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Medicare Advantage 2016 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 2.0 million to 2.1 million beneficiaries between 2015 and 2016 (Figure A1 and Table A8). In 2016, 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 five states and the District of Columbia, enrollment in SNPs comprises more than one-fifth of Medicare Advantage enrollment (35% in DC, 28% in SC, 22% in AZ, 21% in AR, and 20% in AL and MS; data not shown).

Figure A1: Number of Beneficiaries in Special Needs Plans, by Type, 2006 – 2016

Figure A1: Number of Beneficiaries in Special Needs Plans, by Type, 2006 – 2016

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 (50%) and Arizona (40%) (Table A8).

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. As of March 2016, more than 400,000 dual eligibles were enrolled in the demonstrations (Table A9). Most of 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 the state’s D-SNPs. In most states operating demonstrations for dual eligibles, enrollment in D-SNPs has increased since the demonstrations began in 2013. In the few states in which enrollment in D-SNPs has declined since 2013 (CA, MI, and MN), the decline has been much smaller than the total enrollment in the state demonstration. As a consequence, in all states operating demonstrations, the total number of dual eligibles in capitated Medicare arrangements has increased since 2013. It is unclear whether D-SNPs will continue to operate alongside the demonstrations in these states or how the demonstrations will affect the growth in D-SNP enrollment over time.

Appendix B: Tables

Table A1. Medicare Advantage Enrollment by State and Plan Type, 2016
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. 17,625,200 64% 23% 7% 1% 3% <1%
Alabama 257,218 61% 33% 6% <1% 0% <1%
Alaska 93 0% 100% 0% 0% 0% 0%
Arizona 442,282 92% 6% 2% 1% <1% 0%
Arkansas 121,543 42% 16% 26% 16% 0% <1%
California 2,244,709 96% 3% 0% <1% <1% <1%
Colorado 293,275 81% 9% 0% 1% 8% 1%
Connecticut 165,722 86% 11% 3% 0% 0% 0%
Delaware 16,792 55% 44% 0% 0% 0% 1%
District of Columbia 12,292 15% 36% 0% 0% 49% 0%
Florida 1,670,266 71% 7% 22% <1% <1% <1%
Georgia 508,161 32% 44% 22% 2% 0% 0%
Hawaii 113,451 41% 56% 3% 0% 0% 0%
Idaho 90,435 56% 43% 0% 1% 0% 0%
Illinois 405,756 45% 52% 2% 1% <1% 0%
Indiana 279,338 24% 57% 18% 1% 0% <1%
Iowa 98,790 30% 60% 0% 1% 9% <1%
Kansas 67,733 43% 48% 2% 6% 0% <1%
Kentucky 229,916 20% 56% 22% 1% 0% 0%
Louisiana 249,920 87% 5% 8% <1% 0% <1%
Maine 75,116 63% 32% 0% 5% 0% 0%
Maryland 88,998 31% 25% 0% 0% 44% <1%
Massachusetts 246,018 76% 18% 4% 0% 0% 1%
Michigan 621,118 39% 56% 4% 1% 0% <1%
Minnesota 510,713 23% 7% 0% <1% 69% 0%
Mississippi 85,208 53% 16% 29% 2% 0% 0%
Missouri 337,119 66% 21% 11% 2% 0% <1%
Montana 39,200 4% 91% 0% 5% 0% 0%
Nebraska 37,169 59% 24% <1% 17% <1% <1%
Nevada 157,379 89% 11% 0% 0% 0% 0%
New Hampshire 20,756 51% 30% 0% 19% 0% 0%
New Jersey 245,651 74% 25% <1% 0% 0% <1%
New Mexico 120,099 64% 35% 0% 1% 0% <1%
New York 1,243,714 73% 16% 8% 2% <1% <1%
North Carolina 547,079 44% 49% 6% 1% 0% <1%
North Dakota 21,627 0% 7% 0% <1% 92% 1%
Ohio 748,125 53% 38% 7% <1% 1% <1%
Oklahoma 116,489 66% 27% 3% 4% 0% <1%
Oregon 339,461 63% 36% 0% <1% 0% <1%
Pennsylvania 1,022,462 63% 35% 1% 1% 0% <1%
Rhode Island 72,954 94% 4% 2% 0% 0% <1%
South Carolina 224,130 30% 20% 46% 4% 0% <1%
South Dakota 31,158 <1% 22% 0% 1% 76% 0%
Tennessee 440,394 69% 29% 2% 0% 0% <1%
Texas 1,174,621 58% 24% 13% 2% 2% <1%
Utah 120,237 82% 18% 0% 0% 0% 0%
Vermont 9,671 11% 18% 52% 19% 0% 0%
Virginia 219,382 40% 25% 12% 13% 9% 1%
Washington 360,712 86% 14% 0% <1% 0% <1%
West Virginia 103,805 8% 82% 5% 5% 0% 0%
Wisconsin 410,771 48% 32% 4% 3% 13% 1%
Wyoming 2,079 8% 18% 0% 69% 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, 2016.
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Table A4. Weighted Average Premiums and the Share of Enrollees with Zero Premium in Medicare Advantage Prescription Drug Plans
(MA-PDs), 2010-2016
2010 2011 2012 2013 2014 2015 2016
Weighted Average Monthly Premiums for MA-PDs
Total $44 $39 $35 $35 $35 $38 $37
HMOs $36 $34 $29 $27 $27 $28 $28
Local PPOs $66 $59 $53 $57 $59 $65 $63
Regional PPOs $29 $23 $26 $29 $32 $36 $37
PFFS Plans $55 $43 $42 $51 $63 $68 $76
Share of Enrollees in MA-PDs with Zero Premium
Total 48% 53% 56% 55% 56% 48% 49%
HMOs 59% 62% 65% 67% 66% 59% 59%
Local PPOs 23% 23% 29% 24% 25% 18% 22%
Regional PPOs 48% 63% 59% 49% 54% 39% 38%
PFFS Plans 15% 23% 29% 17% 17% 0% 0%
NOTE: Excludes SNPs, employer-sponsored (i.e., group) plans, demonstrations, HCPPs, PACE plans, and plans for special populations. Includes only Medicare Advantage plans that offer Part D benefits. The total includes cost plans (not shown separately), as well as plans with zero premiums. The premiums for a subset of sanctioned plans were not available in 2011; these plans were excluded from this analysis. Excludes beneficiaries with unknown county addresses and beneficiaries in territories other than Puerto Rico.
SOURCE: Authors’ analysis of CMS’s Landscape Files for 2010–2016 and March Enrollment files for 2010-2016.

