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UnitedHealthcare 2017 Medicare Advantage First Looks

Posted by www.psmbrokerage.com Admin on Fri, Jul 29, 2016 @ 08:46 AM

UHC - Strength Stability Hassle Free


UnitedHealthcare has released their 2017 Medicare Advantage First Looks.


Known for their strength and stability, UnitedHealthcare is poised for a fantastic 2017 AEP. They have introduced some significant market expansions and have continued to focus on providing their members a world class experience second to none in the industry.

We are proud to represent UnitedHealthcare as one of our Medicare Advantage carriers and look forward to making sure our agents are educated on all the benefits they have to offer as an organization. With strong brand name, comprehensive plan designs and a focus on customer service, UnitedHealthcare is the carrier of choice for senior market agents. Their mantra of "Strength, Stability, and Hassle Free" continues to resonate with both members and agents alike in this ever-changing market.

Highlights Include:

  • Significant market expansions for 2017
  • Comprehensive plan designs with the addition of more $0 premium plans
  • New Part D plans
  • Fitness facility benefit including SilverSneakers
  • Great customer retention programs to keep your business on the books and educate members on all the benefits UHC has to offer
  • Customized marketing materials to help you stand out
  • The popular LEAN enrollment tool 
  • and much more!

Request details today and place your business with a proven leader.

Additional Updates:
  • 2017 Medicare Advantage proposed benefits and expansion counties now available - View
  • 2017 Medicare Advantage Certification instructions now available - View
  • Introducing a New Med Supp from Thrivent Financial  - View
  • Liberty Bankers Life breaks into the Med Supp market  - View
  • Sell Medicare Supplements from virtually anywhere - View
  • FREE Med Supp Online Quoting Tool for PSM Agents - View

Tags: Medicare Advantage, UnitedHealthcare

Anthem, Aetna sued by U.S. seeking to block insurer mergers

Posted by www.psmbrokerage.com Admin on Fri, Jul 22, 2016 @ 09:25 AM

Anthem, Aetna sued by U.S. seeking to block insurer mergers(Bloomberg) — U.S. antitrust enforcers roundly rejected a pair of proposed deals that would consolidate the nation’s five biggest health insurers into just three.

The Justice Department filed an antitrust lawsuit to stop Indianapolis-based Anthem’s merger with Bloomfield, Connecticut-based Cigna Corp. in federal court in Washington on Thursday and also moved to block Hartford-based Aetna’s planned merger with Louisville, Kentucky-based Humana.

Eight states including Florida and Illinois, plus the District of Columbia, are joining the federal government’s suit to block the Aetna-Humana deal.

Nine states and the District of Columbia joined the U.S. action against the Anthem-Cigna deal, including California, New York and Connecticut. "If permitted to proceed, Anthem’s purchase of Cigna likely would lead to higher prices and reduced benefits," the Justice Department said in the complaint, which was filed in federal court in Washington Thursday.

Anthem, in a statement, said it was fully committed to challenging the DOJ action in court but would remain receptive to efforts to reach a settlement with the Justice Department.

The U.S. action is “an unfortunate and misguided step backwards for access to affordable healthcare for America,” Anthem said. “The DOJ’s action is based on a flawed analysis and misunderstanding of the dynamic, competitive and highly regulated healthcare landscape and is inconsistent with the way that the DOJ has reviewed past healthcare transactions. ”

Cigna said it was “evaluating its options consistent with its obligations under the agreement” and said it doesn’t expect the transaction will close in 2016. “The earliest it could close is 2017, if at all.”

The actions are likely to set off a round of court battles as the insurers are obliged to fight the moves and could spark renewed pursuit of smaller players in the industry if the deals fail.

The cases are U.S. v. Anthem Inc., 16-cv-1493, U.S. District Court, District of Columbia (Washington) and U.S. v. Aetna Inc. 16-cv-1494, U.S. District Court, District of Columbia (Washington).

