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Medicare Advantage 2015 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 modestly from 1.9 million to 2.0 million beneficiaries between 2014 and 2015 (Figure A1 and Table A6). As a share of the total Medicare Advantage population, enrollment in SNPs is relatively low, and the 2.0 million SNP enrollees in 2015 account for about 12 percent of total Medicare Advantage enrollment. Yet, in four states and the District of Columbia, enrollment in SNPs is more than one-fifth of total Medicare Advantage enrollment (31% in DC, 28% in SC, 22% in AZ, 21% in AR, and 20% in AL; data not shown).

Figure A1: Number of Beneficiaries in Special Needs Plans, by Type, 2006 – 2015

Figure A1: Number of Beneficiaries in Special Needs Plans, by Type, 2006 – 2015

Similar to prior years, most SNP enrollees are in HMOs (86%), with 11 percent enrolled regional PPOs and 3 percent in local PPOs. The majority of SNP enrollees (82%) 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 (49%) and Arizona (41%) (Table A6).

Separately, several states (including CA, IL, MA, MI, MN, NY, OH, SC, TX, and VA) are undertaking demonstrations with CMS to improve the alignment of Medicare and Medicaid for dually eligible beneficiaries using a capitated model. These enrollees are not included in the SNP enrollment statistics provided here because they operate under unique authority and CMS classifies them as demonstrations. Minnesota is an exception because the demonstration uses its existing D-SNPs to improve the administrative alignment of Medicare and Medicaid in these dual SNPs. (Enrollment in Minnesota’s demonstration is included in the SNP enrollment in Table A6.)

It is unclear how the demonstration will affect the growth in D-SNP enrollment over time in states pursing capitated demonstrations. As of March 2015, more than 300,000 dual eligibles were enrolled in the demonstrations. Between 2014 and 2015, enrollment in D-SNPs increased or remained stable in the majority of demonstration states but enrollment in D-SNPs declined in California, Michigan, and Ohio.

Appendix B: Tables

Table A1: Medicare Advantage Enrollment by State and Plan Type, 2015
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. 16,761,673 64% 24% 7% 2% 3% <1%
Alabama 238,091 62% 31% 7% <1% 0% <1%
Alaska 56 0% 100% 0% 0% 0% 0%
Arizona 425,454 91% 7% 1% 1% <1% 0%
Arkansas 114,326 39% 16% 26% 18% 0% <1%
California 2,127,666 98% 2% 0% <1% <1% <1%
Colorado 281,467 80% 9% 0% 1% 8% <1%
Connecticut 157,692 85% 12% 3% 0% 0% 0%
Delaware 13,841 62% 37% 0% 0% 0% 1%
District of Columbia 11,033 16% 32% 0% 0% 52% 0%
Florida 1,570,845 70% 7% 23% <1% <1% <1%
Georgia 460,670 30% 44% 24% 2% 0% 0%
Hawaii 110,465 42% 55% 3% 0% 0% 0%
Idaho 87,837 52% 47% 0% 1% 0% 0%
Illinois 371,007 44% 52% 2% 1% <1% 0%
Indiana 264,104 15% 65% 19% 2% 0% 0%
Iowa 81,541 31% 56% 0% 2% 11% <1%
Kansas 61,600 44% 46% 2% 7% 0% <1%
Kentucky 212,948 18% 57% 23% 2% 0% 0%
Louisiana 232,445 86% 5% 8% <1% 0% <1%
Maine 66,307 64% 32% 0% 3% 0% 0%
Maryland 76,375 32% 20% 0% 0% 47% <1%
Massachusetts 233,084 75% 17% 4% 0% 0% 1%
Michigan 595,239 39% 55% 4% 1% 0% <1%
Minnesota 480,474 25% 8% 0% <1% 67% 0%
Mississippi 76,776 51% 18% 28% 3% 0% 0%
Missouri 311,364 68% 19% 10% 3% 0% <1%
Montana 34,758 2% 88% 0% 11% 0% 0%
Nebraska 34,982 53% 28% 0% 19% 0% <1%
Nevada 146,094 89% 11% 0% 0% 0% 0%
New Hampshire 17,295 42% 35% 0% 23% 0% 0%
New Jersey 222,846 78% 21% 0% 0% 0% 1%
New Mexico 113,807 62% 36% 0% 1% 0% <1%
New York 1,212,239 72% 18% 7% 2% <1% <1%
North Carolina 512,924 45% 47% 6% 3% 2% <1%
North Dakota 17,878 0% 9% 0% 1% 89% 1%
Ohio 811,503 44% 46% 7% 1% 2% <1%
Oklahoma 111,013 66% 27% 3% 4% 0% <1%
Oregon 323,765 60% 40% 0% <1% 0% <1%
Pennsylvania 1,001,864 62% 34% 1% 1% 0% 1%
Rhode Island 71,009 93% 4% 2% 0% 0% <1%
South Carolina 209,812 29% 20% 46% 5% 0% <1%
South Dakota 26,400 <1% 27% 0% 2% 71% 0%
Tennessee 412,042 69% 28% 2% 0% 0% <1%
Texas 1,098,678 59% 23% 13% 3% 2% <1%
Utah 113,034 82% 18% 0% 0% 0% 0%
Vermont 8,984 6% 21% 45% 27% 0% <1%
Virginia 206,427 38% 25% 12% 14% 9% 1%
Washington 348,467 83% 17% 0% <1% 0% <1%
West Virginia 99,454 7% 82% 5% 6% 0% 0%
Wisconsin 388,732 48% 33% 4% 3% 12% <1%
Wyoming 2,071 9% 18% 0% 66% 0% 3%