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Table A7. Medicare Advantage Market Share by Firm, by State, 2016
State Total Medicare Advantage Enrollment Medicare Advantage Penetration Rate Humana
Medicare Advantage Market Share
Aetna
Medicare Advantage
Market Share
Combined
Aetna-Humana
Market Share
Cigna
Medicare Advantage
Market Share
Anthem
Medicare Advantage Market Share
Combined Anthem-Cigna Market Share
Total U.S. 17,625,200 31% 18% 7% 25% 3% 3% 6%
Alabama 257,218 26% 20% 1% 21% 23% <1% 23%
Alaska 93 <1% 39% 39%
Arizona 442,282 38% 12% 1% 13% 12% 3% 14%
Arkansas 121,543 20% 35% 7% 42% 2% 2%
California 2,244,709 39% 3% 1% 4% 4% 4%
Colorado 293,275 36% 13% 1% 14% <1% <1%
Connecticut 165,722 26% 0% 21% 21% 8% 8%
Delaware 16,792 9% 10% 44% 53% 34% 34%
District of Columbia 12,292 14% 0% 7% 7% 8% 8%
Florida 1,670,266 41% 36% 6% 42% 3% 2% 5%
Georgia 508,161 33% 22% 10% 32% 9% 1% 9%
Hawaii 113,451 46% 12% <1% 12%
Idaho 90,435 31% 9% <1% 9%
Illinois 405,756 19% 25% 11% 36% 5% <1% 5%
Indiana 279,338 24% 37% 3% 40% 1% 15% 16%
Iowa 98,790 17% 20% 36% 56%
Kansas 67,733 14% 42% 43% 86% 1% 1%
Kentucky 229,916 26% 60% 2% 62% 16% 16%
Louisiana 249,920 31% 65% 1% 66%
Maine 75,116 24% 6% 22% 29% 3% 3%
Maryland 88,998 9% 2% 8% 10% 16% 16%
Massachusetts 246,018 20% <1% 1% 1% <1% <1%
Michigan 621,118 32% 9% 2% 11%
Minnesota 510,713 55% 6% <1% 7%
Mississippi 85,208 15% 63% 1% 64% 13% 13%
Missouri 337,119 29% 20% 29% 48% <1% 2% 2%
Montana 39,200 19% 14% <1% 15%
Nebraska 37,169 12% 14% 33% 47%
Nevada 157,379 34% 33% 4% 37% 4% 4%
New Hampshire 20,756 8% 15% 2% 17% 12% 12%
New Jersey 245,651 16% 0% 26% 26% <1% 3% 3%
New Mexico 120,099 32% 13% 1% 14% 2% 2%
New York 1,243,714 37% 2% 5% 7% 6% 6%
North Carolina 547,079 30% 33% 10% 43% 2% 2%
North Dakota 21,627 18% 7% 0% 7%
Ohio 748,125 34% 16% 25% 41% 25% 25%
Oklahoma 116,489 17% 28% 3% 31%
Oregon 339,461 44% 1% <1% 1%
Pennsylvania 1,022,462 40% 4% 21% 25% 5% <1% 5%
Rhode Island 72,954 35% <1% <1%
South Carolina 224,130 23% 44% 2% 46% 5% <1% 5%
South Dakota 31,158 20% 16% 6% 23%
Tennessee 440,394 35% 30% 1% 31% 21% 2% 23%
Texas 1,174,621 32% 24% 13% 37% 10% 3% 12%
Utah 120,237 34% 6% 8% 15%
Vermont 9,671 7% <1% 2% 2%
Virginia 219,382 16% 60% 5% 65% 3% 3%
Washington 360,712 30% 9% <1% 9% <1% <1%
West Virginia 103,805 25% 70% 16% 86%
Wisconsin 410,771 38% 18% <1% 18% 1% 1%
Wyoming 2,079 2% 3% 9% 11%
NOTE: Totals may not sum to 100% due to rounding. Includes employer-sponsored plans, special needs plans, and other private plans. Total U.S. includes Puerto Rico. Blank cells indicate no plans offered. Anthem includes BCBS plans and other plans.