Source: http://www.lifehealthpro.com/2016/07/21/anthem-aetna-sued-by-us-seeking-to-block-insurer-m?t=medicare

Additional Updates:
  • New Medicare Supplement releases from Mutual of Omaha in Pennsylvania, Tennessee and Texas with "Cash for Apps" incentive. Call today for details at 800-998-7715
  • Medicare Advantage market penetration - Mark Farrah Associates report - View
  • 2017 Medicare Advantage preliminary benefits and expansion counties now available - View
  • 2017 Medicare Advantage Certification instructions now available - View
  • Introducing a New Med Supp from Thrivent Financial  - View
  • Liberty Bankers Life breaks into the Med Supp market  - View
  • Sell Medicare Supplements from virtually anywhere - View
  • FREE Med Supp Online Quoting Tool for PSM Agents - View

Tags: Humana, Cigna, Medicare Advantage, Medicare Supplement, aetna, Anthem, DOJ

Med Supp vs. MA: Which One Is Right for Your Client?

Posted by www.psmbrokerage.com Admin on Fri, Jul 08, 2016 @ 04:57 PM


If you’ve been keeping up with everything that has been happening in senior health care, then you have noticed all the changes within the Medicare program. However, Medicare is more than just insurance.

In many ways, Medicare is a capstone for the years and, in some cases, decades of planning and work that advisors have done to help their clients plan and save for a comfortable retirement. 

Health care costs continue to be the No.1 cause of bankruptcies in the United States, and this is especially true among the elderly. A good, solid, compatible health care plan that works with Medicare can go a long way toward making sure your clients’ retirement years work out the way they, and you, have planned.

The catch is that there are two solutions to these problems. Depending on where you live, both solutions are viable for some clients, but are not the right fit for others. A third option exists: employer or group coverage. I will skip discussing that third option in this article because employer/group coverage is not available to all your clients, and the benefits and costs associated with that coverage are vast. If a group option exists, take a look at it as a viable choice for your client, but do not assume it is better coverage than the private options. It always pays to do some due diligence comparisons with these plans.

So let’s take a look at our two contenders.

Old Faithful: The Medicare Supplement

Medicare supplements have been mostly unchanged since 1990. Prescription drugs were removed from the plans in 2006. Over the years, a few plan letters were eliminated and a few more plan types were added. But for the most part, a Medicare supplement today is still the Medicare supplement of 20 years ago.  That is important. Medicare supplements generally do not change their benefits much from year to year. 

Medicare supplements have plan letters. They range from A through N, with some letters skipped. And the plan letters from 1990 offer pretty much the same things today as they did then. The best way to get a look at Medicare supplement benefits is to review an insurance company’s summary of benefits or the government guide, “Choosing a Medigap Policy.” For most plans, a benefit is covered at 100 percent or not covered at all. If you have a client who wants something fully covered — no copays, no fuss, no annual changes — this could be what they want. And to make things even more convenient, your client can use most supplements with any doctor, any hospital, anywhere in the United States as long as those doctors and hospitals accept Medicare. So there are neither network considerations nor travel restrictions on health care if your client opts for a Medicare supplement.

But the Medicare supplement has two downsides. The first is the premium. Although premiums generally vary by state, county and even ZIP code, they tend to be larger than premiums charged by other plans. Medicare supplement premiums also have a tendency to go up, probably on an annual basis. 

The other downside to a Medicare supplement is underwriting. A supplement requires your client to answer health questions. Depending on your client’s health, the opportunity might be closed to them at a later date. Federal laws require one opportunity to get a Medicare supplement on a guaranteed basis once in a person’s lifetime. This is called an “open enrollment period.” Some states extend or repeat that period beyond the federally mandated minimums, but if your client lives in a state where there is only one open enrollment period in a lifetime, the idea of a supplement and the consequences of its premium should not be overlooked.

This type of plan is a natural extension of financial planning and the other insurance products the advisor offers. The premium is easily projected coverage that’s guaranteed renewable for life.

The Scrappy Contender: Medicare Advantage

OK, that’s a bit of a misnomer. Medicare Advantage isn’t exactly new. This year marks the 10th anniversary of Medicare Advantage in its current form, but Medicare Advantage has a history of more than 20 years in the market under different names. 

Medicare Advantage plans are alternative ways to receive health care. A person in a Medicare Advantage plan is still in the Medicare program (they must continue to pay their Medicare Part B premium), but they choose to replace Medicare Parts A and B’s cost-sharing with the insurance company’s coinsurance and copays. The 20 percent coinsurance of Medicare Part B is still there, just broken down and transformed into more projectable costs. There is no Medicare supplement-style product that will cover leftover costs as thoroughly and completely as Medicare plus a Medicare supplement. But if you have clients with a preference for a reduced “pay-as-you-go” program, this is a way to give them what they want.

