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Medicare Advantage 2016 Data Spotlight: Overview of Plan Changes

Box 1: Availability of Special Needs Plans in 2016
Special Needs Plans (SNPs) are a type of Medicare Advantage plan that was authorized in 2003 as part of the Medicare Prescription Drug, Improvement and Modernization Act (MMA) to provide a managed care option for beneficiaries with significant or relatively specialized health care needs. Medicare beneficiaries can enroll in a SNP if they are dually eligible for Medicare and Medicaid (D-SNPs), require an institutional-level of care (I-SNPs), or have a severe or chronic condition (C-SNP). Most SNPs are HMOs, but they can also be PPOs.

When SNPs were authorized, there were few requirements beyond those otherwise required of other Medicare Advantage plans. The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 established additional requirements for SNPs, including requiring all SNPs to provide a care management plan to document how care would be provided for enrollees and requiring C-SNPs to limit enrollment to beneficiaries with specific diagnoses or conditions. As a result of the MIPPA requirements, the number of SNPs declined in 2010. The ACA required D-SNPs to have a contract with the Medicaid agency for every state in which the plan operates, beginning in 2013. Additionally, in 2013, joint federal-state financial alignment demonstrations to improve the coordination of Medicare and Medicaid for dually eligible beneficiaries began to enroll beneficiaries. Today, financial alignment demonstrations are underway in 12 states: California, Colorado, Illinois, Massachusetts, Michigan, Minnesota, New York, Ohio, South Carolina, Texas, Virginia, and Washington. The financial alignment demonstrations could influence the availability of D-SNPs in these states, either increasing or decreasing the availability of SNPs, depending on the design of the demonstration.

In 2016, 550 SNPs will be available, similar to 548 plans available in 2015 (Figure 13; Table A7). The availability of SNPs will continue to vary across states in 2016, as it has in prior years. In 2016, at least one SNP of any type will be available in all states but eight (AK, IA, NE, ND, RI, SD, VT, and WY). While Montana did not have SNPs available in 2015, 1 new D-SNP will be available in Montana in 2016, and similarly while New Hampshire did not have SNPs available in 2015, 1 new I-SNP will be available in the state in 2016. In Iowa, Nebraska, and Rhode Island, SNPs were available in 2015 but will not be available in these states in 2016. As in past years, SNPs will be most numerous in selected high population states, notably Florida (94 plans), California (72 plans), and New York (53 plans).

The total number of D-SNPs will slightly increase from 339 plans to 342 plans between 2015 and 2016, with some variation across states. In Florida, the number of D-SNPs increased from 49 plans in 2015 to 58 plans in 2016. Other states will experience smaller changes in the availability of D-SNPs. Notably, states with ongoing financial alignment demonstrations to improve the coordination of Medicare and Medicaid for dual eligibles will not see large changes, if any, in the number of available D-SNPs between 2015 and 2016. The total number of C-SNPs will decline from 152 plans in 2015 to 139 plans in 2016, and the total number of I-SNPs will increase from 57 plans in 2015 to 69 plans in 2016. With the exception of Florida where the number of C-SNPs will decrease from 39 plans to 30 plans, no states will experience large changes in the availability of C-SNPs and I-SNPs between 2015 and 2016. Similar to prior years, most C-SNPs (66%) will focus on diabetes, chronic heart failure, or cardiovascular disorders.

