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
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. |
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| 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% |
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NOTE: Total U.S. includes Puerto Rico. |
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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) |
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| 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% |
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NOTE: Total U.S. includes Puerto Rico. Blank cells indicate no plans offered. |
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