Medicare Advantage, Part D members shifting to higher-rated plans
The number of Medicare Part D prescription drug plan members who will be in plans with four stars or more in 2020 rose to 27.6%, up from just 3.5% last year, according to data released by the CMS on Friday. The percentage of four-star or greater Medicare Advantage Part C plans with prescription drug coverage grew to a whopping 81.1% of members in 2020, up from 75.3% in 2019.
The topic of lopsided star ratings toward the high end of the scale has been a sticking point with the Medicare Payment Advisory Commission, which believes $6 billion a year could be saved by revamping the way stars are awarded in the Medicare Advantage program.
Medicare prescription drug plans 2020 star ratings
The percentage of Medicare Part D prescription drug plan members in plans with four stars or more in 2020 rose sharply from the year before.
The average star rating of Part D plans, which are managed by pharmacy benefit management companies and health insurers, has bobbed up and down for years but has always hovered below four stars. The average star rating across the 54 Part D contracts in 2020 was 3.5, up from last year's average rating of 3.34.
Enrollment in Part D prescription drug plans with fewer than three stars dropped to 0.8%, compared to 6.2% last year. Just 5.6% of Part D plans received below three stars, whereas 9.6% did in 2018.
Meanwhile, more than 200 Medicare Advantage plans offering prescription drug coverage, representing 52.4% of these plans for 2020, received at least four stars. Last year, 172, or 45.7% of plans, were part of that category. The average star rating for Medicare Advantage plans with prescription drug coverage was 4.16 for 2020, up from last year's 4.06. Medicare Advantage plans with fewer than three stars dropped to 15%, compared with 21.3% in 2019.
Higher rated plans get larger share of enrollees
More people were enrolled in Medicare Advantage plans with prescription drug coverage that had 4.5- or 5-star ratings.
The CMS star rating system for Medicare's private insurance coverage is meant to hold insurers accountable for the care provided to their members.
Health plans have a financial incentive to provide better quality care for their members, because those that garner four or more stars receive a 5% boost to their monthly per-member payments from Medicare.
Twenty-three individual plans scored five stars for 2020. Twenty of those were Medicare Advantage plans offering prescription drug coverage, including nine new contracts that had not earned the high performing indicator last year. Two of the plans were stand-alone prescription drug plans and one was a Medicare Advantage-only plan.
Five individual plans covering more than 73,000 people received a warning from the CMS for consistently low quality ratings. Those plans—owned by QHP Financial Group, Delaware Life Insurance Co., Centers Plan for Healthy Living, Universal Health Services and Magellan Health—have earned ratings of 2.5 stars or fewer for a Medicare Advantage or Part D contract since at least 2018.
CMS Administrator Seema Verma said in a statement that the star ratings in the Medicare Advantage and Part D programs indicate that "seniors will have access to more high-quality plans," and pointed to projections the agency released last month suggesting that in 2020 Medicare Advantage average monthly premiums will hit their lowest point in 13 years.
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Administration Drives Access to More High-Quality Medicare Plan Choices in 2020
Consistent with the direction of President Trump’s recent Executive Order on Strengthening and Improving Medicare for Our Nation’s Seniors, the Centers for Medicare & Medicaid Services (CMS) announced today that seniors will have access to more high-quality Medicare Advantage and Part D prescription drug plans in 2020. Most people with Medicare will have access to Medicare Advantage and Part D plans with four or more stars in 2020, and approximately 81 percent of Medicare Advantage enrollees with prescription drug coverage will be in plans with four and five stars in 2020, an increase from 69 percent in 2017.
Medicare Advantage remains a popular choice among beneficiaries and has high satisfaction rates. Due to recent actions CMS has made to protect and strengthen Medicare Advantage, Medicare Advantage plans are better able to compete on the basis of cost and quality. As a result, beneficiaries are benefiting from more plan choices, lower costs and increased quality. As announced last month, on average, Medicare Advantage premiums are expected to decline by 23 percent from 2018, and will be the lowest in the last thirteen years for the more than 24 million people with Medicare who are projected to enroll in Medicare Advantage for 2020. Beneficiaries will have more plan choices, with about 1,200 more Medicare Advantage plans operating in 2020 than in 2018.
“President Trump continues to be the great protector of the Medicare program for our nation’s seniors,” said CMS Administrator Seema Verma. “Thanks to the President’s leadership and commitment, the improvements that CMS has made to the Medicare Advantage and Part D programs means that seniors will have access to more high-quality plans. Proposals for more government in our healthcare – such as Medicare-for-All – would eviscerate the progress we’ve made to strengthen the program by empowering patients to make informed choices in choosing high-quality plans that best fit their needs.”
