As Medicare Advantage continues to grow, payers, experts, and states are looking for ways to boost dual eligibility enrollment.
Enrollment of dual eligible individuals in Medicare Advantage has been “lagging” even with MA numbers projected to hit 70 percent between 2030 and 2040, according to a recent analysis by LEK Consulting.
“Medicare Advantage penetration of dual eligibles, which represents roughly 20 percent of Medicare eligibles, has lagged behind Medicare Advantage penetration of seniors due to a lack of coordinated state offerings and managed care,” the authors of the report state.
Medicare Advantage is an overlooked resource for many dual eligible individuals, who qualify to enroll in Medicare and Medicaid because of their income. LEK Consulting’s estimate of a 70 percent increase in Medicare Advantage enrollment between 2030 and 2040 is backed by the rate at which MA is penetrating urban and rural counties, several of which have reached 55 to 65 percent enrollment. In 14 of the top 20 counties, the rates keep rising.
The dual eligibility population could prove critical to Medicare Advantage’s growth.
Medicare Advantage presents dual eligible individuals with an option that is affordable and has the ability to “detect, treat, and prevent the progression of chronic disease,” according to a report by America's Health Insurance Plans.
Similar to AHIP’s report, the LEK analysis found that Medicare Advantage enrollees are drawn to MA largely because of affordability and the level of care they receive through the plans.
For many over 65 years, the 20 percent coinsurance is too high, especially as Medicare costs are projected to rise by 7.4 percentage points annually through 2027, the CMS stated.
Additionally, Medicare Advantage provides a superior level of care management over original Medicare as the probability of developing age-related conditions increases. The conditions include obesity, diabetes, and other chronic conditions.
Between 2009 and 2010, 45 percent of adults 65 years and older have two or more chronic conditions the Center for Disease Control (CDC) revealed in a study of nine chronic conditions. The LEK analysis adds that the number of adults with more than one chronic condition rose by 8 percentage points during that study.
Dual eligibility beneficiaries are affected by those statistics. In March, the CMS released a report on the dual eligible population, which concluded:
Though dual eligible may be lagging, “states are moving aggressively to manage the cost of this high-needs population,” LEK Consulting states in their analysis.
In particular, the report cites the escalation of Dual Eligible Special Needs Plans (D-SNPs). D-SNPs have increased by 10 percent per year.
However, misalignment between D-SNPs and Medicare and Medicaid timelines and processes can put unnecessary strain on beneficiaries.
The Department of Health and Human Services (HHS) recently posted a paper from 2017 by the Center for Health Care Strategies which offered potential solutions in six areas related to D-SNPs: network standards and reviews, care management, marketing, beneficiary and provider notices, data collection and quality measurement, and grievances and appeals.
They conclude with 23 policy options, such as HHS-state collaborations for non-emergency medical transportation, integration of MA and state care management requirements for D-SNPs, coordination between states and D-SNPs on outreach, integration of beneficiary and provider D-SNP materials, DSNPs receiving beneficiaries' Medicaid or Medicare service utilization history, and MA denials that disclose whether a beneficiary denied by an MA plan might still acquire coverage under Medicaid.
Payers are responding to the growing demand for Medicare Advantage. Established payers such as Anthem are acquiring companies with MA plans while their emerging counterparts—Bright Health, Devoted Health, and Clover Health—are expanding their MA plans or are starting to offer them.
Medicare Blog | Medicare News | Medicare Information
For now, the regulatory and political environment remains positive for expansion of Medicare Advantage, which allows private health plans to contract with the federal government to provide medical benefits to seniors. Medicare Advantage plans provide extra benefits and services to seniors, such as disease management and nurse help hotlines, as well as some plans providing vision and dental care.
“Today the status and long-term structure of healthcare reform remain in flux, but MA enrollment is still growing — and with largely bipartisan support,” the report released this week by L.E.K. Consulting on Medicare Advantage penetration shows.
