The State of Medicare Advantage

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Tamsin Hudson
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1 The State of Medicare Advantage Danielle R. Moon, J.D., M.P.A., Director Medicare Drug & Health Plan Contract Administration Group Center for Medicare Centers for Medicare & Medicaid Services November 15, MA and Part D Landscape Access to Medicare Advantage and Part D plans remains strong Premiums projected to remain stable Average premiums today are lower than before the Affordable Care Act went into effect Medicare Advantage enrollment is at an all-time high Overall Medicare Advantage enrollment is expected to grow 4.7 percent in 2014 No significant changes in supplemental benefits 2 Highlights of the 2014 Medicare Advantage and Part D Landscapes Access remains strong and stable relative to 2013 Beneficiary access to an MA plan remains stable at 99.1% Average number of MA plan choices per enrollee remains unchanged Prescription Drug Plan (PDP) access remains the same at 100% for individual market plans and has increased for employer plans for 2014 Average number of PDP choices per region has increased for 2014 Premiums projected to remain stable MA projected weighted average premium is expected to increase by 5.3% ($1.64) Weighted average Total Beneficiary Cost (TBC), which includes beneficiary premiums and estimated out-of-pocket costs, increased by $6.79 per member per month (PMPM) Part D estimated average basic premium will slightly increase and the estimated average total premium will remain the same for 2014 MA organizations are projecting enrollment to increase by 4.7% (670,000) for 2014 MA supplemental benefits remain relatively stable (e.g., dental, vision and hearing) MA enrollment will represent 29% of total Medicare eligible beneficiaries in ,000 enrollees will be impacted by non-renewing MA and PDP plans (compared to 424,000 in 2013) 3 1

, Director Medicare Drug & Health Plan Contract Administration Group Center for Medicare Centers for Medicare & Medicaid Services November 15, 2013 1 2014 MA and Part D Landscape Access to Medicare

2 MA Enrollment Projected to Grow by 4.7% (670,000) in ,000 Projected vs. Actual Enrollment 15,000 14,000 13,000 12,000 Thousands 11,000 10,000 9,000 8,000 Projected Enrollment Actual Enrollment 7,000 6, Projected Enrollment 9,813 11,809 12,517 11,266 11,973 13,079 14,521 14,995 Actual Enrollment 8,039 9,657 10,724 11,317 11,912 13,105 14,323 Growth Percentage* 20.74% 20.13% 11.05% 5.53% 5.25% 10.02% 9.29% 4.69% * Growth percentage is based on actual enrollment with the exception of CY 2014 which is based on projected enrollment. Note: July enrollment of the plan year used for actual enrollment. Plan projected enrollment used for projected enrollment. 4 Access of an MA Plan Generally Remains Stable The number of counties without access to MA plans will increase from 85 in 2013 to 174 in 2014 The number of eligible beneficiaries without access to MA plans will increase from about 220,000 to 443,000 Six (6) states (California, Iowa, Montana, Nebraska, Nevada and Washington) have counties without access to MA plans in 2014 that previously had access The following states have more counties without access for CY 2014 as compared to CY 2013: Colorado, Idaho, North Dakota, South Dakota, Utah and Wyoming MA and PDP Non-Renewals 1.58% (584,109) of MA and PDP enrollees will be losing coverage at the end of 2013 because their plan will not be offered in This is a slight increase from the number of MA and PDP enrollees that lost coverage at the end of % (540,754) of MA enrollees 0.19% (43,355) of PDP enrollees States with the largest number of enrollees affected by nonrenewals in 2014 are New Jersey (80,400), Florida (68,200), California (36,300), Georgia (34,600) and Pennsylvania (32,100) 4,500 (0.03%) of affected MA enrollees will not have access to another plan 6 2

11,809 12,517 11,266 11,973 13,079 14,521 14,995 Actual Enrollment 8,039 9,657 10,724 11,317 11,912 13,105 14,323 Growth Percentage* 20.74% 20.13% 11.05% 5.53% 5.25% 10.02% 9.29% 4.

3 MA Supplemental Benefits Remain Relatively Stable 100% Percentage of Enrollees 80% 60% 40% 20% % SNF Waive 3 Day Hospital Vision Dental Hearing Annual Physical Exam* Fitness Benefits Number of plans in analysis: ,532, ,704, ,604 SNF= skilled nursing facility Includes A/B non-employer plans as of September prior to plan year Enrollee data is weighted by projected enrollment 7 MA Premiums Projected to Remain Stable Actual premiums tend to be lower compared to projected premiums because: As people age into MA, they select lower premium plans Enrollees with the option to change plans typically select plans with lower premiums Projected vs. Actual Premium $45.00 Weighted Average Premium $40.00 $35.00 $30.00 $25.00 $31.15 $31.30 $30.92 $31.32 $30.17 $29.92 $40.02 $36.14 $33.48 $35.62 $32.00 $32.59 $31.12 $30.96 $32.60 Projected WAvg Premium Actual WAvg Premium $ Quality is Improving Star Ratings, coupled with Quality Bonus Payments, are driving improvements in Medicare quality. For the 2014 Star Ratings there are significant increases in MA quality compared to the 2013 ratings. Over a third of MA contracts will receive 4 or more stars. Over half of all MA enrollees are in contracts with 4 or more stars, which is a significant increase from last year s 37% of enrollees. There is a significant decline in the percentage of enrollees in contracts with below average star ratings. The average rating increased for both stand alone plans and MA- PDs, but at a greater rate for the MA-PDs. 9 3