Medicare Advantage plans are the right choice for some clients. A Medicare Advantage plan typically has a monthly cost that is lower than a Medicare supplement. In some areas, there are options available at no additional cost beyond the payment of the Medicare Part B premium.

I’ve had financial advisors ask, “If these just change the structure of the Medicare Part B coinsurance, is there any reason to consider these plans over having nothing at all?” The answer is a definite yes. The copays on Medicare are typically a flat 20 percent with no cap on them.

Medicare Advantage gives you a schedule of costs your clients can plan for. Medicare Advantage plans also have a maximum out-of-pocket limit. This means that if the worst happens to your client’s health, there is a fixed amount of cost they can prepare for. Also, many Medicare Advantage plans include prescription drug coverage, adding a level of convenience for some clients.

Medicare Advantage plans have some downsides, however. The two most critical are networks and the out-of-pocket maximum. Typically, that maximum is many times the annual premium of a Medicare supplement. If you are dealing with a client who is concerned about having many out-of-pocket costs, the Medicare Advantage plans might not be a good fit.

And a Medicare Advantage plan is networked. The two most prevalent types of plans around the country are HMO plans and PPO plans. This means that access to doctors might be a concern, depending on your client’s needs and location.

Medicare Advantage plans have another consideration: change. Medicare Advantage plans alter their cost structure annually. This means that the premiums, copays, coverage, drug list and even counties where they provide service can increase, decrease or drop completely. Essentially, every Jan. 1, any client you have in a Medicare Advantage plan has a brand-new plan.

The Referee: You!

We tell our clients that we understand they really don’t need us if they want to buy insurance. Just about every company will sell it to them online, over the telephone or by mail. The reason why you will get clients to buy from you is because you will do the analysis for them. A typical client does not know what they do not know about health care. And by showing the good and the bad about the choices available to them, you are doing as much to help them protect their assets as you would with any other line of product.

Source: http://www.insurancenewsnetmagazine.com/article/-med-supp-vs-ma-which-one-is-right-for-your-client-3062#.V4AWa9IrJhE

Additional Updates:
  • Aetna and UnitedHealthcare have announced their 2017 Medicare Advantage expansion counties. Call 800-998-7715 for details.
  • 2017 Medicare Advantage Certification instructions now available - View
  • Introducing a New Med Supp from Thrivent Financial  - View
  • Liberty Bankers Life breaks into the Med Supp market  - View
  • Sell Medicare Supplements from virtually anywhere - View
  • FREE Med Supp Online Quoting Tool for PSM Agents - View

Tags: Medicare Advantage, Medicare Supplement

Medicare Advantage Hospital Networks: How Much Do They Vary?

Posted by www.psmbrokerage.com Admin on Fri, Jul 08, 2016 @ 08:40 AM

Medicare Advantage Hospital Networks

A growing number of Medicare beneficiaries receive their care through HMOs and PPOs, known as Medicare Advantage plans; yet, little is known about the size and scope of the provider networks available to beneficiaries enrolled in these plans.  Beneficiaries enrolled in Medicare Advantage plans can face significant expense if treated by an out-of-network provider, except in emergencies.

This report, the first broad-based study of Medicare Advantage networks, takes an in-depth look at plans’ hospital networks, examining their size and composition.  The analysis draws upon data from 409 plans, including 307 HMOs and 102 local PPOs, serving beneficiaries in 20 diverse counties that together accounted for about one in seven (14%) Medicare Advantage enrollees nationwide in 2015.  Key findings include:

  • On average, Medicare Advantage plan networks included about half (51%) of all hospitals in their county.
  • Most plans (80%) included an Academic Medical Center in their network, but one in five did not.
  • Two in five plans in areas with an NCI-designated cancer center did not include the center in their networks.
  • Almost one-quarter (23%) of Medicare Advantage plans in our study had broad hospital networks in 2015. About one in six plans (16%) had narrow or ultra-narrow networks (Figure ES.1).
  • In 9 of the 20 counties studied, none of the plans offered in 2015 had a broad network of hospitals within that county (Clark, NV; Cook, IL; Davison, TN; Harris, TX; Jefferson, AL; King, WA; Los Angeles, CA; Pima, AZ; and Salt Lake, UT).
  • Among HMOs, which comprised the majority of the plans in the study (75%), broad and narrow network plans had similar average premiums ($37 vs. $36 per month) and similar quality ratings (3.8 vs. 4.1 stars).