Enrollment in MA plans surpassed 22 million last year, which is 35% of total Medicare beneficiaries. “Looking ahead, we expect enrollment growth to continue in line with our previous forecasts of 7.7% compound annual growth rate (CAGR) to reach 47% penetration, or just over 37 million members in 2025,” L.E.K. executives Andrew Kadar, Andrew Garibaldi and Daniel Parker wrote in their 7-page report.
Health insurers Humana, UnitedHealth Group, Anthem, Cigna and CVS Health’s Aetna health insurance business dominate the Medicare Advantage business while Centene is poised to expand with its proposed acquisition of WellCare Health Plans. Meanwhile, several startups like Bright Health and Oscar Health are looking to expand into Medicare Advantage.
Health insurers see growth thanks in part to changes by the Trump administration in regulations that allow Medicare Advantage plans to cover more supplemental benefits. MA plans are also benefitting from more than 10,000 baby boomers turning 65 every day and becoming eligible for Medicare.
“As seniors increasingly eschew Original Medicare in favor of lower payments, enhanced care management and more cost certainty, with encouragement from both health plans and, albeit indirectly, the government, we expect that growth to continue — to 47% penetration by 2025 and, eventually, up to as high as 70%,” L.E.K said in its report. “Payers will therefore need to take aggressive action to grow market share of their Medicare Advantage offering. That could include expanding into new counties, investing in targeted sales to age-ins, and designing new products to attract new members and keep them healthy.”
Tags: Medicare Advantage
✪ 2020 AHIP Training
Precision Senior Marketing is proud to be able to help support our agents that sell Medicare Advantage and Prescription Drug Plans. That's why our agents will be able to access AHIP's 2020 Medicare certification for only $125. That's a $50 savings to you just for being part of our team.
As an added "Thank You" to our writing agents we would like to pay for 100% of your AHIP costs after you have five issued 2020 Medicare Advantage enrollments. Ask your Marketer for details. *This is only available to street level agents contracted directly with Precision Senior Marketing.
✪ 2020 Carrier Specific Certifications
To keep things simple, we have all the carrier specific certification instructions available on our certification page. Most will require you complete AHIP in advance, but not all. Please take the time to review the requirements for the different carriers you represent.
✪ 2020 Medicare Advantage and PDP First Looks
As we receive first looks and product information from the carriers we represent, we will be sharing those details with our agents. You can sign up to receive this information by visiting the following web page and completing the form. You can also call one of our marketing representatives at 800-998-7715 and ask for more details.
✪ Online Quoting Tools and Submission Platforms
PSM Has made significant investments to make sure our agents have access to the best in class quoting tools and online submission platforms. Even better, these tools are provided at no cost to our contracted agents. Please visit the following web page for more details and to request access.
✪ Lead Incentives and Opportunities
PSM is proud to be able to help support our directly contracted Medicare agents.For every ten (10) Medicare Supplement* or Medicare Advantage enrollments placed and issued, you will qualify for a complimentary 1,000 piece lead mailer*. This offer includes the postage, printing, mailing data and return postage on all submitted business return cards ~ ZERO cost to you!
For agent use only. Not for use with consumers. Certain exclusions and limitations may apply. Not affiliated with the United States government or the federal Medicare program. Enrollments for this promotion must be with carriers the agent is appointed with through Precision Senior Marketing. Eligibility for this program will be determined by PSM. Only directly contracted writing agents may participate. Lead vendor and mailers for this program will be determined by PSM, and cash equivalents and reimbursements will not be offered. Agent must be trained and certified and must abide by PSM’s compliance program.
✪ Service and Support
As a reminder, We pride ourselves on a "Do the Right Thing" approach and will go above and beyond to service the needs of our agents. We look forward to having a successful AEP and supporting you with products, technology and the personalized service you have come to expect from PSM. We appreciate the opportunity to earn your business and wish you the best!
