Medicare Advantage 2014 Spotlight: Plan Availability and Premiums
Issue Brief
See Kaiser Family Foundation “Explaining Health Reform: Key Changes in the Medicare Advantage Program, April 29, 2010 http://www.kff.org/health-reform/issue-brief/explaining-health-reform-key-changes-in-the/.
Plan specific information about cost-sharing requirements and benefits is at www.medicare.gov on the “Find Health and Drug Plan” database. However, this database does not include summary statistics on the characteristics of plans available nationwide or in particular areas. Further research is needed to assess changes in benefits and cost sharing among Medicare Advantage plans over time.
There have been anecdotal reports of some plans making changes in provider networks in 2014. See, for example, Matthew Sturdevant, “Insurer’s Move Draws Attention of Delegation, AMA,” The Hartford Courant, October 10, 2013. However, data to assess broad-based trends is lacking, making it difficult to assess whether such phenomena reflect specific localized situations or more general trends.
Data for individual plans offered are contained in the MA and SNP Landscape Source files for 2014 and previous years. http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/index.html
Plan counts exclude group plans and SNPs since they are not available to all beneficiaries for individual enrollment. They also exclude plans with special eligibility or other requirements, including Health Care Prepayment Plans (HCPPs), the Program for All Inclusive Care for the Elderly (PACE), demonstrations, and plans offered by selected groups like the Mennonites.
For additional information see, https://www.kff.org/medicaid/fact-sheet/state-demonstration-proposals-to-integrate-care-and-align-financing-for-dual-eligible-beneficiaries/ and M. Gold, W. Wang, and G. Jacobson. “Medicare Health Plans and Dually Eligible Beneficiaries: Industry Perspectives on the Current and Future Market, Kaiser Family Foundation, March 2013.
Medicare Advantage plans are required to cover all Part A and B Medicare benefits on an actuarially equivalent basis. While they are not precluded from charging beneficiaries an extra premium for those benefits if the plan’s costs exceed what Medicare pays for such benefits, this is not a very likely option in the current environment given current benchmarks used to set Medicare Advantage rates and the important role premiums play in competing for enrollment.
For 2013 enrollment weighted statistics, see M. Gold, G. Jacobson, A. Damico and T. Neuman. “Medicare Advantage 2013 Spotlight: Enrollment Market Update, June 2013.
M. Gold “Medicare+Choice: An Interim Report Card” Health Affairs 40(4): 120-138, July 2001. See also, M. Gold, M. Hudson, G. Jacobson, and T. Neuman “Medicare Advantage 2010 Data Spotlight: Benefits and Cost Sharing” Kaiser Family Foundation, February 2010.
M. Gold. “Making Sense of the Change in How Medicare Advantage Plans are Paid.” Issue Brief. New York: The Commonwealth Fund, May 2013; and M. Gold and M. Hudson, “Analysis of the Variation in Efficiency of Medicare Advantage Plans Relative to Medicare FFS.” Paper developed for the Commonwealth Fund. Washington, DC: Mathematica Policy Research, Research Brief, May 2013.
This statistic includes both those enrolled in individual and group plans because CMS does not breakdown MA-PD data this way; it only breaks down overall Medicare Advantage data and some of those enrollees are not in a Part D plan. Authors’ calculation from October 2013 data from the 10.17.13 Medicare Advantage, Cost, PACE, Demo and Prescription Drug Plan Organizations—Monthly Summary Report released by CMS on its website at: http: //www.cms.hhs.gov/MCARAdvPartDEnrolData/.)
In contrast, free-standing prescription drug plans all have some associated premium, with the average monthly PDP premium in 2013 at $39.90 (weighted by 2013 enrollment, assuming currently enrolled beneficiaries remain in their current plan). This is a 5 percent increase from the weighted average monthly premium of $38.14 in 2013 and a 54 percent increase from 2006, the first year of the Medicare Part D drug benefit. See J. Hoadley, et al. “Medicare Part D: A First Look at Plan Offerings in 2014” Kaiser Family Foundation Issue Brief, October 2013.
J. Hoadley, et al. op site. The paper indicates that 82 percent of PDPs will offer no or limited gap coverage, including 76 percent with nothing and an additional 6 percent with fewer than 10 percent of drugs on their formulary coverage.
J. Hoadley, et al. “To Switch or Not to Switch: Are Medicare Beneficiaries Switching Drug Plans to Save Money?” Kaiser Family Foundation, October 10, 2013.