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Medicare Advantage 2017 Spotlight: Enrollment Market Update

Appendix A: Special Needs Plans

Special Needs Plans (SNPs) restrict enrollment to specific types of beneficiaries with significant or relatively specialized care needs, including beneficiaries: (1) dually eligible for Medicare and Medicaid (D-SNPs); (2) requiring a nursing home or institutional level of care (I-SNPs); or (3) with severe chronic or disabling conditions (C-SNPs.)

Enrollment in SNPs increased from 2.1 million to 2.3 million beneficiaries between 2016 and 2017 (Figure A1 and Table A7).  In 2017, SNP enrollees account for about 12 percent of total Medicare Advantage enrollment, but account for a larger share of the Medicare Advantage enrollment in some states.  In three states and the District of Columbia, enrollment in SNPs comprises more than one-fifth of Medicare Advantage enrollment (40% in DC, 28% in SC, 22% in AR, and 21% in AZ; data not shown).

Figure A1: Number of Beneficiaries in Special Needs Plans, by Type, 2006 – 2017

The majority of SNP enrollees (81%) are in plans serving those dually eligible for Medicare and Medicaid (D-SNPs). Enrollment of dually eligible beneficiaries in D-SNPs varies greatly by state, and is particularly prevalent in Hawaii (53%) and Arizona (42%) (Table A7).  In 2017, almost half (46%) of Medicare Advantage enrollees who received Part D Low-Income Subsidies (LIS) were in SNPs; this percentage has been relatively stable since 2008.

Separately, several states are undertaking demonstrations with CMS to improve the alignment of Medicare and Medicaid for dually eligible beneficiaries using a capitated model, with the first state (Washington) beginning enrollment in its demonstration in July 2013.  Enrollment in the demonstrations has been relatively low and as of March 2017, more than 392,000 dually eligible beneficiaries were enrolled in the demonstrations.

Appendix B: Tables

Table A1.  Medicare Advantage Enrollment by State and Plan Type, 2017
State Total Distribution of Enrollment, by State and Plan Type
% in HMOs %  in Local PPOs % in Regional PPOs % in PFFS Plans % in Cost Plans % in Other Plans
Total U.S. 18,973,154 63% 26% 7% 1% 3% <1%
Alabama 358,325 45% 51% 3% <1% 0% <1%
Alaska 655 0% 100% 0% 0% 0% 0%
Arizona 463,447 91% 7% 2% 1% <1% 0%
Arkansas 130,465 41% 16% 30% 13% 0% <1%
California 2,348,224 95% 5% 0% <1% <1% <1%
Colorado 309,369 81% 9% 0% 1% 7% 1%
Connecticut 180,612 86% 12% 2% 0% 0% 0%
Delaware 20,739 50% 49% 0% 0% 0% 1%
District of Columbia 13,914 12% 44% 0% 0% 45% 0%
Florida 1,793,258 69% 14% 18% <1% <1% <1%
Georgia 554,075 30% 45% 24% 1% 0% 0%
Hawaii 116,082 39% 58% 3% 0% 0% 0%
Idaho 92,580 60% 40% 0% 0% 0% 0%
Illinois 454,965 46% 51% 2% 1% <1% 0%
Indiana 311,612 28% 56% 16% 1% 0% <1%
Iowa 104,458 32% 58% 0% 1% 9% <1%
Kansas 75,281 41% 51% 2% 6% 0% <1%
Kentucky 245,786 23% 55% 21% 1% 0% 0%
Louisiana 271,778 86% 7% 7% <1% 0% <1%
Maine 87,548 61% 35% <1% 4% 0% 0%
Maryland 106,861 28% 33% 0% 0% 39% <1%
Massachusetts 266,741 73% 22% 4% 0% 0% 1%
Michigan 673,166 39% 57% 3% 1% 0% <1%
Minnesota 542,941 22% 8% 0% <1% 70% 0%
Mississippi 93,708 53% 15% 30% 2% 0% 0%
Missouri 368,222 63% 23% 12% 2% 0% 0%
Montana 42,742 9% 88% 0% 3% 0% 0%
Nebraska 39,967 62% 22% 0% 15% <1% <1%
Nevada 169,207 87% 13% 0% 0% 0% 0%
New Hampshire 27,996 54% 32% 5% 9% 0% 0%
New Jersey 326,486 54% 45% 1% 0% 0% <1%
New Mexico 129,973 65% 34% 0% 1% 0% <1%
New York 1,325,900 70% 18% 10% 2% <1% <1%
North Carolina 587,632 42% 50% 6% 1% 0% <1%
North Dakota 21,353 0% 9% 0% <1% 90% 1%
Ohio 787,209 55% 38% 7% <1% 0% <1%
Oklahoma 124,677 64% 29% 4% 3% 0% <1%
Oregon 355,438 65% 35% 0% <1% 0% <1%
Pennsylvania 1,065,053 62% 36% 1% 1% 0% 1%
Rhode Island 77,285 92% 5% 2% 0% 0% <1%
South Carolina 243,030 27% 20% 51% 2% 0% <1%
South Dakota 32,694 <1% 22% 0% 1% 77% 0%
Tennessee 465,345 67% 31% 2% 0% 0% <1%
Texas 1,284,153 56% 28% 13% 1% 2% <1%
Utah 127,850 83% 17% 0% 0% 0% 0%
Vermont 11,676 19% 23% 45% 13% 0% 0%
Virginia 241,530 41% 28% 13% 9% 9% 1%
Washington 382,571 86% 14% 0% 0% 0% <1%
West Virginia 107,246 10% 81% 5% 4% 0% 0%
Wisconsin 434,584 50% 31% 4% 2% 12% 1%
Wyoming 2,596 7% 31% 0% 57% 0% 5%
NOTE: Total U.S. includes Puerto Rico. Includes employer-sponsored plans, special needs plans, and other private plans. Other includes MSAs and demonstration plans.
SOURCE:  Authors’ analysis of CMS Medicare Advantage enrollment and Landscape files, 2017.