Alabama: Blue Cross and Blue Shield of Alabama, Cigna, Humana, UnitedHealthcare, Viva Health
Vermont: Aetna, Anthem, Horizon Blue Cross and Blue Shield of New Jersey, MVP Health Care, UnitedHealthcare
Tags: Medicare Advantage
Link to certification will be available here when launched on July 10th.
One line of thinking has been that the Baby Boom Generation will enroll in Medicare Advantage plans over traditional Medicare at much higher rates than prior generations because they have had more experience with managed care during their working years. Our prior analysis found that, in 2011, nearly one in four people enrolled in Medicare Advantage plans during their first year on Medicare. This brief examines whether the rate has increased with more boomers aging onto Medicare, and whether these coverage decisions vary by geographic area and select characteristics. The analysis is based on a five percent sample of claims from 2010 to 2016.
In 2016, Less than one-third (29 percent) of new beneficiaries enrolled in Medicare Advantage plans during their first year on Medicare, slightly more than the 23 percent observed in 2011, but far from a majority (Figure 1). Most new beneficiaries (71 percent) were covered under traditional Medicare for their first year on Medicare.
While the issue has since been resolved and premium payments should be processed correctly moving forward, Medicare Rights remains concerned about the scope of the processing error and the potential impacts on beneficiaries—including confusion, financial hardship, and coverage losses.
According to the Centers for Medicare & Medicaid Services (CMS), affected individuals include those who were “enrolled either in a Medicare Advantage Plan or in a Medicare Prescription Drug Plan for coverage starting January 1, 2019” and chose to have their premiums automatically deducted from their monthly Social Security benefit, rather than pay the plan directly.
However, it’s not yet clear how many of these enrollees were affected, if those who were have been made aware, or how much they might owe. The Social Security Administration (SSA) notes that “Plans will be sending premium bills to those affected. If you are affected and haven’t already received a bill in the mail, you will soon. The first bill will likely be for a larger amount than usual to make up for the unpaid premiums.”
Importantly, plans must offer enrollees a “grace period” to repay the missed premium payments, which must last at least as long as the delay in billing. Plans also have the option not to pursue these outstanding payments.
CMS advises beneficiaries to call their plan directly with any questions or concerns. Medicare Rights’ Helpline counselors are also available at 800-333-4114, and enrollees may want to contact their local SHIP or 1-800-Medicare for assistance.
Medicare Rights appreciates federal agency and plan efforts to educate affected enrollees and we encourage them to continue to work together to hold beneficiaries harmless.
By the Kaiser Family Foundation – June 6 2019
Medicare Advantage enrollment has grown rapidly over the past decade, and Medicare Advantage plans have taken on a larger role in the Medicare program. This data collection provides current information and trends about Medicare Advantage enrollment, premiums, and out-of-pocket limits. It also includes analyses of Medicare Advantage plans’ extra benefits and prior authorization requirements.
Figure 1: Total Medicare Advantage Enrollment, 1999-2019 (in millions)
In 2019, one-third (34%) of all Medicare beneficiaries – 22 million people – are enrolled in Medicare Advantage plans, similar to the rate in 2017 and 2018. Between 2018 and 2019, total Medicare Advantage enrollment grew by about 1.6 million beneficiaries, or 8 percent – nearly the same growth rate as the prior year. The Congressional Budget Office (CBO) projects that the share of beneficiaries enrolled in Medicare Advantage plans will rise to about 47 percent by 2029.
Figure 2: Medicare Advantage Penetration, by State, 2019
The share of Medicare beneficiaries in Medicare Advantage plans (including Medicare cost plans), varies across the country. In 28 states and Puerto Rico, at least 31 percent of Medicare beneficiaries are enrolled in Medicare Advantage plans, with more than 40 percent of enrollees in six states (HI, FL, MN, OR, WI, PA) and Puerto Rico. The majority of the Medicare private health plan enrollment in Minnesota has historically been in cost plans, rather than Medicare Advantage plans, but as of 2019, most cost plans in Minnesota are no longer offered and have been replaced with risk-based HMOs and PPOs. Medicare Advantage enrollment is relatively low (20 percent or lower) in 14 states and the District of Columbia, including two mostly rural states where it is virtually non-existent (AK and WY).