People on Medicare often say that having access to specific doctors and hospitals is a high priority when choosing their Medicare Advantage plans. Yet, plan directories are often riddled with errors, omissions and outdated information that makes it difficult and sometimes impossible to tell which hospitals are included in-network – a finding that emerged over the course of this study.

Creating networks of providers is one of many strategies available to insurers to help control costs and manage the delivery of care. But narrower networks may also limit consumers’ access to certain providers or increase costs for care obtained out-of-network.  For Medicare Advantage enrollees who place a high value on having access to a particular set of providers, or a broad range of providers, the findings underscore the importance of comparing provider networks during the Annual Election Period – a task that is easier said than done.

Source: http://kff.org/medicare/report/medicare-advantage-hospital-networks-how-much-do-they-vary/

Additional Updates:
  • Aetna and UnitedHealthcare have announced their 2017 Medicare Advantage expansion counties. Call 800-998-7715 for details.
  • 2017 Medicare Advantage Certification instructions now available - View
  • Manage your attention, not your time  - View
  • Introducing a New Med Supp from Thrivent Financial  - View
  • Liberty Bankers Life breaks into the Med Supp market  - View
  • Sell Medicare Supplements from virtually anywhere - View
  • FREE Med Supp Online Quoting Tool for PSM Agents - View

Tags: Medicare Advantage

Sell Value Rather Than Price

Posted by www.psmbrokerage.com Admin on Wed, Jun 29, 2016 @ 08:47 AM

Sell Value Rather Than Price

Value selling says that customers buy your value or service because they anticipate enjoying a value that they would not have in the absence of your product or service. People don’t buy products, they buy the results the product will give them.

Sell the value and the benefit of your product or service to your customer. Focus on explaining and expressing how it works for the customer. If you focus on the value, the price becomes less and less important. If you don’t focus on value, the only thing you can talk about is price.


What is value selling?

Now, here’s the research…

 The research says that the value is the difference between the price you charge and the benefits the customer perceives he will get. If the customer perceives he will get a lot of benefit for the price they pay, then their perception of value is very high. So you can control that.

Teach people how much they will benefit, how much your product or service will help them, and all of the things your product or service can do to help them achieve their goals and solve their problems. The more you focus on these values, the less important price becomes.

How to sell value instead of price

Here are a few actionable items you need to do to ensure you’ll get the sale.

1) Who will buy your product?

Ask yourself, “Who is the person who is most likely to buy my product and buy it immediately?”

Then create a customer avatar based on this information. How old are they? Are they male or female? Do they have children? How much money do they make? What is their level of education?

2) Identify your customer’s problem clearly

Once, you’ve done this, you’ll be able to move on to the next step which is identifying your ideal customer avatar’s problem clearly.

What kind of problem does your customer have that you can solve? If you have identified your customer correctly, these people will pay you to solve their problem. Sometimes the problems are obvious and clear. Sometimes the problems are not obvious or clear. Sometimes the problems do not exist for the customer. If the problem does not exist, the customer will not buy your product.

3) Make a list of all your product benefits

Finally, make a list of all of the benefits of your product or service and the ways it will solve your customer’s problems. The more benefits and solutions you can clearly provide to your customers, the less they will be able to deny your product will solve their problem.

I’d like to leave you with a thought: “The more you focus on the value of your product or service, the less important price becomes.”

Source: http://www.lifehealthpro.com/2016/06/23/how-to-sell-value-rather-than-price

Additional Updates:
  • PSM 4th of July holiday hours - View
  • Aetna and UnitedHealthcare have announced their 2017 Medicare Advantage expansion counties. Call 800-998-7715 for details.
  • 2017 Medicare Advantage Certification details - View
  • Hot - Introducing a New Med Supp from Thrivent Financial  - View
  • Hot - Liberty Bankers Life breaks into the Med Supp market  - View
  • Sell Medicare Supplements from virtually anywhere - View
  • FREE Med Supp Online Quoting Tool for PSM Agents - View

Tags: Creating Value

The 2017 Medicare Advantage Enrollment Window is Right Around the Corner...Be Prepared with PSM

Posted by www.psmbrokerage.com Admin on Thu, Jun 23, 2016 @ 09:58 AM

2017 Medicare Advantage Sneak Peeks

The AEP is right around the corner and there are some exciting opportunities on the horizon for 2017.