Figure 13: Distribution of Special Needs Plans by Plan Type, 2007-2016

Figure 13: Distribution of Special Needs Plans by Plan Type, 2007-2016

Table A1. Medicare Advantage Plan Market Entries and Exits, Average Monthly Premiums and Average Out-of-Pocket Spending Limits for Medicare Advantage Prescription Drug plans (MA-PDs), Weighted by 2015 Enrollment, 2015-2016
All Medicare Advantage Plans (MA-PD and MA-only plans) All plans HMO Local PPO PFFS Regional PPO Cost MSA
2015 Plan Total 1,945 1,275 465 69 43 86 7
Total number of staying plans 1,742 1,151 413 55 43 79 1
Number of staying plans with no service area reductions 1,565 983 365 33 43 76 1
Number of staying plans with reduced service areas 111 64 33 14
Number of consolidating plans, post consolidation 66 40 15 8 3
Total number of departing plans 203 124 52 14 7 6
Number of plans departing due to consolidation 78 46 19 10 3
Number of terminating plans 125 78 33 4 4 6
Number of new plans 259 200 48 2 4 2 3
2016 Plan Total 2,001 1,351 461 57 47 81 4
Total Medicare Advantage enrollees, as of September 2015 11,637,572 7,988,548 1,991,109 249,694 995,330 400,924 11,967
Number of staying plans’ enrollees 11,309,785 7,809,203 1,865,672 239,000 995,330 399,643 937
Number of enrollees losing access to their plan 327,787 179,345 125,437 10,694 1,281 11,030
Average premiums of MA-PDs, weighted by 2015 enrollment
Premiums for all plans, 2015 $37.63 $27.94 $63.38 $51.75 $31.49 $110.23 N/A
Terminating plans, 2015 $40.57 $26.19 $63.41 $53.66 N/A $58.26 N/A
Staying plans, 2015 $37.54 $27.98 $63.37 $51.67 $31.49 $110.39 N/A
2016 Premiums for remaining 2015 plans $40.63 $30.51 $68.36 $58.14 $33.59 $116.26 N/A
Change in premiums for plans available in both 2015 and 2016 $3.09 $2.52 $4.98 $6.47 $2.10 $5.86 N/A
Share of enrollees in MA-PDs with no premiums, among plans available in both 2015 and 2016
2015 48% 59% 19% 8% 45% 1% N/A
2016 46% 56% 19% 6% 45% 1% N/A
Change in share of plans with no premiums -2% -3% 0% -1% 0% 0% N/A
Average premiums paid per enrollee, among MA-PDs with premiums (excluding zero premium plans) and available in both 2015 and 2016
2015 $72.25 $68.30 $77.96 $55.96 $57.47 $111.76 N/A
2016 $75.39 $69.75 $84.13 $62.02 $61.30 $117.69 N/A
Average out-of-pocket spending limits per year among MA-PDs, weighted by 2015 enrollment, among plans available in both 2015 and 2016
2015 $5,043 $4,850 $5,257 N/A $6,651 $3,280 N/A
2016 $5,235 $5,010 $5,688 N/A $6,619 $3,531 N/A
Change in average out-of-pocket spending limits $193 $160 $431 N/A -$32 $251 N/A
Total MA-PD enrollees, as of September 2015 11,038,587 7,819,071 1,956,315 173,839 889,195 200,167
Number of staying MA-PDs’ enrollees 10,729,142 7,644,846 1,831,671 164,544 889,195 198,886
Number of enrollees losing access to their MA-PD 309,445 174,225 124,644 9,295 1,281
NOTE: Excludes Special Needs Plans (SNPs), demonstrations, Health Care Prepayment Plans (HCPPs), Program of All Inclusive Care for the Elderly (PACE) plans, employer-sponsored (i.e., group) plans, and plans for special populations.
SOURCE: Authors’ analysis of CMS’s Landscape Files for 2015 and 2016 and CMS’s 2015 and 2016 Part C and D Crosswalk file and September 2015 enrollment.
Table A2. Average Number of Plans Available to Beneficiaries by County of Residence, 2009-2016
2009 2010 2011 2012 2013 2014 2015 2016
National Average 48 33 24 20 20 18 18 19
Metro counties 51 35 26 22 22 20 20 21
Non-metro counties 36 24 16 13 13 11 10 11
Fee-for-Service Costs, by Quartile
Lowest cost quartile 45 28 18 17 17 17 15 15
Second quartile 46 31 20 17 16 15 14 15
Third quartile 44 30 20 17 18 16 16 17
Highest cost counties 53 37 30 24 24 21 22 23
NOTE: Excludes SNPs, employer-sponsored (i.e., group) plans, demonstrations, HCPPs, PACE plans, and plans for special populations.
SOURCE: Authors’ analysis of CMS’s Landscape and Penetration Files for 2009 – 2016.
Table A3.   Unweighted Average Monthly Premiums for Medicare Advantage Prescription Drug Plans, by Plan Type, 2009-2016
2009 2010 2011 2012 2013 2014 2015 2016 Change, 2015-2016
All Plans $51.81 $55.86 $50.61 $49.80 $51.43 $51.47 $53.42 $52.57 -$0.85
HMOs $34.52 $40.11 $36.24 $33.20 $34.11 $35.37 $38.28 $39.14 $0.86
Local PPOs $65.12 $70.17 $65.72 $69.14 $72.57 $74.92 $81.02 $78.61 -$2.41
PFFS plans $74.46 $75.09 $65.79 $70.96 $83.29 $90.93 $87.86 $91.40 $3.54
Regional PPOs $55.68 $59.29 $53.38 $55.64 $56.89 $59.30 $67.85 $74.93 $7.08
NOTE: Excludes SNPs, demonstrations, HCPPs, PACE plans, employer-sponsored (i.e., group) plans, and plans for special populations. Premiums include plans with premiums as well as plans with no premiums. Cost plans are included in the total but are not shown separately.
SOURCE: Authors’ analysis of CMS’s Landscape Files for 2009-2016.

Table A4.  Number of Medicare Advantage Plans Available, by Plan Type and Firm, 2009-2016

8812 Table A4
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Table A5.  Share of Medicare Beneficiaries with Access to Firms’ Medicare Advantage Plan Offerings, by Plan Type and Firm, 2009-2016