Approximately 52 percent of Medicare Advantage plans that offer prescription drug coverage will have an overall rating of four stars or higher, compared to approximately 45 percent in 2019. The average star rating for all Medicare Advantage plans with prescription drug coverage has improved to 4.16 out of 5 stars, increasing from 4.02 in 2017.
More Medicare beneficiaries will have access to a greater number of high-quality stand-alone Medicare Part D prescription drug plans. In 2020, based on current enrollment, approximately 28 percent of enrollees will be in stand-alone prescription drug plans with 4 stars or higher, an increase from approximately 3 percent in 2018. And the average star rating for a stand-alone prescription drug plan has improved from 3.34 in 2019 to 3.50 in 2020.
Earlier this year, CMS made improvements to the Medicare Advantage and Part D Star Ratings so that consumers can more easily identify high-value and high-quality plans. The Star Ratings methodology was enhanced to better account for differences in a plan’s enrollee population.
The Star Ratings system helps people with Medicare, their families, and their caregivers compare the quality of health and drug plans being offered. Medicare health and drug plans are given a rating on a 1 to 5 star scale, with 1 representing poor performance and 5 stars representing excellent performance. Medicare beneficiaries can compare health coverage choices and the Star Ratings through the online Medicare Plan Finder tool available at Medicare.gov (https://www.medicare.gov). CMS publishes the Medicare Advantage and Part D Star Ratings every year to measure the quality of, and reflect the experiences of beneficiaries in, Medicare Advantage and Part D plans.
It will be easier than ever to compare Medicare Advantage and Part D plans on Medicare.gov. As the 2020 Medicare Open Enrollment period approaches, CMS for the first time in a decade launched a modernized and redesigned Medicare Plan Finder – the most-used tool on Medicare.gov – that allows users to shop and compare Medicare Advantage and Part D plans (including by total costs of estimated annual drug costs plus premiums) as well as compare costs between original Medicare, Medicare prescription drug plans, Medicare Advantage plans and Medicare supplemental insurance (Medigap) policies.
Medicare Open Enrollment begins on October 15, 2019, and ends on December 7, 2019. During this time, Medicare beneficiaries can compare coverage options like Original Medicare and Medicare Advantage and choose health and drug plans for 2020. Medicare health and drug plan costs and covered benefits can change from year to year, so people with Medicare should look at their coverage choices and decide on the options that best meet their health needs. They can visit Medicare.gov (https://www.medicare.gov), call 1-800-MEDICARE, or contact their State Health Insurance Assistance Program.
For more information on the 2020 Medicare Advantage and Part D Star Ratings, including a fact sheet, please visit: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData.html, and download the “2020 Part C and D Medicare Star Ratings Data” zip file in the downloads section.
To view the premiums and costs of the 2020 Medicare Advantage and Part D plans, please visit: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/index.html.
Medicare Market Insights and
Medicare Advantage (MA) plans have been eagerly preparing their Medicare products in anticipation of the 2019 Annual Election Period (AEP) which is now upon us. The 2019 Medicare Advantage market is comprised of national health plans, Blue Cross Blue Shield organizations, prominent regional health plans and specialized Medicare companies. MA plans currently provide medical coverage for over 21.5 million beneficiaries. In the last three years, these plans have collectively increased enrollment by approximately 3.7 million members and currently cover over 34% of the nearly 63 million people eligible for Medicare benefits.
As Medicare companies finalize sales and marketing strategies, they analyze data from Medicare Plan Finder (MPF), an online tool that makes it easy for seniors to review options and shop for new Medicare plans. Medicare Benefits Analyzer™ , a Mark Farrah Associates’ database, helps simplify the analysis of the Medicare Plan Finder data for companies competing in this segment. This brief presents a snapshot of the 2019 Medicare Advantage market with insights from the Centers for Medicare and Medicaid Services (CMS) Medicare Landscape reports and discusses the plans that will be vying for business during the AEP.
The Competitive Medicare Landscape
MA plans, along with stand-alone PDPs (prescription drug plans), are immersed in competitive assessments as beneficiaries begin to choose plans during this Annual Election Period, which runs between October 15th and December 7th. Based on an aggregate analysis of CMS Landscape reports, a total of 3,810 distinct Medicare Advantage (MA) plan offerings are in the market lineup for the onset of the 2019 AEP. This includes MA plans, Medicare Advantage with prescription drug plans (MAPDs), Medicare/Medicaid plans (MMPs), and Special Needs Plans (SNPs). During the AEP, Medicare beneficiaries can choose to change MA plans or switch from Original Medicare to MA, and plan benefits will become effective on January 1, 2019.