NOTE: Total U.S. includes Puerto Rico. Includes employer-sponsored plans, special needs plans, and other private plans.
SOURCE:  Authors’ analysis of CMS Medicare Advantage enrollment and Landscape files, 2015.

Table A2: Medicare Advantage Enrollment in the Individual and Group Markets, by State, 2015
State Total Individual plans Group plans % enrollees in group plans
Total U.S. 16,761,673 13,634,978 3,126,695 19%
Alabama 238,091 226,722 11,369 5%
Alaska 56 0 56 100%
Arizona 425,454 380,348 45,106 11%
Arkansas 114,326 109,552 4,774 4%
California 2,127,666 1,647,253 480,413 23%
Colorado 281,467 232,166 49,301 18%
Connecticut 157,692 142,843 14,849 9%
Delaware 13,841 10,656 3,185 23%
District of Columbia 11,033 7,738 3,295 30%
Florida 1,570,845 1,465,892 104,953 7%
Georgia 460,670 333,521 127,149 28%
Hawaii 110,465 83,119 27,346 25%
Idaho 87,837 86,197 1,640 2%
Illinois 371,007 217,198 153,809 41%
Indiana 264,104 218,813 45,291 17%
Iowa 81,541 76,739 4,802 6%
Kansas 61,600 57,017 4,583 7%
Kentucky 212,948 124,342 88,606 42%
Louisiana 232,445 213,612 18,833 8%
Maine 66,307 53,713 12,594 19%
Maryland 76,375 51,724 24,651 32%
Massachusetts 233,084 196,422 36,662 16%
Michigan 595,239 302,171 293,068 49%
Minnesota 480,474 437,232 43,242 9%
Mississippi 76,776 74,762 2,014 3%
Missouri 311,364 279,712 31,652 10%
Montana 34,758 32,961 1,797 5%
Nebraska 34,982 31,769 3,213 9%
Nevada 146,094 138,940 7,154 5%
New Hampshire 17,295 12,005 5,290 31%
New Jersey 222,846 170,491 52,355 23%
New Mexico 113,807 94,595 19,212 17%
New York 1,212,239 999,021 213,218 18%
North Carolina 512,924 385,512 127,412 25%
North Dakota 17,878 17,775 103 1%
Ohio 811,503 500,372 311,131 38%
Oklahoma 111,013 100,538 10,475 9%
Oregon 323,765 272,682 51,083 16%
Pennsylvania 1,001,864 798,441 203,423 20%
Rhode Island 71,009 65,268 5,741 8%
South Carolina 209,812 195,819 13,993 7%
South Dakota 26,400 26,006 394 1%
Tennessee 412,042 389,994 22,048 5%
Texas 1,098,678 909,082 189,596 17%
Utah 113,034 109,107 3,927 3%
Vermont 8,984 7,338 1,646 18%
Virginia 206,427 179,573 26,854 13%
Washington 348,467 304,472 43,995 13%
West Virginia 99,454 44,273 55,181 55%
Wisconsin 388,732 347,663 41,069 11%
Wyoming 2,071 1,681 390 19%

NOTE:  Total U.S. includes Puerto Rico.
SOURCE:  Authors’ analysis of CMS Medicare Advantage enrollment and Landscape files, 2015.

