Medicare Advantage 2017 Spotlight: Enrollment Market Update

Gretchen Jacobson , Anthony Damico , Tricia Neuman Follow @tricia_neuman on Twitter , and Marsha Gold
Published: Jun 06, 2017

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
State	Total	% 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

Click to enlarge table

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

Click to enlarge table

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

Click to enlarge table

Table A6. Market Share of the Top Three Medicare Advantage Firms, by State, 2017
State	Total		Firm 1		Firm 2		Firm 3		Other Firms
State	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
State	Total	Dual eligibles (D-SNPs)	Chronic or disabling conditions (C-SNPs)	Institutional (I-SNPs)	Total Dual Eligibles (in 2014)	% of Dual Eligibles in D-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.

Issue Brief

Topics

Medicare