Make sure you are up to date with the latest information including expansion areas (available now for select carriers), plan designs (coming soon) and certification announcements.Join our update list today or call one of our marketing representatives at 800-998-7715 for the latest information.

As an added value, we are providing a discount on AHIP training for being a part of our team. Click on the link below to access the details.

Updates Include:

  • Service area expansions and reductions from current companies
  • Sneak Peeks at pricing and benefit information
  • Comparison tools and lead generation ideas
  • Certification announcements - AHIP Discount for PSM Agents

Bonus: CMS also just released some great news for Medicare Advantage and PDP commission rates for 2017 and they are the highest ever! Details located here.

More exciting details to come and we look forward to being your one-stop-shop for all your Medicare needs this enrollment season.

Additional Updates:
  • Aetna and UnitedHealthcare have announced their 2017 Medicare Advantage expansion counties. Call 800-998-7715 for details.
  • 2017 UnitedHealthcare and AHIP Certification details - View
  • Introducing a New Med Supp from Thrivent Financial  - View
  • Liberty Bankers Life breaks into the Med Supp market  - View
  • A great product for lead generation and referrals - View
  • New electronic scope of appoitment with Silverscript - View
  • Sell Medicare Supplements from virtually anywhere - View
  • FREE Med Supp Online Quoting Tool for PSM Agents - View

Tags: Medicare Advantage, Medicare, ma commissions,, PDP

2 New Exclusive Medicare Supplement Releases from PSM - Liberty Bankers Life and Thrivent Financial

Posted by www.psmbrokerage.com Admin on Thu, Jun 16, 2016 @ 04:15 PM

New Med Supp Product ReleaseSPECIAL ANNOUNCEMENT:

PSM is proud to announce two New Exclusive Medicare Supplement products now available for our agents to get contracted.

Liberty Bankers Life Medicare Supplement

Thrivent Financial Medicare Supplement

Both products are poised to take the industry by storm with ultra competitive rates and commissions. We are excited to bring these new opportunities to our agents and make sure you have the most competitive options in your portfolio.

Along with excellent rates and commissions, you can also expect to see best in class service and support along with some new technology to make it easy to write business.

Some preliminary highlights include:

  • Multi-state release
  • Well respected brand names
  • Excellent commissions with immediate vesting
  • Ultra competitive rates with HHD*
  • e-Contracting for agents
  • e-App for clients
  • Comprehensive portal to run quotes, access forms and manage business
  • and much more

We appreciate the opportunity to be your broker of choice and look forward to working with you on these exciting new offerings. Please click on the links above to request information or call our office at 800-998-7715.

* May not be available in all states
Image courtesy of Freepik

Additional Updates:

Tags: Medicare, Medicare Supplement, Breaking News

Update: Maximum Broker Commissions for Medicare Advantage and Medicare Part D for 2017

Posted by www.psmbrokerage.com Admin on Thu, Jun 02, 2016 @ 05:33 PM


For 2017 effective dates, CMS has increased maximum broker commissions for both Medicare Advantage and Prescription drug plans. Below is the content from the memorandum published by CMS.

SUBJECT: Contract Year 2017 Agent and Broker Compensation Rate Adjustments, Submissions, and Agent and Broker Training and Testing Requirements

This memorandum provides the updated agent and broker compensation limits for Contract Year (CY) 2017 and information regarding submitting compensation amounts to the Centers for Medicare & Medicaid Services (CMS) through the Health Plan Management System (HPMS).

Additionally, this memorandum provides requirements for Medicare Advantage organizations, Prescription Drug Plan sponsors, and Section 1876 Cost Plans (herein after “organizations”) to use in developing their curricula for training and testing agents and brokers for CY 2017.

Compensation Rate Adjustment for CY 2017

As provided in 42 C.F.R. §§422.2274(b)(1) and 423.2274(b), the compensation amount paid to an independent agent or broker for an enrollment must be at or below the fair market value (FMV) cutoff amounts published yearly by CMS.