SOURCE: Authors’ analysis of CMS Medicare Advantage enrollment and Landscape files, 2016.
Table A8.   Enrollment in Special Needs Plans (SNPs), by Plan Type and State, 2016
State Enrollment in Special Needs Plans Total Dual Eligibles (in 2014) % of Dual Eligibles in D-SNPs
Total Dual eligibles
(D-SNPs)
Institutional
(I-SNPs)
Chronic or disabling conditions (C-SNPs)
Total U.S. 1,852,085 1,482,050 55,439 314,596 11,063,740 13%
Alabama 51,365 51,103 262 0 222,740 23%
Alaska 0 0 0 0 17,420 0%
Arizona 96,389 80,156 2,192 14,041 199,180 40%
Arkansas 25,705 12,877 12,828 138,480 9%
California 191,776 145,860 2,451 43,465 1,424,500 10%
Colorado 12,278 9,417 2,772 89 112,220 8%
Connecticut 17,222 14,310 2,912 0 181,120 8%
Delaware 2,232 988 520 724 30,440 3%
District of Columbia 4,253 4,045 80 128 32,580 12%
Florida 301,744 232,581 3,840 65,323 819,220 28%
Georgia 98,080 52,120 2,541 43,419 330,800 16%
Hawaii 20,068 20,068 0 0 39,860 50%
Idaho 2,120 2,120 0 0 45,980 5%
Illinois 14,249 11,561 944 1,744 402,620 3%
Indiana 3,130 1,720 753 657 205,580 1%
Iowa 0 0 0 0 91,920 0%
Kansas 285 0 228 57 71,540 0%
Kentucky 7,246 6,093 79 1,074 198,640 3%
Louisiana 33,419 31,084 0 2,335 218,100 14%
Maine 2,667 2,563 0 104 96,480 3%
Maryland 12,443 5,601 2,870 3,972 148,480 4%
Massachusetts 37,924 37,580 132 212 320,920 12%
Michigan 12,489 12,384 16 89 330,840 4%
Minnesota 36,591 36,591 0 0 149,660 24%
Mississippi 16,675 14,697 0 1,978 172,020 9%
Missouri 27,362 11,653 314 15,395 199,400 6%
Montana 33 33 0 0 27,420 <1%
Nebraska 11 11 0 0 45,340 <1%
Nevada 9,998 0 514 9,484 60,200 0%
New Hampshire 28 28 0 0 35,120 <1%
New Jersey 16,309 14,211 1,898 200 229,660 6%
New Mexico 13,443 13,142 301 0 86,000 15%
New York 218,678 201,444 16,474 760 900,480 22%
North Carolina 25,306 19,764 2,457 3,085 345,240 6%
North Dakota 0 0 0 0 17,540 0%
Ohio 17,368 14,294 1,131 1,943 376,040 4%
Oklahoma 156 0 156 0 124,120 0%
Oregon 27,872 22,193 748 4,931 128,180 17%
Pennsylvania 124,470 111,431 3,383 9,656 469,580 24%
Rhode Island 1,610 11 1,599 0 43,360 <1%
South Carolina 62,133 22,518 0 39,615 164,720 14%
South Dakota 0 0 0 0 22,880 0%
Tennessee 79,561 79,561 0 0 285,100 28%
Texas 162,745 130,210 229 32,306 740,940 18%
Utah 8,036 8,036 0 0 39,620 20%
Vermont 0 0 0 0 30,880 0%
Virginia 5,379 1,737 163 3,479 204,900 1%
Washington 26,226 24,574 1,652 0 200,040 12%
West Virginia 371 371 0 0 93,240 <1%
Wisconsin 24,640 21,309 1,828 1,503 180,020 12%
