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Medicare Advantage Plans in 2017: Short-term Outlook is Stable

Box 1: Availability of Special Needs Plans in 2017
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 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.

In 2017, 578 SNPs will be available, similar years since 2013 (Figure 16; Table A6). The availability of SNPs will continue to vary across states. In 2017, at least one SNP of any type will be available in all states but six (AK, IA, ND, SD, VT, and WY). SNPs were not available in Nebraska and Rhode Island in 2016 but will be available in 2017; Nebraska will have one D-SNP and Rhode Island will have one D-SNP and two I-SNPs. As in past years, SNPs will be most numerous in selected high population states, notably Florida (97 plans), California (70 plans), and New York (45 plans).

The total number of D-SNPs will increase from 342 plans to 373 plans between 2016 and 2017, and the number of C-SNPs will decline from 139 plans in 2016 to 122 plans in 2017. Similar to prior years, most C-SNPs (72%) will focus on diabetes, chronic heart failure, or cardiovascular disorders. The total number of I-SNPs will increase from 69 plans in 2016 to 83 plans in 2017, and six new companies will offer I-SNPs for the first time in 2017 (accounting for 8% of plans).

Figure 16: Distribution of Special Needs Plans by Plan Type, 2007-2017

Figure 16: Distribution of Special Needs Plans by Plan Type, 2007-2017

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 2016 Enrollment, 2016-2017
All Medicare Advantage Plans (MA-PD and MA-only plans) All plans HMO Local PPO PFFS Regional PPO Cost MSA
2016 Plan Total  2,001  1,351  461  57  47  81  4
Total number of staying plans  1,763  1,193  400  47  47  72  4
Number of staying plans with no service area reductions  1,519  1,048  324  24  47  72  4
Number of staying plans with reduced service areas  185  99  63  23  –  –  –
Number of consolidating plans, post consolidation  59  46  13  –  –  –  –
Total number of departing plans  238  158  61  10  –  9  –
Number of plans departing due to consolidation  67  50  13  –  –  4  –
Number of terminating plans  171  108  48  10  –  5  –
Number of new plans  271  194  69  1  2  5  –
2017 Plan Total  2,034  1,387  469  48  49  77  4
Total Medicare Advantage enrollees, as of September 2016  12,282,452  8,496,896  2,065,184  225,353  1,065,036  427,283  2,700
Number of staying plans’ enrollees  11,867,742  8,223,231  1,951,216  198,751  1,065,036  426,808  2,700
Number of enrollees losing access to their plan  414,710  273,665  113,968  26,602  –  475  –
Average premiums of MA-PDs, weighted by 2016 enrollment
Premiums for all plans, 2016 $37.24 $27.61 $61.59 $55.82 $32.89 $112.38 $0.00
Terminating plans, 2016 $41.83 $25.41 $78.57 $52.76 N/A $71.02 N/A
Staying plans, 2016 $37.08 $27.69 $60.60 $56.23 $32.89 $112.42 $0.00
2017 Premiums for remaining 2016 plans $38.61 $29.12 $62.41 $60.96 $34.53 $112.68 $0.00
Change in premiums for plans available in both 2016 and 2017 $1.53 $1.44 $1.82 $4.73 $1.64 $0.26 $0.00
Share of enrollees in MA-PDs with no premiums, among plans available in both 2016 and 2017
2016 49% 59% 24% 8% 45% 1% 100%
2017 48% 58% 24% 8% 45% 1% 100%
Change in share of plans with no premiums -1% -1% 0% 0% 0% 0% 0%
Average premiums paid per enrollee, among MA-PDs with premiums (excluding zero premium plans) and available in both 2016 and 2017