Figure 3: Medicare Advantage Penetration, by County, 2019
Within states, Medicare Advantage penetration varies widely across counties. For example, in Florida, 66 percent of all beneficiaries living in Miami-Dade County are enrolled in Medicare Advantage plans whereas only 10 percent of beneficiaries living in Monroe County (Key West) do so. In 172 counties, accounting for 10 percent of the population, more than half of all Medicare beneficiaries are enrolled in Medicare Advantage plans or cost plans. Many of these counties are centered around large, urban areas, such as Monroe County, NY (66%), which includes Rochester, and Allegheny County, PA (61%), which includes Pittsburgh. In contrast, in 619 counties, accounting for 4 percent of Medicare beneficiaries, no more than 10 percent of beneficiaries are enrolled in Medicare private plans; many of these low penetration counties are in rural parts of the country but some urban areas, such as Baltimore City (17%), also have relatively low Medicare Advantage enrollment.
Figure 4: Medicare Advantage Enrollment by Firm or Affiliate, 2019
Medicare Advantage enrollment is highly concentrated among a small number of firms. UnitedHealthcare and Humana together account for 44 percent of all Medicare Advantage enrollees nationwide, and the BCBS affiliates (including Anthem BCBS plans) account for another 15 percent of enrollment in 2019. Another four firms (CVS/Aetna, Kaiser Permanente, Wellcare, and Cigna) account for another 22 percent of enrollment in 2019. For the third year in a row, enrollment in UnitedHealthcare’s plans grew more than any other firm, increasing by about 520,000 beneficiaries between March 2018 and March 2019. CVS purchased Aetna in 2018 and the combined company had the second largest growth in Medicare Advantage enrollment in 2019, increasing by also about 520,000 beneficiaries between March 2018 and March 2019.
Figure 5: Distribution of Medicare Advantage Enrollees, by Prescription Drug Plan Premium, 2019
In 2019, 90% of Medicare Advantage plans offer prescription drug coverage (MA-PDs), and most Medicare Advantage enrollees (88%) are in plans that include this prescription drug coverage. More than half of these beneficiaries (56%) pay no premium for their plan, other than the Medicare Part B premium. However, 21 percent of beneficiaries in MA-PDs (3.0 million enrollees) pay at least $50 per month, including 7 percent who pay $100 or more per month, in addition to the monthly Part B premium ($135.50 in 2019). Among MA-PD enrollees who pay a premium for their plan, the average premium is $65 per month. All together, including those who do not pay a premium, the average MA-PD enrollee pays $29 per month in 2019.
Figure 6: Average Monthly Medicare Advantage Prescription Drug Plan Premiums, Weighted by Plan Enrollment, 2010-2019
Nationwide, average Medicare Advantage Prescription Drug (MA-PD) premiums declined by $5 per month between 2018 and 2019, much of which was due to the relatively sharp decline in premiums for local PPOs this past year, and since 2015. Average premiums for HMOs also declined $3 per month, while premiums for regional PPOs were relatively similar between 2018 and 2019. Average MA-PD premiums vary by plan type, ranging from $23 per month for HMO enrollees to $39 per month for local PPO enrollees and $44 per month for regional PPO enrollees. Nearly two-thirds (62%) of Medicare Advantage enrollees are in HMOs, 31% are in local PPOs, and 6% are in regional PPOs in 2019.