Wyoming 0 0 0 0 12,380 0%
NOTE: Excludes Puerto Rico. Blank cells indicate no plans offered.
SOURCE: Authors’ analysis of CMS Medicare Advantage enrollment and Landscape files, 2016. Number of dual eligibles by state is derived from the CMS Chronic Conditions Data Warehouse standard analytic files for 2014.
Table A9. Enrollment in Dual Eligible Special Needs Plans and Financial/Administrative Alignment Demonstrations, by State, 2016
State Enrollment in Dual Eligible Special Needs Plans (D-SNPs) Enrollment in Financial Alignment Demonstration
2013 2016 Change,
2013-2016
Total U.S. 1,099,100 1,482,050 382,950 365,826
Alabama 38,281 51,103 12,822 0
Alaska 0 0 0 0
Arizona 68,495 80,156 11,661 0
Arkansas 9,189 12,877 3,688 0
California 190,668 145,860 -44,808 126,057
Colorado 8,444 9,417 973 0
Connecticut 4,612 14,310 9,698 0
Delaware 733 988 255 0
District of Columbia 1,756 4,045 2,289 0
Florida 135,100 232,581 97,481 0
Georgia 17,500 52,120 34,620 0
Hawaii 15,442 20,068 4,626 0
Idaho 662 2,120 1,458 0
Illinois 5,617 11,561 5,944 48,192
Indiana 2,998 1,720 -1,278 0
Iowa 726 0 -726 0
Kansas 0 0 0 0
Kentucky 683 6,093 5,410 0
Louisiana 18,354 31,084 12,730 0
Maine 2,553 2,563 10 0
Maryland 5,480 5,601 121 0
Massachusetts 23,616 37,580 13,964 12,524
Michigan 15,490 12,384 -3,106 34,177
Minnesota 36,975 36,591 -384 36,591
Mississippi 9,336 14,697 5,361 0
Missouri 8,383 11,653 3,270 0
Montana 0 33 33 0
Nebraska 1,073 11 -1,062 0
Nevada 12 0 -12 0
New Hampshire 12 28 16 0
New Jersey 23,745 14,211 -9,534 0
New Mexico 6,076 13,142 7,066 0
New York 124,216 201,444 77,228 5,801
North Carolina 10,585 19,764 9,179 0
North Dakota 0 0 0 0
Ohio 11,754 14,294 2,540 62,177
Oklahoma 0 0 0 0
Oregon 19,271 22,193 2,922 0
Pennsylvania 93,372 111,431 18,059 0
Rhode Island 11 11 0
South Carolina 9,213 22,518 13,305 1,418
South Dakota 0 0 0 0
Tennessee 51,760 79,561 27,801 0
Texas 87,476 130,210 42,734 48,010
Utah 7,497 8,036 539 0
Vermont 0 0 0 0
Virginia 635 1,737 1,102 27,470
Washington 16,988 24,574 7,586 0
West Virginia 44 371 327 0
Wisconsin 14,278 21,309 7,031 0
Wyoming 0 0 0 0
NOTE: Excludes Puerto Rico. Blank cells indicate no plans offered. Excludes dual eligible beneficiaries enrolled in financial/administrative alignment demonstrations who are missing state designation. All enrollment is from March of the respective year.
SOURCE: Authors’ analysis of CMS Medicare Advantage enrollment and Landscape files, 2013 and 2016.
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