Table A2: Medicare Advantage Enrollment in the Individual and Group Markets, by State, 2017

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Table A3: Medicare Advantage enrollment and penetration rates in HMOs and other plan types, by counties’ costs, 2011-2017

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Table A4.  Medicare Advantage Enrollment and Penetration Rate in Large Metropolitan Counties
(100,000 Medicare Beneficiaries or More), by County, 2017
State County Total Enrollment Penetration Rate
Alabama Jefferson 65,759 51%
Arizona Maricopa 268,891 42%
Arizona Pima 97,124 47%
California Alameda 97,869 42%
California Contra Costa 88,458 48%
California Fresno 41,137 31%
California Kern 40,813 37%
California Los Angeles 639,520 45%
California Orange 219,249 46%
California Riverside 181,277 52%
California Sacramento 116,798 48%
California San Bernardino 146,628 53%
California San Diego 217,053 44%
California San Francisco 56,527 40%
California San Joaquin 38,980 37%
California San Mateo 44,608 37%
California Santa Clara 100,245 39%
California Sonoma 44,545 44%
California Ventura 43,504 31%
Colorado Jefferson 53,376 53%
Connecticut Fairfield 35,151 23%
Connecticut Hartford 54,412 33%
Connecticut New Haven 48,292 30%
Florida Brevard 55,313 38%
Florida Broward 166,180 54%
Florida Duval 53,480 35%
Florida Hillsborough 104,666 48%
Florida Lee 58,106 33%
Florida Marion 45,816 42%
Florida Miami-Dade 290,857 65%
Florida Orange 80,947 47%
Florida Palm Beach 115,630 38%
Florida Pasco 66,884 54%
Florida Pinellas 110,150 47%
Florida Polk 71,220 49%
Florida Sarasota 36,151 27%
Florida Volusia 66,489 48%
Georgia Fulton 50,473 39%
Hawaii Honolulu 83,398 48%
Illinois Cook 171,918 22%
Illinois DuPage 27,705 19%
Illinois Lake 11,084 11%
Indiana Marion 42,489 30%
Kentucky Jefferson 46,993 33%
Maryland Baltimore 19,402 13%
Maryland Baltimore City 16,821 17%
Maryland Montgomery 17,547 11%
Maryland Prince George’s 20,040 16%
Massachusetts Bristol 20,334 18%
Massachusetts Essex 30,072 20%
Massachusetts Middlesex 60,732 23%
Massachusetts Norfolk 24,673 20%
Massachusetts Plymouth 16,614 16%
Massachusetts Suffolk 21,779 21%
Massachusetts Worcester 47,120 32%
Michigan Kent 53,086 52%
Michigan Macomb 56,213 34%
Michigan Oakland 77,577 34%
Michigan Wayne 102,845 32%
Minnesota Hennepin 108,361 58%
Missouri Jackson 47,282 39%
Missouri St. Louis 76,796 39%
Nevada Clark 131,003 40%
New Jersey Bergen 29,458 18%
New Jersey Essex 33,149 29%
New Jersey Middlesex 27,018 21%
New Jersey Monmouth 19,712 17%
New Jersey Ocean 34,291 23%
New Mexico Bernalillo 60,277 50%
New York Bronx 110,278 56%
New York Erie 110,904 58%
New York Kings 149,430 42%
New York Monroe 96,445 65%
New York Nassau 57,919 23%
New York New York 98,022 36%
New York Queens 154,052 45%
New York Suffolk 51,613 19%
New York Westchester 44,012 26%
North Carolina Mecklenburg 44,127 34%
North Carolina Wake 43,123 33%
Ohio Cuyahoga 87,214 35%
Ohio Franklin 65,479 38%
Ohio Hamilton 50,705 36%
Ohio Montgomery 45,788 42%
Ohio Summit 48,913 46%
Oklahoma Oklahoma 29,151 24%
Oklahoma Tulsa 33,382 31%
Oregon Multnomah 69,679 58%
Pennsylvania Allegheny 159,008 62%
Pennsylvania Bucks 43,020 33%
Pennsylvania Delaware 28,842 28%
Pennsylvania Lancaster 40,192 38%
Pennsylvania Montgomery 43,756 28%
Pennsylvania Philadelphia 109,904 43%
Rhode Island Providence 44,163 38%
Tennessee Shelby 41,251 29%
Texas Bexar 114,372 42%
Texas Collin 28,562 28%
Texas Dallas 100,954 33%
Texas El Paso 61,792 51%
Texas Harris 207,140 41%
Texas Tarrant 102,386 41%
Texas Travis 35,645 29%
Utah Salt Lake 55,961 42%
Virginia Fairfax 19,360 14%
Washington King 109,340 36%
Washington Pierce 43,582 31%
Washington Snohomish 53,518 46%
Wisconsin Milwaukee 68,712 46%
SOURCE:  Authors’ analysis of CMS Medicare Advantage Enrollment files, 2017.