Figure 7: Average Medicare Advantage Plan Out-of-Pocket Limits, Weighted by Plan Enrollment, 2019
In 2019, Medicare Advantage enrollees’ average out-of-pocket limit for in-network services is $5,059 (HMOs and PPOs) and $8,818 for out-of-network services (PPOs). For HMO enrollees, the average out-of-pocket (in network) limit is $4,706; these plans do not cover services received from out-of-network providers. For local and regional PPO enrollees, the average out-of-pocket limit for both in-network and out-of-network services are $8,796, and $8,901, respectively.
Since 2011, the Administration has required Medicare Advantage plans to provide an out-of-pocket limit for services covered under Parts A and B not to exceed $6,700 (in-network) or $10,000 (in-network and out-of-network combined). Limits have been required for regional PPOs since 2006.
HMOs generally only cover the services provided by in-network providers, whereas PPOs also cover services delivered by out-of-network providers but charge enrollees higher cost-sharing for this care. The size of Medicare Advantage provider networks for physicians and hospitals vary greatly both across counties and across plans in the same county.
Figure 8: Share of Medicare Advantage Enrollees in Plans with Extra Benefits by Benefit Type, 2019
Medicare Advantage plans may provide extra benefits that are not offered in traditional Medicare, and can use rebate dollars to help cover the cost of extra benefits. Plans can also charge additional premiums for such benefits. Most enrollees are in plans that provide access to some dental care (67%), a fitness benefit (72%), and/or eye exams or glasses (78%). Since 2010, the share of enrollees in plans that provide some dental care or fitness benefits has increased (from 48% and 52% of enrollees, respectively) while the share with a vision benefit has been relatively steady (77% in 2010).
Figure 9: Share of Medicare Advantage Enrollees Required to Receive Prior Authorization, by Service, 2019
Medicare Advantage plans can require enrollees to receive prior authorization before a service will be covered, and nearly four out of five Medicare Advantage enrollees (79%) are in plans that require prior authorization for some services in 2019. Prior authorization is most often required for relatively expensive services, such as inpatient hospital stays, skilled nursing facility stays, and Part B drugs, but infrequently required for preventive services. Beginning in 2019, Medicare Advantage plans can also require enrollees to use “step therapy” for Part B drugs, meaning that they are required to try some specific drugs (and fail to improve on those drugs) before they receive approval to try other drugs. In contrast to Medicare Advantage plans, traditional Medicare does not generally require prior authorization for services, and does not require step therapy for Part B drugs.
Figure 10: Distribution of Medicare Advantage Enrollees by Plan Star Rating, 2015-2019
In 2019, more than two-thirds (72%) of Medicare Advantage enrollees are in plans with quality ratings of 4 or more stars, a decrease from 74 percent in 2018. An additional 2 percent of enrollees are in plans that were not rated because they were part of contracts that had too few enrollees or were too new to receive ratings. Plans with 4 or more stars and plans without ratings are eligible to receive bonus payments for each enrollee the following plan year (2020). The share of enrollees in plans with 2.5 stars (below average ratings) nearly doubled from 3 percent in 2018 to 6 percent (nearly 1 million people) in 2019.
For many years, the Centers for Medicare and Medicaid Services (CMS) has posted quality ratings of Medicare Advantage plans to provide beneficiaries with additional information about plans offered in their area. All plans are rated on a 1 to 5-star scale, with 1 star representing poor performance, 3 stars representing average performance, and 5 stars representing excellent performance. CMS assigns quality ratings at the contract level, rather than for each individual plan, meaning that each plan covered under the same contract receives the same quality rating (and most contracts cover multiple plans).
Figure 11: Distribution of Medicare Advantage Enrollees, by Plan Type, 2019
One in five Medicare Advantage enrollees (4.4 million) are in group plans offered by employers and unions for their retirees in 2019. Under these arrangements, employers or unions contract with an insurer and Medicare pays the insurer a fixed amount per enrollee to provide benefits covered by Medicare. The employer or union (and sometimes the retiree) may also pay a premium for additional benefits or lower cost-sharing. Group enrollees comprise a disproportionately large share of Medicare Advantage enrollees in ten states: Alaska (100%), West Virginia (50%), Michigan (49%), New Jersey (42%), Illinois (39%), Kentucky (38%), Wyoming (37%), Maryland (36%), Delaware (35%), and New Hampshire (33%).