8812 Table A5
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Table A6.   Unweighted Average Monthly Premiums for Medicare Advantage Prescription Drug Plans, by Plan Type and Firm, 2015 and 2016
2015 2016
All HMOs Local PPOs PFFS Plans Regional PPOs Cost Plans All HMOs Local PPOs PFFS Plans Regional PPOs Cost Plans
All Plans Combined $53.42 $38.28 $81.02 $87.86 $67.85 $141.09 $52.57 $39.14 $78.61 $91.40 $74.93 $146.14
UnitedHealthCare $26.59 $26.23 $29.62 $43.00 $20.17 N/A $26.37 $24.68 $35.91 $50.00 $32.25 N/A
Humana $47.42 $18.73 $73.09 $93.90 $87.29 N/A $46.90 $19.99 $71.44 $99.58 $88.88 N/A
BCBS – Total $76.14 $50.34 $108.93 $41.95 $53.03 $108.40 $70.64 $49.55 $103.87 $56.48 $56.97 $102.27
Anthem BCBS $37.94 $12.14 $80.75 N/A $61.50 N/A $37.48 $19.45 $78.44 N/A $65.50 N/A
Other BCBS plans $85.57 $61.39 $114.35 $41.95 $36.10 $108.40 $79.41 $59.21 $108.59 $56.48 $39.90 $102.27
Kaiser Permanente $48.86 $47.50 N/A N/A N/A $72.00 $52.92 $52.50 N/A N/A N/A $57.67
Aetna $37.68 $31.34 $47.46 N/A N/A N/A $43.01 $33.86 $52.90 N/A $154.00 N/A
WellCare $7.10 $7.10 N/A N/A N/A N/A $5.60 $5.60 N/A N/A N/A N/A
CIGNA $23.89 $23.34 $33.75 N/A N/A N/A $28.24 $27.96 $33.75 N/A N/A N/A
Other $61.72 $49.11 $90.15 $64.40 N/A $148.04 $62.90 $51.58 $87.25 $76.94 N/A $160.33
NOTE: Excludes SNPs, demonstrations, HCPPs, PACE plans, employer-sponsored (i.e., group) plans, and plans for special populations. BCBS are BlueCross BlueShield affiliates, which includes Anthem BCBS plans. In 2015, Aetna includes plans acquired through the merger with Coventry.   Premiums include plans with premiums as well as plans with no premiums. N/A indicates plan not available.
SOURCE: Authors’ analysis of CMS’s Landscape Files for 2015 and 2016.
Table A7.   Number and Type of Special Needs Plans, by State, 2015 and 2016
2015 2016
State Overall Dual eligibles Institutional Chronic conditions Overall Dual eligibles Institutional Chronic conditions
Alabama 5 4 1 0 6 4 2 0
Alaska 0 0 0 0 0 0 0 0
Arizona 34 22 2 10 33 21 4 8
Arkansas 8 5 0 3 7 4 0 3
California 69 29 2 38 72 31 4 37
Colorado 8 4 3 1 9 4 3 2
Connecticut 3 2 1 0 4 2 2 0
Delaware 4 1 2 1 3 1 1 1
District of Columbia 7 3 2 2 5 2 1 2
Florida 92 49 4 39 94 58 6 30
Georgia 16 10 2 4 14 8 2 4
Hawaii 4 4 0 0 5 5 0 0
Idaho 1 1 0 0 1 1 0 0
Illinois 10 6 1 3 10 5 2 3
Indiana 8 3 1 4 8 4 2 2
Iowa 3 1 0 2 0 0 0 0
Kansas 2 0 1 1 2 0 1 1
Kentucky 10 6 0 4 13 8 1 4
Louisiana 14 10 0 4 13 9 0 4
Maine 3 3 0 0 4 2 1 1
Maryland 9 2 3 4 10 3 3 4
Massachusetts 10 6 3 1 9 7 1 1
Michigan 12 8 3 1 6 4 1 1
Minnesota 9 9 0 0 9 9 0 0
Mississippi 8 6 0 2 6 4 0 2
Missouri 10 4 2 4 12 3 5 4
Montana 0 0 0 0 1 1 0 0
Nebraska 1 0 0 1 0 0 0 0
Nevada 6 0 0 6 7 0 1 6
New Hampshire 0 0 0 0 1 0 1 0
New Jersey 8 3 4 1 9 4 3 2
New Mexico 7 4 2 1 3 2 1 0
New York 56 40 10 6 53 37 11 5
North Carolina 11 6 1 4 14 7 2 5
North Dakota 0 0 0 0 0 0 0 0
Ohio 18 11 3 4 18 11 4 3
Oklahoma 1 0 1 0 1 0 1 0
Oregon 12 7 4 1 11 7 3 1
Pennsylvania 21 10 6 5 21 11 6 4
Puerto Rico 16 12 0 4 15 13 0 2
Rhode Island 1 0 1 0 0 0 0 0
South Carolina 8 3 1 4 8 3 1 4
South Dakota 0 0 0 0 0 0 0 0
Tennessee 7 6 1 0 8 7 1 0
Texas 31 21 3 7 31 22 2 7
Utah 2 2 0 0 2 2 0 0
Vermont 0 0 0 0 0 0 0 0
Virginia 11 2 4 5 9 2 3 4
Washington 6 5 1 0 8 6 2 0
West Virginia 1 1 0 0 1 1 0 0
Wisconsin 19 15 3 1 18 13 4 1
Wyoming 0 0 0 0 0 0 0 0
Total, U.S. 548 339 57 152 550 342 69 139
NOTE: Columns do not sum to U.S. total because some SNPs overlap state boundaries.
SOURCE: Authors’ analysis of CMS’s Landscape Files for 2015-2016.
Discussion

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