Table A5: Medicare Advantage Enrollment by Firm, 2016-2017

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Table A6.  Market Share of the Top Three Medicare Advantage Firms, by State, 2017
State Total Firm 1 Firm 2 Firm 3 Other Firms
Enrollment Share for 3 Firms Name Share Name Share Name Share Share
Alabama 358,325 72% UnitedHealth Group, Inc. 32% BCBS 24% Humana Inc. 15% 28%
Alaska 655 100% Aetna Inc. 85% UnitedHealth Group, Inc. 15% N/A N/A 0%
Arizona 463,447 73% UnitedHealth Group, Inc. 45% BCBS 15% Humana Inc. 13% 27%
Arkansas 130,465 77% UnitedHealth Group, Inc. 33% Humana Inc. 31% BCBS 12% 23%
California 2,348,224 73% Kaiser Foundation Health Plan, Inc. 47% UnitedHealth Group, Inc. 18% SCAN Health Plan 8% 27%
Colorado 309,369 88% UnitedHealth Group, Inc. 41% Kaiser Foundation Health Plan, Inc. 34% Humana Inc. 13% 12%
Connecticut 180,612 81% UnitedHealth Group, Inc. 34% EmblemHealth, Inc. 27% Aetna Inc. 20% 19%
Delaware 20,739 87% Aetna Inc. 46% CIGNA 21% UnitedHealth Group, Inc. 20% 13%
District of Columbia 13,914 91% Kaiser Foundation Health Plan, Inc. 45% UnitedHealth Group, Inc. 40% Aetna Inc. 6% 9%
Florida 1,793,258 68% Humana Inc. 34% UnitedHealth Group, Inc. 26% BCBS 8% 32%
Georgia 554,075 81% UnitedHealth Group, Inc. 47% Humana Inc. 20% Aetna Inc. 13% 19%
Hawaii 116,082 80% BCBS 31% Kaiser Foundation Health Plan, Inc. 27% UnitedHealth Group, Inc. 23% 20%
Idaho 92,580 75% BCBS 33% PacificSource Health Plans 22% UnitedHealth Group, Inc. 21% 25%
Illinois 454,965 74% UnitedHealth Group, Inc. 37% Humana Inc. 24% Aetna Inc. 13% 26%
Indiana 311,612 88% UnitedHealth Group, Inc. 34% Humana Inc. 33% BCBS 21% 12%
Iowa 104,458 90% UnitedHealth Group, Inc. 36% Aetna Inc. 36% Humana Inc. 18% 10%
Kansas 75,281 92% Aetna Inc. 45% Humana Inc. 33% UnitedHealth Group, Inc. 14% 8%
Kentucky 245,786 92% Humana Inc. 59% BCBS 18% UnitedHealth Group, Inc. 15% 8%
Louisiana 271,778 90% Humana Inc. 62% PH Holdings, LLC 22% Vantage Holdings, Inc. 6% 10%
Maine 87,548 84% Martin’s Point Health Care, Inc. 46% Aetna Inc. 20% UnitedHealth Group, Inc. 19% 16%
Maryland 106,861 66% Kaiser Foundation Health Plan, Inc. 39% UnitedHealth Group, Inc. 17% CIGNA 10% 34%
Massachusetts 266,741 78% Tufts Associated HMO, Inc. 37% UnitedHealth Group, Inc. 22% BCBS 18% 22%
Michigan 673,166 84% BCBS 56% Spectrum Health System 19% Henry Ford Health System 10% 16%
Minnesota 542,941 81% BCBS 45% Medica Holding Company 19% UCare Minnesota 17% 19%
Mississippi 93,708 95% Humana Inc. 61% WellCare Health Plans, Inc. 25% CIGNA 10% 5%
Missouri 368,222 79% UnitedHealth Group, Inc. 36% Aetna Inc. 27% Humana Inc. 16% 21%