The chart below summarizes the CY 2017 FMV cut-off amounts for all organizations.


Medicare Advantage Broker Commissions:

  • For CA and NJ, initial MA commissions increased to $553. Replacement commissions increased to $277.
  • For CT, PA and DC, initial MA commissions increased to $498. Replacement commissions increased to $249.
  • For all other states, initial MA commissions increase to $443. Replacement commissions increased to $222.

Medicare Part D Broker Commissions:

  • Initial PDP commissions increased to $71. Replacement commissions increased to $36.

Click on the link below to read the full article.

Source: CMS
Image courtesy of Freepik

Additional Updates:
  • How to change a habit for good - View
  • Crafting the perfect sales pitch - View
  • Medicare Advantage premium analysis  - View
  • CMS posts new Medicare agent sample test  - View
  • Mutual of Omaha Med Supp - New Hospital Choice Savings Program - View
  • The perfect sidekick for your Senior Business - View
  • Sell Medicare Supplements from virtually anywhere - View
  • FREE Med Supp Online Quoting Tool for PSM Agents - View

Tags: Medicare Advantage, Medicare, ma commissions,, PDP

Baby Boomers Will Become Sicker Seniors Than Earlier Generations

Posted by www.psmbrokerage.com Admin on Thu, May 26, 2016 @ 12:50 PM


The next generation of senior citizens will be sicker and costlier to the health care system over the next 14 years than previous generations, according to a new report from the United Health Foundation.

The report looks at the current health status of people ages 50 to 64 and compares them to the same ages in 1999.

The upshot? There will be about 55 percent more senior citizens who have diabetes than there are today, and about 25 percent more who are obese. Overall, the report says that the next generation of seniors will be 9 percent less likely to say they have good or excellent overall health.

That's bad news for baby boomers. Health care costs for people with diabetes are about 2.5 times higher than for those without, according to the study.

It's also bad news for taxpayers.

"The dramatic increase has serious implications for the long-term health of those individuals and for the finances of our nation," says Rhonda Randall, a senior adviser to the United Health Foundation and chief medical officer at UnitedHealthcare Retiree Solutions, which sells Medicare Advantage plans.

Most of the costs will be borne by Medicare, the government-run health care system for seniors, and by extension, taxpayers.

Some states will be harder hit than others. Colorado, for example, can expect the numbers of older people with diabetes to increase by 138 percent by 2030, while Arizona will see its population of obese people over 65 grow by 90 percent.

There is some good news in the report, too.

People who are now between 65 and 80 years old have seen their overall health improve compared to three years ago. And people who are aging into the senior community are far less likely to smoke than earlier generations.

"Some of these trends are very good and in the right direction," Randall tells Shots.

She says the decrease in smoking shows that it's possible to change health behaviors, noting that doctors, public health professionals and policymakers used a variety of strategies simultaneously to reduce smoking.

"That's a good model for what we need to look at to tackle the epidemic of diabetes and the big concern we have around obesity," she says.

The study also ranked states on the health of their current senior populations. Massachusetts topped the list, jumping to No. 1 from the No. 6 ranking it had the last time the rankings were calculated. Vermont slipped to No. 2. Louisiana is the least healthy state for older adults.


Click on the link below to read the full article.

Source: http://www.npr.org/sections/health-shots/2016/05/25/479359856/baby-boomers-will-become-sicker-seniors-than-earlier-generations
Image courtesy of Freepik

Additional Updates:
  • May we never forget. PSM Memorial Day Hours - View
  • 3 Rich sources for overlooked leads - View
  • 6 leadership lessons: John Wooden - View
  • Medicare facts for agents who know everything - View
  • The perfect sidekick for your Senior Business - View
  • Sell Medicare Supplements from virtually anywhere - View
  • FREE Med Supp Online Quoting Tool for PSM Agents - View

Tags: Medicare, Seniors

Medicare Advantage 2016 Spotlight: Enrollment Market Update

Posted by www.psmbrokerage.com Admin on Thu, May 19, 2016 @ 09:32 AM


The number and share of Medicare beneficiaries enrolled in Medicare Advantage has steadily climbed over the past decade, and this trend in enrollment growth is continuing in 2016. The growth in enrollment has occurred despite reductions in payments to plans enacted by the Affordable Care Act of 2010 (ACA).1 As of 2016, the payment reductions have been fully phased-in in 78 percent of counties, accounting for 70 percent of beneficiaries and 68 percent of Medicare Advantage enrollees.