2016 $73.11 $67.99 $79.98 $60.91 $59.60 $113.90 N/A
2017 $74.84 $69.39 $82.29 $66.03 $62.58 $114.16 N/A
Average out-of-pocket spending limits per year among MA-PDs, weighted by 2016 enrollment, among plans available in both 2016 and 2017
2016 $5,204 $4,974 $5,661 N/A $6,595 $3,538 N/A
2017 $5,235 $4,974 $5,817 N/A $6,605 $3,698 N/A
Change in average out-of-pocket spending limits $32 $1 $156 N/A $10 $160 N/A
Total MA-PD enrollees, as of September 2016  11,668,604  8,343,955  2,032,438  132,299  951,002  208,910  –
Number of staying MA-PDs’ enrollees  11,284,612  8,072,317  1,920,084  132,299  951,002  208,910  –
Number of enrollees losing access to their MA-PD  383,992  271,638  112,354  –  –  –  –
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 2016 and 2017 and CMS’s 2016 and 2017 Part C and D Crosswalk file and September 2016 enrollment.
Table A2.  Average Number of Plans Available to Beneficiaries by County of Residence, 2009-2017
2009 2010 2011 2012 2013 2014 2015 2016 2017
National Average 48 33 24 20 20 18 18 19 19
Metro counties 51 35 26 22 22 20 20 21 21
Non-metro counties 36 24 16 13 13 11 10 11 11
Fee-for-Service Costs, by Quartile
Lowest cost quartile 45 28 18 17 17 17 15 15 15
Second quartile 46 31 20 17 16 15 14 15 15
Third quartile 44 30 20 17 18 16 16 17 17
Highest cost counties 53 37 30 24 24 21 22 23 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 – 2017.
Table A3.  Unweighted Average Monthly Premiums for Medicare Advantage Prescription Drug Plans, by Plan Type, 2009-2017
2009 2010 2011 2012 2013 2014 2015 2016 2017 Change, 2016-2017
 All Plans $51.81 $55.86 $50.61 $49.80 $51.43 $51.47 $53.42 $52.57 $50.97 -$1.60
 HMOs $34.52 $40.11 $36.24 $33.20 $34.11 $35.37 $38.28 $39.14 $38.81 -$0.33
 Local PPOs $65.12 $70.17 $65.72 $69.14 $72.57 $74.92 $81.02 $78.61 $72.91 -$5.70
 PFFS plans $74.46 $75.09 $65.79 $70.96 $83.29 $90.93 $87.86 $91.40 $92.43 $1.03
 Regional PPOs $55.68 $59.29 $53.38 $55.64 $56.89 $59.30 $67.85 $74.93 $80.84 $5.91
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 – 2017.
Table A4.  Number of Medicare Advantage Plans Available, by Plan Type and Firm, 2015-2017
All HMOs Local PPOs PFFS Plans Regional PPOs Cost Plans
2015 2016 2017 2015 2016 2017 2015 2016 2017 2015 2016 2017 2015 2016 2017 2015 2016 2017
Number of Plans – Total 1945 2001 2034 1275 1351 1387 465 461 469 69 57 48 43 47 49 86 81 77
UnitedHealthCare 164 223 272 132 187 234 22 24 25 2 2 2 8 10 11 0 0 0
Humana 395 362 337 195 184 164 116 106 105 53 41 37 31 31 31 0 0 0
BCBS – Total 291 311 316 163 189 194 110 110 109 4 2 3 4 4 4 6 6 6
Anthem BCBS 54 62 65 35 45 48 16 14 14 0 0 0 3 3 3 0 0 0
Other BCBS plans 237 249 251 128 144 146 94 96 95 4 2 3 1 1 1 6 6 6
Kaiser Permanente 39 41 41 34 34 34 0 0 0 0 0 0 0 0 0 5 6 6
Aetna 195 203 233 121 119 113 74 82 117 0 0 0 0 2 3 0 0 0
WellCare 40 49 50 40 49 50 0 0 0 0 0 0 0 0 0 0 0 0
Cigna 43 46 43 40 43 41 3 3 2 0 0 0 0 0 0 0 0 0
Other 778 766 742 550 546 557 140 136 111 10 12 6 0 0 0 75 69 65
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.  Total includes MSAs, which are not shown separately.  For earlier years of data, see See Jacobson G, Gold M, Damico A, Neuman T, and Casillas, G. “Medicare Advantage 2016 Data Spotlight: Overview of Plan Changes.” December 2015. http://kff.org/medicare/issue-brief/medicare-advantage-2016-data-spotlight-overview-of-plan-changes/