Montana 42,742 100% BCBS 81% Humana Inc. 16% UnitedHealth Group, Inc. 3% <1%
Nebraska 39,967 94% UnitedHealth Group, Inc. 53% Aetna Inc. 27% Humana Inc. 14% 6%
Nevada 169,207 87% UnitedHealth Group, Inc. 46% Humana Inc. 31% Renown Health 10% 13%
New Hampshire 27,996 83% UnitedHealth Group, Inc. 57% Harvard Pilgrim Health Care, Inc. 14% Humana Inc. 12% 17%
New Jersey 326,486 89% UnitedHealth Group, Inc. 40% Aetna Inc. 26% BCBS 22% 11%
New Mexico 129,973 81% Presbyterian Healthcare Services 36% BCBS 24% UnitedHealth Group, Inc. 21% 19%
New York 1,325,900 53% UnitedHealth Group, Inc. 25% BCBS 17% Healthfirst, Inc. 11% 47%
North Carolina 587,632 84% UnitedHealth Group, Inc. 43% Humana Inc. 24% BCBS 17% 16%
North Dakota 21,353 98% Medica Holding Company 90% Humana Inc. 8% UnitedHealth Group, Inc. 1% 2%
Ohio 787,209 67% BCBS 26% Aetna Inc. 25% Humana Inc. 16% 33%
Oklahoma 124,677 76% UnitedHealth Group, Inc. 27% Humana Inc. 26% CommunityCare Managed Healthcare Plans of OK, Inc. 23% 24%
Oregon 355,438 50% Health Net, Inc. 19% Kaiser Foundation Health Plan, Inc. 17% UnitedHealth Group, Inc. 14% 50%
Pennsylvania 1,065,053 71% BCBS 33% Aetna Inc. 22% UPMC Health System 15% 29%
Rhode Island 77,285 100% BCBS 69% UnitedHealth Group, Inc. 30% PACE Organization of Rhode Island <1% 0%
South Carolina 243,030 92% UnitedHealth Group, Inc. 51% Humana Inc. 38% Aetna Inc. 3% 8%
South Dakota 32,694 98% Medica Holding Company 77% Humana Inc. 15% Aetna Inc. 6% 2%
Tennessee 465,345 77% Humana Inc. 29% BCBS 28% UnitedHealth Group, Inc. 20% 23%
Texas 1,284,153 74% UnitedHealth Group, Inc. 35% Humana Inc. 31% CIGNA 7% 26%
Utah 127,850 81% UnitedHealth Group, Inc. 54% Intermountain Health Care, Inc. 18% Aetna Inc. 9% 19%
Vermont 11,676 99% UnitedHealth Group, Inc. 85% MVP Health Care, Inc. 13% Aetna Inc. 2% 1%
Virginia 241,530 85% Humana Inc. 55% UnitedHealth Group, Inc. 21% Kaiser Foundation Health Plan, Inc. 9% 15%
Washington 382,571 76% UnitedHealth Group, Inc. 32% Kaiser Foundation Health Plan, Inc. 31% BCBS 14% 24%
West Virginia 107,246 90% Humana Inc. 70% Aetna Inc. 15% BCBS 5% 10%
Wisconsin 434,584 69% UnitedHealth Group, Inc. 38% Humana Inc. 16% Ministry Health Care, Inc. 15% 31%
Wyoming 2,596 98% UnitedHealth Group, Inc. 67% Aetna Inc. 26% Memorial Hospital of Laramie County 5% 2%
NOTE:  Territories are excluded.  BCBS is Blue Cross and Blue Shield affiliated health plans.SOURCE:  Authors’ analysis of CMS Medicare Advantage enrollment and Landscape files, 2017.
Table A7.  Enrollment in Special Needs Plans (SNPs), by Plan Type and State, 2017
