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Now Available: 2012 Medicare Advantage Spotlight: Plan Availability and Premiums
The Kaiser Family Foundation has issued a series of data spotlights and issue briefs examining the Medicare Advantage plan options available in 2011 and trends affecting the Medicare Advantage marketplace. These analyses were prepared by researchers at Mathematica Policy Research, Inc. and the Kaiser Family Foundation.
Medicare Advantage Enrollment Market Update
The Republican leadership in the House of Representatives recently indicated that it will be seeking to repeal regulations under the Affordable Care Act (ACA) that govern the “grandfathered” status of health plans. As this aspect of the health reform law gets more scrutiny, it may be useful to review some of the specifics of how grandfathering works.
The purpose of grandfathering: As provisions of the ACA go into effect, grandfathering provides for a smoother transition by allowing health plans to remain as is and not be required to implement certain aspects of the law’s new rules and protections.
How plans maintain grandfathered status: To remain grandfathered, a plan had to be in existence as of March 23, 2010 (when the health reform law passed) and not make any major changes in coverage since then. Some examples of changes in coverage that would cause a plan to lose grandfathering include:
Keep in mind that for employer-sponsored insurance, any change in grandfathered status is up to the employer, who can choose whether or not to make changes to the plan.
Why it matters: Many of the ACA’s provisions apply regardless of grandfathered status. For example, all plans have to allow dependents up to age 26 to enroll (though only non-grandfathered plans are required to enroll dependents who have access to their own employer coverage). And lifetime limits on coverage are now prohibited. But here are some of the key provisions that do not apply to grandfathered plans:
For the provisions now in effect, the only one that grandfathered plans are exempt from that is likely to have a material effect on costs is the preventive services requirement. According to the economic impact analysis that accompanied the regulation implementing this requirement, it’s projected to increase premiums in non-grandfathered employer plans by about 1 percent.
Grandfathering may have significant symbolic value. Advocates of the health reform law point to it as helping people keep coverage they had pre-reform, while opponents argue that the loss of grandfathered status could lead to higher costs. As a practical matter, the effects throughout the insurance market are likely to be quite modest in either case. And, where employers make changes that result in a plan no longer being grandfathered – for example, raising deductibles or employee premium contributions – those changes are probably going to be more consequential for workers and their families than whether or not the plan is grandfathered.
—Larry Levitt
This data spotlight examines the availability of gap coverage in the private Medicare Part D drug plans offered to beneficiaries in 2011, the first year of the phase-out of the gap, as required under the 2010 health reform law. The changes for 2011 include a 50 percent discount on brand-name drugs purchased during the gap in coverage, reducing an enrollee’s potential out-of-pocket costs in the gap from about $3,600 to $1,800.
The analysis was conducted jointly by Jack Hoadley and Laura Summer of Georgetown University, Juliette Cubanski and Tricia Neuman of the Kaiser Family Foundation, and Elizabeth Hargrave of NORC at the University of Chicago.
Data Spotlight (.pdf)
This report considers Medicaid’s current role in providing health coverage for people with HIV. It analyzes national enrollment and spending patterns for Medicaid enrollees with HIV, looking at key demographics, Medicaid eligibility pathways, services and geographic distribution. It also compares Medicaid enrollees with HIV to their counterparts without the disease, as well as to the population of people living with HIV in the U.S.
The report finds that while Medicaid enrollees with HIV represent less than 1 percent of the overall Medicaid population, they account for almost half of people with HIV in regular care. This analysis provides an important baseline for monitoring the impact of health reform in expanding coverage to this population beginning in 2014.
On August 2, 2011, President Obama signed the Budget Control Act of 2011 into law. The Act was designed to reduce federal spending and raise the debt ceiling. It established the Joint Select Committee, also known as the “Super Committee,” tasked with decreasing projected deficits by $1.5 trillion between FY2012 and FY2021. The Committee has broad authority to propose changes to meet its target, including changes to Medicare, Social Security, Medicaid, defense, taxes, and any other element of the budget.
On September 19, 2011, the Obama Administration released the President’s Plan for Economic Growth and Deficit Reduction, which assumes $3 trillion in deficit reduction proposals over the next decade. The plan included revenue increases and spending reductions, including cuts to Medicaid. The Super Committee may consider this plan, as well as plans from other deficit reduction commissions. This brief provides a summary of some of the Medicaid proposals, including those proposed by the Obama administration, that could be debated by the congressional Super Committee in an effort to achieve federal deficit reduction targets.
Policy Brief (.pdf)
On October 3, 2011, the U.S. Supreme Court is scheduled to hear oral argument in a group of three cases, Douglas v. Independent Living Center of Southern California, Douglas v. California Pharmacists Association, and Douglas v. Santa Rosa Memorial Hospital. All three cases raise the same issue: whether Medicaid beneficiaries and providers can challenge a state law in federal court on the basis that it violates the federal Medicaid Act and therefore is “preempted” by the Supremacy Clause of the U.S. Constitution.
This policy brief explains the major issues raised by the Douglas case, answers some key questions about the parties’ legal arguments, and considers potential effects of a U.S. Supreme Court decision.
Policy Brief (.pdf)
The September tracking poll examines public opinion about the “super committee” and explores the views and experience of individuals who have pre-existing health conditions, in addition to continuing tracking opinion about the health reform law. Findings from the poll include:
The September poll is the latest in a series designed and analyzed by the Foundation’s public opinion research team.
Findings (.pdf)
Chartpack (.pdf)
Toplines (.pdf)
This paper examines the impact on enrollment and families of Arizona’s Dec. 21, 2009, decision to freeze enrollment in KidsCare, the state’s Children’s Health Insurance Program (CHIP). The CHIP enrollment freeze, enacted in response to recession-driven state budget pressures, saved the state $12.9 million in FY 2011, but has also resulted in more than 100,000 children being placed on a waiting list for coverage and the loss of $41 million in federal matching funds.
Issue Brief (.pdf)
This policy brief provides perspective on the potential for using comparative effectiveness research in Medicaid pharmacy programs by looking at seven states to determine how they currently evaluate relative clinical and cost information about prescription drugs when making coverage decisions for their Medicaid pharmacy benefits. The brief was prepared by researchers at the Foundation’s Kaiser Commission on Medicaid and the Uninsured and Avalere Health.
Policy Brief (.pdf)
This fact sheet summarizes Medicaid’s role as the major source of outpatient pharmacy services for low-income Americans. Medicaid spent $25.4 billion on prescription drugs in fiscal year 2009, and outpatient prescription drug coverage is an optional benefit that all state Medicaid programs currently provide.
Fact Sheet (.pdf)