This Data Spotlight reviews national and state-level Medicare Advantage enrollment trends as of March 2016 and examines variations in enrollment by plan type and firm. It analyzes the most recent data on premiums, out-of-pocket limits, Part D cost sharing, and plans’ quality ratings. Key findings include:

  • Medicare Advantage enrollment has increased in virtually all states over the past year. Almost one in three people on Medicare (31% or 17.6 million beneficiaries) is enrolled in a Medicare Advantage plan in 2016 (Figure 1). The penetration rate exceeds 40 percent in 5 states.


  • Over 3 million enrollees (18%) are in a group plan in 2016.
  • UnitedHealthcare and Humana together account for 39 percent of enrollment in 2016; enrollment continues to be highly concentrated among a handful of firms, both nationally and in local markets. If Aetna acquired Humana with no divestitures in 2016, the combined firm would account for 25 percent of Medicare Advantage enrollees nationwide.
  • On average, premiums paid by enrollees were relatively constant between 2015 and 2016 ($37 per month in 2016 versus $38 per month in 2015), although premiums vary widely across states, counties, and plan types.
  • Medicare Advantage plans, unlike traditional Medicare, are required to provide an out-of-pocket limit (not to exceed $6,700) for services covered under Parts A and B. In 2016, the average enrollee had an out-of-pocket limit of $5,223 – nearly $1,000 higher than it was in 2011 ($4,313). More than one-third of all enrollees in Medicare Advantage prescription drug plans in 2016 (37%) are in plans with limits at the maximum.

Overall Trends in Enrollment


In 2016, 17.6 million beneficiaries – 31 percent of the Medicare population – are enrolled in a Medicare Advantage plan (Figure 2). Total Medicare Advantage enrollment grew by about 0.9 million beneficiaries, or 5 percent, between 2015 and 2016. Although this is a slower rate of growth in percentage terms than any year since 2006, the growth reflects the ongoing expansion of the position Medicare Advantage plays in the Medicare program. The growth in Medicare Advantage enrollment reflects both the influence of seniors aging on to Medicare as well as small shifts in the larger pool of beneficiaries in traditional Medicare switching to Medicare Advantage plans.



As has been the case each year since 2007, about two-thirds (64%) of Medicare Advantage enrollees are in HMOs in 2016 (Figure 3). Almost one-third of enrollees are in PPOs – with more in local PPOs (23%) than regional PPOs (7%) – and the remainder are in Private Fee-For Service (PFFS) plans (1%) and other types of plans (4%), including cost plans and Medicare Medical Savings Accounts (MSAs)


  • Enrollment in HMOs increased by 0.6 million to 11.3 million beneficiaries in 2016 (Figure 4 and Table A1).


  • Enrollment in local PPOs and regional PPOs increased by 0.1 million each, with 4.1 million beneficiaries in local PPOs and 1.3 million beneficiaries in regional PPOs 2016.

A key difference between an HMO and a PPO is that the latter provides enrollees with more flexibility to see providers outside of the plan’s provider network. Local PPOs, like HMOs, are required to serve areas no smaller than a county, whereas regional PPOs are required to serve areas defined by one or more states with a uniform benefit package across the service area.

  • PFFS Plans. Enrollment in PFFS plans (0.2 million) has slowly declined since MIPPA of 2008 required PFFS plans in most parts of the country to have networks of providers, and today, about 1 percent of all Medicare Advantage enrollees are in these plans. Among PFFS plan enrollees, 26 percent are in counties in which PFFS plans are exempted from network requirements


In 2016, enrollment increased in all states in 2015, with the exception of Ohio where enrollment declined by 8 percent, in large part to the Ohio Public Employees Retirement System pulling out of the Medicare Advantage group market and ceasing to sponsor a Medicare Advantage plan (Table 1). In 9 states (DE, IA, MD, ME, MS, MT, ND, NH, and SD) and the District of Columbia, enrollment increased by more than 10 percent – double the national average – including four states (DE, IA, ND, and NH) in which enrollment increased by more than 20 percent. All of these states have Medicare Advantage penetration rates far below the national average with relatively few enrollees and their growth rates are sensitive to small changes in enrollment.


