total Enrollment, In millions: BBA MMA ACA NOTE: Includes cost and demonstration plans, and enrollees in Special Needs Plans as well as other plans. SOURCE: MPR/Kaiser Family Foundation analysis of CMS enrollment files, , and MPR, Tracking Health and Prescription Drug Plans Monthly Report, Report of the Board of Trustees,
3 Exhibit 4 Share of beneficiaries enrolled in plans varies across states in 2013 National Average, 2013 = <1% 7% 15% 42% 49% 33% 30% 13% 33% 3% 27% 14% 39% 37% 32% 11% 21% 33% 21% 37% 35% 15% 24% 22% 20% 29% 38% 16% 20% 29% 22% 25% 26% 27% 36% 46% 5% 18% 35% 23% 16% 7% 8% DC 10% < 10% 10% 19% 20% 29% 30% (6 states) (14 states + DC) (15 states) (15 states) NOTE: Includes cost and demonstration plans, and enrollees in Special Needs Plans as well as other plans. SOURCE: MPR/Kaiser Family Foundation analysis of CMS State/County Market Penetration Files, Exhibit 5 Plan Choice and Benefits beneficiaries can choose from among 20 plans on average in plans in urban counties and 13 plans in rural counties Plans are required to cover Part A and Part B benefits and have costsharing that is (at least) actuarially equivalent to cost sharing in traditional For some benefits, plans cost sharing can not be higher than traditional s Plans can also cover Part D drugs Most plans (82%) offer prescription drug coverage and 49% provide some coverage in the gap Plans are required to limit enrollees out of pocket expenses to $6700 or less Almost half of enrollees are in plans with limits at or below $3400 in 2013 Most plans provide extra benefits, such as lower cost sharing or benefits not covered by traditional (e.g., eyeglasses) 3
4 Exhibit 6 Five firms or affiliates (BCBS) account for two thirds of enrollment in 2013 All others 25% United Healthcare 21% Other national insurers 9% Aetna 4% Kaiser Permanente 8% Humana BCBS Total Enrollment, 2013 = 14.4 Million NOTE: BCBS are BlueCross BlueShield affiliates and includes Wellpoint BCBS plans that comprise 4% of all enrollment. Percentages may not sum to 100% due to rounding. SOURCE: MPR/Kaiser Family Foundation, 2013 Spotlight: Enrollment Market Update, June Analysis of CMS Enrollment files, Exhibit 7 More than one third (39%) of enrollees are in plans with quality ratings of four or more stars in % 2013 Contracts 2013 Enrollees 2% 10% 4 or more stars 14% 25% 24% Total Number of Contracts = 520 <1% <1% NOTE: The analysis of the distribution of contracts by quality ratings is not weighted by enrollment. Includes HMOs, local PPOs, regional PPOs, and PFFS plans. SOURCE: Kaiser Family Foundation analysis of CMS s plan star ratings for 2013 and January 2013 Enrollment files. 13% 37% 4% 2% Total Enrollment = 14.4 million 5 stars 4.5 stars 4 stars 3.5 stars 3 stars 2.5 stars 2 stars Unrated 4
5 Exhibit 8 Average monthly premiums for Prescription Drug (MA PD) plans vary by plan type in 2013 $57 $51 $35 $27 $29 Total HMOs Local PPOs Regional PPOs PFFS NOTE: Excludes SNPs, employer sponsored (i.e., group) plans, demonstrations, HCPPs, PACE plans, and plans for special populations. Includes only MAPDs. The total includes cost plans (not shown separately), as well as plans with zero premiums. SOURCE: MPR/Kaiser Family Foundation, 2013 Spotlight: Enrollment Market Update, June Analysis of CMS s Landscape Files for 2013 and March Enrollment files for Exhibit 9 What is the future outlook for? In millions ACA 2013 Actual enrollment CBO 2013 Projections Trustees 2013 Projections SOURCE: MPR/Kaiser Family Foundation analysis of CMS enrollment files, CBO, Baseline May Report of the Board of Trustees,
6 Exhibit 10 Resources on kff.org 2013 Spotlight: Enrollment Market Update 2013 Spotlight: Plan Availability and Premiums Health Plans and Dually Eligible Beneficiaries: Industry Perspectives on the Current and Future Market Plan Star Ratings and Bonus Payments in 2012 Fact Sheet Explaining Health Reform: Key Changes in the Program Health and Prescription Drug Plan Data: health and prescriptiondrug plans/ For more information, visit kff.org/medicare 6
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