SOURCE: Authors’ analysis of CMS’s Landscape Files for 2015 – 2017.
Table A5.  Share of Medicare Beneficiaries with Access to Firms’ Medicare Advantage Plan Offerings, by Plan Type and Firm, 2015-2017
Any Plan HMOs Local PPOs PFFS Plans Regional PPOs Cost Plans
Firm 2015 2016 2017 2015 2016 2017 2015 2016 2017 2015 2016 2017 2015 2016 2017 2015 2016 2017
UnitedHealthcare 69% 70% 74% 49% 55% 61% 18% 13% 10% 2% 2% 2% 32% 32% 33% 0% 0% 0%
Humana 86% 85% 83% 56% 58% 56% 54% 53% 58% 44% 43% 39% 61% 61% 61% 0% 0% 0%
BCBS – Total 71% 72% 72% 54% 58% 58% 46% 45% 41% 1% 1% 3% 15% 15% 15% 2% 2% 2%
Anthem BCBS plans 21% 24% 24% 15% 20% 22% 9% 9% 8% 0% 0% 0% 8% 8% 8% 0% 0% 0%
Other BCBS plans 58% 55% 55% 46% 44% 43% 37% 36% 33% 1% 1% 3% 7% 7% 7% 2% 2% 2%
Kaiser Permanente 15% 17% 17% 13% 13% 13% 0% 0% 0% 0% 0% 0% 0% 0% 0% 2% 2% 2%
Aetna 45% 49% 56% 42% 43% 45% 33% 40% 52% 0% 0% 0% 0% 7% 7% 0% 0% 0%
Wellcare 25% 32% 29% 25% 32% 29% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%
Cigna 19% 20% 20% 19% 20% 20% 2% 2% 1% 0% 0% 0% 0% 0% 0% 0% 0% 0%
Others 79% 79% 79% 73% 73% 73% 30% 34% 28% 4% 4% 3% 0% 0% 0% 6% 6% 5%
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.  Any plan includes beneficiaries with access to an MSA (not shown separately).  For earlier years of data, see See Jacobson G, Gold M, Damico A, Neuman T, and Casillas, G. “Medicare Advantage 2016 Data Spotlight: Overview of Plan Changes.” December 2015. http://kff.org/medicare/issue-brief/medicare-advantage-2016-data-spotlight-overview-of-plan-changes/
SOURCE:  Authors’ analysis of CMS’s Landscape Files for 2015 – 2017.
 Table A6. Number and Type of Special Needs Plans, by State, 2016 and 2017
2016 2017
State Overall Dual eligibles Institutional Chronic conditions Overall Dual eligibles Institutional Chronic conditions
Alabama 6 4 2 0 6 4 2 0
Alaska 0 0 0 0 0 0 0 0
Arizona 33 21 4 8 30 19 4 7
Arkansas 7 4 0 3 7 5 0 2
California 72 31 4 37 70 28 4 38
Colorado 9 4 3 2 9 4 3 2
Connecticut 4 2 2 0 4 2 2 0
Delaware 3 1 1 1 6 2 3 1
District of Columbia 5 2 1 2 9 4 3 2
Florida 94 58 6 30 97 64 8 25
Georgia 14 8 2 4 20 12 3 5
Hawaii 5 5 0 0 6 6 0 0
Idaho 1 1 0 0 1 1 0 0
Illinois 10 5 2 3 8 3 2 3
Indiana 8 4 2 2 6 3 2 1
Iowa 0 0 0 0 0 0 0 0
Kansas 2 0 1 1 3 1 1 1
Kentucky 13 8 1 4 13 9 1 3
Louisiana 13 9 0 4 11 10 0 1
Maine 4 2 1 1 4 2 1 1
Maryland 10 3 3 4 12 3 5 4
Massachusetts 9 7 1 1 10 7 2 1
Michigan 6 4 1 1 6 4 1 1
Minnesota 9 9 0 0 10 10 0 0
Mississippi 6 4 0 2 6 6 0 0
Missouri 12 3 5 4 8 3 3 2
Montana 1 1 0 0 1 1 0 0
Nebraska 0 0 0 0 1 1 0 0
Nevada 7 0 1 6 7 0 1 6
New Hampshire 1 0 1 0 1 0 1 0
New Jersey 9 4 3 2 11 5 4 2
New Mexico 3 2 1 0 6 6 0 0
New York 53 37 11 5 45 31 11 3
North Carolina 14 7 2 5 9 6 2 1
North Dakota 0 0 0 0 0 0 0 0
Ohio 18 11 4 3 18 12 5 1
Oklahoma 1 0 1 0 1 0 1 0
Oregon 11 7 3 1 15 8 6 1
Pennsylvania 21 11 6 4 22 13 7 2
Puerto Rico 15 13 0 2 16 14 0 2
Rhode Island 0 0 0 0 3 1 2 0
South Carolina 8 3 1 4 13 5 1 7
South Dakota 0 0 0 0 0 0 0 0
Tennessee 8 7 1 0 8 7 1 0
Texas 31 22 2 7 36 26 2 8
Utah 2 2 0 0 2 2 0 0
Vermont 0 0 0 0 0 0 0 0
Virginia 9 2 3 4 18 9 5 4
Washington 8 6 2 0 9 6 3 0
West Virginia 1 1 0 0 2 1 1 0
Wisconsin 18 13 4 1 18 14 3 1
Wyoming 0 0 0 0 0 0 0 0
Total, U.S. 550 342 69 139 578 373 83 122
NOTE: Columns do not sum to U.S. total because some SNPs overlap state boundaries.
SOURCE: Authors’ analysis of CMS’s Landscape Files for 2016-2017.
Issue Brief

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