Figure 12: Number of Beneficiaries in Special Needs Plans, 2006-2019 (in millions)
Special Needs Plans (SNPs) restrict enrollment to specific types of beneficiaries with significant or relatively specialized care needs. The majority of SNP enrollees (85%) are in plans for beneficiaries dually eligible for Medicare and Medicaid (D-SNPs), with the remainder in plans for beneficiaries requiring a nursing home or institutional level of care (I-SNPs), or with severe chronic or disabling conditions (C-SNPs.)
Enrollment in SNPs increased modestly from 2.6 million beneficiaries in 2018 to 2.9 million beneficiaries in 2019, accounting for about 13 percent of total Medicare Advantage enrollment in 2019, with some variation across states. In seven states, the District of Columbia, and Puerto Rico, enrollment in SNPs comprises at least one-fifth of Medicare Advantage enrollment (51% in DC, 49% in PR, 25% in SC, 22% in NY, 21% in AR, 20% in AZ, 20% in FL, 20% in GA, and 20% in TN). Most C-SNPs enrollees (93%) are in plans for people with diabetes or cardiovascular disorders in 2019. Enrollment in I-SNPs has been increasing, but is still less than 100,000 beneficiaries.
Tags: Medicare Advantage
When zero-dollar premium plans were removed, costs still dropped by 13%, according to a survey from eHealth.
The health insurance exchange reported a 87% year-over-year increase in the amount of MA and Medicare Part D applications received during the open enrollment period (OEP) that lasted from January to March.
2019 marked the first year that consumers enrolled in a MA plan could switch to a different MA plan during OEP or leave MA and supplement their original Medicare coverage with a Part D prescription drug plan.
Between 2011 and 2018, consumers weren't able to switch to a MA plan outside of the fall OEP unless they had "a circumstance that allowed you a Special Enrollment Period."
Despite the opportunity for additional coverage options, including those with lower average monthly premiums, 51% of respondents did not know about OEP prior to shopping for a new plan, according to eHealth.
Those surveyed gave several responses for why they switched to a new Medicare plan, including unhappiness with a former insurer, increased copays, doctor leaving network, and changes to drug coverage.
During the OEP, the average monthly for MA plans was $8, down from $12 in Q1 2018, while the average out-of-pocket limits decreased 11%, from $5,815 to $5,164.
PDF for the report here.
Tags: Medicare Advantage
Lyft Hails Medicare Advantage As Next Profitable Ride
Lyft is signing new contracts and targeting a booming number of Medicare beneficiaries choosing private Advantage plans as a lucrative new growth area for the ride-sharing company.
New rules that allow health insurance companies to include more supplemental benefits in their Medicare Advantage plans is opening the door to Lyft and rivals to have more of their services woven into benefits for next year. Health plan bids to participate in Medicare Advantage for 2020 are due Monday, June. 3.
"We expect to be working with the majority of the largest MA plans by 2020,” said Lyft’s vice president of healthcare Megan Callahan, who was hired last year to lead the company’s growing healthcare businesses.
Medicare Advantage plans contract with the federal government to provide extra benefits and services to seniors, such as disease management and nurse help hotlines, with some even providing vision and dental care and wellness programs.
But the ability of Medicare Advantage plans to integrate ride-sharing services into bids is taking off given new rules announced last year “reinterpreting the standards for health-related supplemental benefits in the Medicare Advantage program to include additional services that increase health and improve quality of life.”
As health insurers move away from fee-for-service medicine to value-based care and population health models that make sure patients are getting quality care in the right place and at the right time, ride-sharing companies say they can have a key role.