State Enrollment in Special Needs Plans Total Dual Eligibles (in 2014) % of Dual Eligibles in
D-SNPs
Total Dual eligibles
(D-SNPs)
Chronic or disabling conditions
(C-SNPs)
Institutional
(I-SNPs)
Total U.S. 2,022,154 1,642,039 318,421 61,694 11,063,740 15%
Alabama 51,525 51,003 0 522 222,740 23%
Alaska 0 0 0 0 17,420 <1%
Arizona 98,451 84,530 11,453 2,468 199,180 42%
Arkansas 28,377 14,497 13,880 0 138,480 10%
California 183,920 135,606 45,825 2,489 1,424,500 10%
Colorado 13,380 10,227 110 3,043 112,220 9%
Connecticut 24,477 21,493 0 2,984 181,120 12%
Delaware 2,342 1,273 529 540 30,440 4%
District of Columbia 5,524 5,322 135 67 32,580 16%
Florida 335,927 262,979 68,601 4,347 819,220 32%
Georgia 106,934 58,201 45,665 3,068 330,800 18%
Hawaii 21,020 21,020 0 0 39,860 53%
Idaho 2,245 2,245 0 0 45,980 5%
Illinois 15,162 10,831 3,607 724 402,620 3%
Indiana 6,462 4,678 819 965 205,580 2%
Iowa 0 0 0 0 91,920 <1%
Kansas 1,078 1,027 51 0 71,540 1%
Kentucky 9,633 8,338 1,174 121 198,640 4%
Louisiana 38,907 37,393 1,514 0 218,100 17%
Maine 3,747 3,559 144 44 96,480 4%
Maryland 13,538 6,352 4,118 3,068 148,480 4%
Massachusetts 42,875 42,575 181 119 320,920 13%
Michigan 13,022 12,915 87 20 330,840 4%
Minnesota 39,147 39,147 0 0 149,660 26%
Mississippi 16,413 16,413 0 0 172,020 10%
Missouri 27,673 14,620 12,548 505 199,400 7%
Montana 219 219 0 0 27,420 1%
Nebraska 33 33 0 0 45,340 <1%
Nevada 10,745 11 10,133 601 60,200 <1%
New Hampshire 200 31 0 169 35,120 <1%
New Jersey 24,092 21,662 229 2,201 229,660 9%
New Mexico 18,044 18,044 0 0 86,000 21%
New York 248,436 230,153 755 17,528 900,480 26%
North Carolina 24,691 21,828 112 2,751 345,240 6%
North Dakota 0 0 0 0 17,540 <1%
Ohio 23,397 19,826 2,141 1,430 376,040 5%
Oklahoma 163 0 0 163 124,120 <1%
Oregon 26,878 21,871 3,952 1,055 128,180 17%
Pennsylvania 126,713 119,049 3,636 4,028 469,580 25%
Rhode Island 2,494 873 0 1,621 43,360 2%
South Carolina 68,425 24,364 44,061 0 164,720 15%
South Dakota 0 0 0 0 22,880 <1%
Tennessee 89,215 89,215 0 0 285,100 31%
Texas 181,104 142,846 38,028 230 740,940 19%
Utah 8,159 8,159 0 0 39,620 21%
Vermont 0 0 0 0 30,880 <1%
Virginia 6,076 2,340 3,147 589 204,900 1%
Washington 31,575 29,801 0 1,774 200,040 15%
West Virginia 1,008 581 0 427 93,240 1%
Wisconsin 28,708 24,889 1,786 2,033 180,020 14%
Wyoming 0 0 0 0 12,380 <1%
NOTE: Territories are excluded.
SOURCE: Authors’ analysis of CMS Medicare Advantage enrollment and Landscape files, 2017.  Number of dual eligibles by state is derived from the CMS Chronic Conditions Data Warehouse standard analytic files for 2014.
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