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Table A6: Enrollment in Special Needs Plans (SNPs), by Plan Type and State, 2015
State Enrollment in Special Needs Plans Total Dual Eligibles (in 2013) % of Dual Eligibles in D-SNPs
Total Dual eligibles
(D-SNPs)
Institutional
(I-SNPs)
Chronic or disabling conditions
(C-SNPs)
Total U.S. 2,011,505 1,657,554 48,740 305,211 10,705,500 15%
Alabama 48,409 48,391 136 220,060 22%
Alaska 16,520 0%
Arizona 95,008 75,703 1,746 17,559 186,160 41%
Arkansas 24,389 12,308 12,081 136,060 9%
California 214,208 170,334 3,645 40,229 1,358,140 13%
Colorado 12,773 10,270 2,425 78 102,800 10%
Connecticut 12,242 9,742 2,500 173,400 6%
Delaware 2,223 885 457 881 29,100 3%
District of Columbia 3,394 3,218 68 108 30,940 10%
Florida 266,831 205,219 3,196 58,416 787,040 26%
Georgia 87,737 44,328 2,236 41,173 317,440 14%
Hawaii 19,118 19,118 39,120 49%
Idaho 1,460 1,460 42,840 3%
Illinois 11,648 9,547 615 1,486 382,340 2%
Indiana 4,454 821 93 3,540 190,460 <1%
Iowa 585 169 416 90,640 <1%
Kansas 289 227 62 70,860 0%
Kentucky 3,977 3,505 472 194,180 2%
Louisiana 27,784 26,293 1,491 214,220 12%
Maine 1,548 1,548 102,000 2%
Maryland 11,164 4,839 2,808 3,517 139,100 3%
Massachusetts 34,195 33,794 191 210 302,300 11%
Michigan 18,966 18,664 198 104 321,400 6%
Minnesota 36,188 36,188 146,460 25%
Mississippi 13,752 12,036 1,716 169,580 7%
Missouri 23,756 10,871 21 12,864 200,440 5%
Montana 27,380 0%
Nebraska 364 364 45,920 0%
Nevada 8,511 15 8,496 54,940 0%
New Hampshire 19 19 34,240 0%
New Jersey 11,207 9,526 1,460 221 226,420 4%
New Mexico 10,950 9,991 297 662 76,080 13%
New York 192,449 177,861 14,276 312 857,220 21%
North Carolina 21,052 16,157 2,417 2,478 342,720 5%
North Dakota 17,580 0%
Ohio 13,453 11,201 1,203 1,049 369,500 3%
Oklahoma 115 115 123,600 0%
Oregon 25,460 21,675 581 3,204 118,820 18%
Pennsylvania 119,052 103,998 2,927 12,127 456,240 23%
Rhode Island 1,538 14 1,524 42,080 0%
South Carolina 58,005 22,242 35,763 162,020 14%
South Dakota 21,920 0%
Tennessee 68,356 68,356 287,800 24%
Texas 163,979 133,966 198 29,815 726,120 18%
Utah 8,155 8,155 38,100 21%
Vermont 30,900 0%
Virginia 3,817 1,329 89 2,399 201,920 1%
Washington 24,563 23,084 1,479 189,940 12%
West Virginia 133 133 88,180 <1%
Wisconsin 21,109 18,454 1,612 1,043 176,620 10%
Wyoming 12,160 0%

NOTE: Total U.S. includes Puerto Rico. Blank cells indicate no plans offered.
SOURCE: Authors’ analysis of CMS Medicare Advantage enrollment and Landscape files, 2015.  Number of dual eligibles by state is derived from the CMS Chronic Conditions Data Warehouse standard analytic files for 2013.

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