MFA’s analysis of CMS landscape data found a total of 3,077 MA plans being offered for 2019, including MMPs, up from 2,619 in 2018. In addition, a total of 733 Special Needs Plans (SNPs) are available in 2019, up from 640 in 2018. Health Maintenance Organizations (HMOs) represent 68% of all MA plan types with over 2,600 offerings for the coming year. Stand-alone PDPs nationwide increased for 2019 with 910 plan offerings, as compared to 795 plans in 2018.
According to the CMS press release, Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019 ; Medicare Advantage average monthly premiums will decrease 6% from 2018, falling to $28. Enrollment is projected to experience 11.5% growth over 2018. In addition, over 91% of people with Medicare will have access to 10 or more Medicare Advantage plans, which is up from 86% for 2018.
Plan Competition for 2019
Based on the 2019 CMS Landscape reports, Humana continues to market more MA plans than any other company nationwide, with 548 distinct plans identified in MFA’s assessment. UnitedHealth continued to increase its MA plan offerings for the 2019 calendar year with 406 distinct plans identified, up 62 plans from last year. Aetna (including Coventry and other affiliates) is offering 355 plans for 2019. Anthem and the vast majority of other Blue Cross Blue Shield plans as well as WellCare and Centene also continue to have a notable plan offerings presence, respectively.
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The 2019 Medicare Star Ratings Program: Making the Cut
The Centers for Medicare & Medicaid Services (CMS) last week published its 2019 Part C and Part D Medicare Star Ratings data and, along with it, the Technical Notes describing the methodology for the Star Ratings. Here, Ashley McNairy, product director for Cotiviti’s Government Quality solutions, breaks down the changes to the cut points, which can have a significant impact on a health plan’s score.
Cut points are the ranges within which a measure’s score needs to fall in order to be assigned a certain star value. As an example, here is the cut point range for Breast Cancer Screening (C01), which measures the percentage of female plan members aged 52 to 74 who had a mammogram during the past two years:
Every year, CMS adjusts these ranges slightly based on how the measures are trending. As the industry’s performance improves in a specific metric, in other words, you can expect the ranges to increase, so it becomes harder for a plan to hit the five-star mark.
Many health plans and analysts try to predict how these cut points may change year over year, as even a 1 percent change in a measure’s cut point range could drop the plan’s rating from five stars to four stars for that measure—or potentially even drop the plan’s overall rating.
Out of the 46 Part C and Part D measures that have carried over from 2018 to 2019, almost half have higher ranges in at least one of the thresholds. Some measures only moved one or two points in a couple thresholds; however, in general the two- and three-star ranges are higher, whereas the four- and five-star ranges were closer to last year’s cut points. This simply means it is harder to get even a two-star rating in several measures.
The most notable shift to higher cut points was the Medication Reconciliation Post-Discharge measure (C20), as each cut point threshold jumped at least 10 percent. As a measure that was only first introduced in 2018, this dramatic change could indicate that the cut points were simply too low in the first year, or that plans are exceeding expectations. These ranges will likely continue to grow, with plans’ measure scores averaging 56 percent for 2019 compared to 50 percent for 2018.
The other notable shift in cut points occurred in the three Care for Older Adult measures (C09-C11). These measures are required for Special Needs Plans (SNPs), which make up about 40 percent of all contracts. Both Medication Review and Functional Status Assessment had lower thresholds in the two- and three-star ranges, but stayed relatively the same in the four- and five-star ranges. For example, a plan only needs to achieve a 1 percent score to earn two stars for Medication Review, whereas last year plans needed to hit 59 percent. This seems like an odd starting point for a threshold in a measure where the average score improved from 90 percent to 92 percent this year. Alternatively, the Pain Assessment measure, which also saw average scores improved, shifted to higher cut points across each threshold.
Only one measure’s cut points stayed exactly the same: the Part C Customer Service measure, which is part of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Cut points for this measure stayed the same even as the other CAHPS measures all experienced slight changes. This could be due to overall health plan performance averaging the same for this measure for both 2018 and 2019.
With the quality of care in Medicare Advantage plans increasing each year and becoming more competitive for both market share and rebates, plans are understandably looking for more predictability in their Star Ratings. Out of the Cotiviti clients that had enough data for either an overall Summary Rating or a Part D score, 13 percent increased their rating, with several being either a four-and-a-half- or five-star plan. The majority of plans that worked with Cotiviti received the same rating as in 2018, which is a success to celebrate considering the many hurdles that plans have to overcome each year as the thresholds change.
Star Navigator is a quality improvement solution that enables Medicare Advantage plans to determine the most direct path to higher Star Ratings, then track and communicate their progress toward goals. Learn more from our fact sheet.