Medicare Advantage: Early Views and Trend Spotting: What We Know From Analyzing Public Data Files Medicare Advantage: Early Views and Trend Spotting: What We Know From Analyzing Public Data Files By Marsha Gold, Sc.D. Senior Fellow Mathematica Policy Research Presentation to the Alliance for Health Reform May 19, 2006 By Marsha Gold, Sc.D. Senior Fellow Mathematica Policy Research Presentation to the Alliance for Health Reform May 19, 2006
Transcript
Medicare Advantage: Early Viewsand Trend Spotting:
What We Know From AnalyzingPublic Data Files
Medicare Advantage: Early Viewsand Trend Spotting:
What We Know From AnalyzingPublic Data Files
By Marsha Gold, Sc.D.Senior Fellow
Mathematica Policy Research
Presentation to the Alliance for Health ReformMay 19, 2006
By Marsha Gold, Sc.D.Senior Fellow
Mathematica Policy Research
Presentation to the Alliance for Health ReformMay 19, 2006
1
More Beneficiaries have MA Available in 2006More Beneficiaries have MA Available in 2006
Source: MPR Analysis of CMS Data for The Kaiser Family Foundation for March of each year.aExceptions are in Alaska and parts of New England.
99%
72%
82% 85%
100%
69%63%
25%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1999 2003 2005 2006
AllRural
a
Percentage of Beneficiaries with Plan Available
2
Growth is Mostly Due to Expansion of PFFSand R-PPOs, Especially in Rural Areas
Growth is Mostly Due to Expansion of PFFSand R-PPOs, Especially in Rural Areas
Source: MPR Analysis of CMS Data for Kaiser Family Foundation
Percentage of Beneficiaries with Plan Available, 2006
78% 80%
88%
79%
89% 88% 89%97%
37%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Any Local HMO or PPO Any PFFS Any Regional PPO
AllUrbanRural
3
Part D Improved Drug Coverage forMA Enrollees in 2006
Part D Improved Drug Coverage forMA Enrollees in 2006
16 22 30 28 31 29 25
829 28 38 39
84 7862
43 41 33 36
010
20304050
607080
90100
1999 2000 2001 2002 2003 2004 2005
No drug coverage Generic only Brand name and generic
Source: MPR Analysis of CMS Medicare Personal Plan Finder data.Note: Weighted by enrollment. 2004 data is as of March.aIn 2005, 30 percent of brand coverage had a limit of $500/year or less; 54 percent had a limit under $1,000.
Distribution of MA Enrollees by Drug Coverage in Basic Plan
a
4
MA-PD Drug Plans Offers a CompetitiveAlternative to PDPs in 2006, In Part Because
the MMA Pays Them To Do So
MA-PD Drug Plans Offers a CompetitiveAlternative to PDPs in 2006, In Part Because
the MMA Pays Them To Do So
$17
$27
$16
$21
$37
$0
$5
$10
$15
$20
$25
$30
$35
$40
PDPs Regional PPOs Local HMOs Local PPOs Local Private Fee-for-Service
Source: MPR analysis of CMS’s November Landscape file for the Kaiser Family Foundation.
Average Monthly Drug Premium, All MA-PDs, 2006
5
MA-PD Premiums (and Benefits)Vary By Plan Type in 2006
MA-PD Premiums (and Benefits)Vary By Plan Type in 2006
15%
$53
8%
$67
R-PPO
All Plans
25%13%58%Percent with no MA premium
$41$60$28Average total premium
Lowest Premium Offeringa
20%10%43%Percent with no MA premium
$45$72$50Average total premium
PFFSL-PPOHMO
Source: MPR Analysis of CMS’s November 2005 Landscape File for CMS.aBy firm within each geographical contract setment.
6
The “Coverage Gap” Persists in MA ThoughSome HMOs and PPOs Offer a Generic Fill InThe “Coverage Gap” Persists in MA ThoughSome HMOs and PPOs Offer a Generic Fill In
85% 85%
68% 70%
100%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PDPs Regional PPOs HMOs Local PPOs PFFS
Source: MPR analysis of CMS Landscape file for The Kaiser Family Foundation. MA data are from November 2005. PDP data are from October 2005.
Note: Few plans offering coverage include brand name drugs. Beneficiaries seeking such coverage can find them in 2 percent of PDPs, 7 percent HMOsand 3 percent of local PPOs. (No regional PPOs or PFFS plans provide such coverage.)
Percent of Plans with Standard Coverage Gap, 2006
7
A Small Number of Firms Historicallyhave Dominated MA Enrollment
A Small Number of Firms Historicallyhave Dominated MA Enrollment
8%
15%
17%
13%
42%
6%
Other
United Healthcare
HumanaBCBS Affiliates
PacifiCareKaiser
Source: MPR analysis of CMS data from the Geographical Service Area File with MPR coded file name.
Distribution of MA Enrollment, September 2005
8
These Firms Had Major Influence onBeneficiary Choice in 2006
These Firms Had Major Influence onBeneficiary Choice in 2006
8%27%36%23%69%BCBS Affiliate
5%15%21%14%36%United Healthcare
39%0%16%0%48%PacifiCare
0%0%11%0%14%aKaiser
69%18%9%61%69%Humana
80%60%72%88%100%All Sponsors
PFFSLocalPPOHMOR-PPO
AnyProductMA Sponsor
Source: MPR Analysis of CMS’s November 2005 Landscape file for The Kaiser Family Foundation.aIncludes cost contract enrollees.
Percent of Beneficiaries with Product Available, 2006
9
MA Enrollment Already was Increasing in 2005,While Most Enrollees Were in HMOs, PFFS
Enrollments was Rising Rapidly
MA Enrollment Already was Increasing in 2005,While Most Enrollees Were in HMOs, PFFS
1. Are beneficiaries focused on MA in 2006 and dothey understand the options and how theyaffect out- of-pocket costs?
2. Increased availability is driven by R-PPOs andPFFS.
• Are R-PPO a competitive option and forwho?
• Is PFFS a viable product long term and doesit improve on traditional Medicare?
1. Are beneficiaries focused on MA in 2006 and dothey understand the options and how theyaffect out- of-pocket costs?
2. Increased availability is driven by R-PPOs andPFFS.
• Are R-PPO a competitive option and forwho?
• Is PFFS a viable product long term and doesit improve on traditional Medicare?
11
Key Questions - IIKey Questions - II
3. MA now gets paid more than it costs intraditional Medicare. What happens tobeneficiaries if Medicare payments stop risingrapidly or are unstable over time?
4. Will CMS release again publicly the monthlyfiles on MA enrollment by contract and county(and add plan) to support independent trackingand analysis of beneficiary choice?
3. MA now gets paid more than it costs intraditional Medicare. What happens tobeneficiaries if Medicare payments stop risingrapidly or are unstable over time?
4. Will CMS release again publicly the monthlyfiles on MA enrollment by contract and county(and add plan) to support independent trackingand analysis of beneficiary choice?