enrollment 7 MA Premiums Projected to Remain Stable Actual premiums tend to be lower compared to projected premiums because: As people age into MA, they select lower premium plans Enrollees with the

4 Low Performing Icon Enhancements for the 2014 ratings include redefining how the Low Performer Icon (LPI) is assigned to encourage at least an average level of performance across both C and D, and revising the Improvement Measure to hold contracts harmless for a decline in scores if they receive 5 stars in the particular measure for the two years being evaluated. Alerts beneficiaries to the sponsor or organization s low rating and encourage them to explore higher rated plan options during the annual election period (AEP). In February, CMS will send a separate notice to individuals who enrolled in a consistently low performing plan during the AEP. Organization s outreach materials may focus on the efforts of the organization to improve its star ratings, but cannot dispute the assignment or validity of the low rating. Of the 26 contracts receiving the LPI in 2013, 14 either improved their ratings in 2014 or their contract was withdrawn, consolidated, or terminated. Percentage of beneficiaries switching out of an LPI increased from 17% in 2012 to 27% in This includes disenrollments from November through April of each year. 10 Medicare Advantage Average Star Rating has Dramatically Increased Medicare Advantage Enrollment Rating Distribution 2-Star 3-Star 4-Star 5-Star 16% 9% 9% 9% 19% 28% 43% 70% 59% 56% 43% 14% 9% 5% 1% or 5 Stars 2 or 3 Stars 16% 29% 37% 55% 84% 71% 63% 45% 11 Star Rating Not Necessarily Tied to Audit Compliance Overall 2012 Score per Plan Compared to 2011 Star Rating Data (Parent Level) Plans with 2.50 to 2.99 Stars Plans with 3.00 to 3.49 Stars Plans with 3.50 to 3.99 Stars Plans with 4.50 to 5.00 Stars 2012 Audit Score Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6 Plan 7 Plan 8 Plan 9 Plan 10 Plan 11 Plan 12 Plan 13 Plan 14 Plan 15 Plan 16 Plan 17 Plan 18 Plan 19 Plan 20 Plan 21 Plan 22 Plan 23 Plan 24 Plan 25 Plan 26 Plan 27 Plan 28 Plan 29 Plan 30 Plan 31 Plan 32 Plan 33 Plan 34 Plan 35 Plan 36 Plan 37 Plan 38 Plan 39 Plan 40 Average 5 Star Average 12 4

Alerts beneficiaries to the sponsor or organization s low rating and encourage them to explore higher rated plan options during the annual election period (AEP).

5 MA Audit Results Continue to Show Compliance Needs Improvement Number of Immediate Corrective Action Required (ICAR) Issued 65 38% 42 25% Formulary & Benefit Administration 62 37% Organization Determinations, Appeals, Grievances Coverage Determinations, Appeals, Grievances *Of 1,525 non compliant conditions discovered during audits, 169 conditions (11%) resulted in an ICAR request. 13 Plan Performance and Readiness for CY2014 Fall Past Performance results now available via HPMS Quality and Performance Part C or Part D Performance Metrics CY 2014 Readiness Checklist released through HPMS on November 4 Draft CY2015 Past Performance Application Cycle Methodology will be released in late November 14 Compliance Finalizing CY2013 ANOC/EOC Retrospective Review Event Upload Analysis November 2013 and January 2014 Annual ANOC/EOC Timeliness Review January 2014 Reminder to review ANOC/EOC accuracy CY2014 ANOC/EOC Retrospective Review Spring

13 Plan Performance and Readiness for CY2014 Fall Past Performance results now available via HPMS Quality and Performance Part C or Part D Performance Metrics CY 2014 Readiness Checklist released

6 Marketing CY 2015 Medicare Marketing Guidelines April Issuing survey to determine needed areas of clarification Revamped CY 2015 Summary of Benefits May Increased use of plain language Based on research/focused groups CY 2015 Model Materials May ANOC/EOC Provider Director 16 Questions 17 6

May Increased use of plain language Based on research/focused groups CY 2015

The State of Medicare Advantage and Part D for 2015

The State of Medicare Advantage and Part D for 2015 Kathryn A. Coleman, Acting Director Medicare Drug & Health Plan Contract Administration Group Center for Medicare Centers for Medicare & Medicaid Services