In 23 states, at least 30 percent of Medicare beneficiaries are enrolled in Medicare private plans, including 5 states (FL, HI, MN, OR, and PA) in which at least 40 percent of beneficiaries are enrolled in Medicare private plans (Figure 6). These five states account for 21 percent of all Medicare private plan enrollees. While Medicare Advantage enrollment is increasing in many states, Medicare Advantage enrollment continues to be very low (less than 10 percent of Medicare beneficiaries) in 6 states (AK, DE, MD, NH, VT, and WY). This variation reflects the history of managed care in the state, the uneven prevalence of employer-sponsored insurance for retirees, and growth strategies pursued by various Medicare Advantage sponsors, among other factors.


Within states, Medicare Advantage penetration varies across counties. For example, 44 percent of beneficiaries in Los Angeles County, California are enrolled in Medicare Advantage plans compared to only 11 percent of beneficiaries in Santa Cruz County, California.


Medicare Advantage enrollees are responsible for paying the Part B premium, in addition to any premium charged by the plan. The Medicare Advantage premium paid by enrollees reflects the difference between the plan’s costs of providing Part A and B benefits and any supplemental benefits offered, and the federal payment to the plan for Part A and B benefits. Plans receive a percentage of the difference between their bid and the maximum federal payment (known as a rebate) and are required to use this amount to offer extra benefits, reduce cost sharing, or reduce the Part B premium. If the plan includes the Medicare Part D prescription drug benefit, as most plans do, the plan may also use the rebate to reduce the Part D premium. This brief analyzes premiums for Medicare Advantage plans that offer prescription drug benefits (MA-PDs) because the vast majority (89%) of Medicare Advantage enrollees is in MA-PDs and Medicare Advantage enrollees who seek Part D prescription drug benefits are, for the most part, required to get them through their plan if the plan offers prescription drugs.


The average MA-PD enrollee pays a monthly premium of about $37 in 2016, about $1 per month (1%) less than in 2015 (Figure 7). 7 Actual premiums paid by enrollees vary widely, across and within counties, by plan type and other plan characteristics. Average premiums range from $28 per month for HMO enrollees to $63 per month for local PPOs and $76 per month for PFFS plan enrollees (Table A4). Since the ACA was enacted in 2010, average Medicare Advantage premiums paid by HMO enrollees and local PPO enrollees have decreased and average premiums paid by regional PPOs and PFFS enrollees have increased.



In 2016, as in prior years, most Medicare beneficiaries (81%) had a choice of at least one “zero premium” MA-PD8 plans that charge no additional premium for coverage, other than the monthly Part B premium. Between 2015 and 2016, the share of enrollees in zero premium MA-PDs remained relatively unchanged (48% in 2015 versus 49% in 2016), about the same share as in 2010 (Figure 8). Similar to prior years, a larger share of HMO enrollees is enrolled in zero premium plans (59%) than regional PPO enrollees (38%) or local PPO enrollees (22%). No zero premium PFFS plans were offered in 2015 or 2016 (Table A4).



Comparing premiums across states is complicated by the fact that premiums reflect many factors, including the underlying costs of care in a given county relative to the national average, the level of payments to Medicare Advantage plans in the area, and firms’ strategy about whether to use plans’ rebates to offer extra benefits, reduce cost-sharing, or lower premiums. Additionally, as previously discussed, premiums vary across plan types and enrollment by plan type varies across states.

Average monthly MA-PD premiums paid per enrollee range from $7 (Florida) to $138 (Minnesota, which is mainly cost rather than risk-based plans plans), relative to the $37 per month average premium in 2016 (Figure 9).9 Average monthly premiums exceed $70 in seven states: Hawaii, Massachusetts, Michigan, Minnesota, North Dakota ($123; not displayed in exhibit), Pennsylvania, and Idaho. In contrast, average monthly premiums are less than $20 in seven states: Arizona, Iowa, Florida, Louisiana, Missouri, Nevada, and Texas. (States with fewer than 50,000 Medicare Advantage enrollees are not displayed in the exhibit.)


Click on the link below to read the full article.

Source: http://kff.org/medicare/issue-brief/medicare-advantage-2016-spotlight-enrollment-market-update/
Image courtesy of Freepik

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