Information about http://www.kff.org/medicare/upload/medicaretracking0907.pdf
…
Tags: foundation program, gold, kaiser family foundation, marsha, mathematica policy research, mathematica policy research inc, medicare, medicare health, penetration, plan offerings, prescription drug, private plan, stephanie peterson,Pages: 6
Language: english
Created: Mon Oct 15 10:14:33 2007
Display cached document
Page 1
Page 2
Page 3
Page 4
Page 5
Page 6
October 10, 2007
TRACKING MEDICARE HEALTH AND PRESCRIPTION DRUG PLANS
Monthly Report for September 2007
Prepared by Stephanie Peterson and Marsha Gold, Mathematica Policy Research Inc.
as part of work commissioned by the Kaiser Family Foundation
PROGRAM STATUS: PRIVATE PLAN OFFERINGS, ENROLLMENT, AND CHANGE
Current Change Same Month Last Year
Month: From
Enrollment and Penetration, Previous September 2006 Change
September Month* From
by Plan Type 2007 September
2006- 2007
Enrollment
Total Stand-Alone
Prescription Drug Plans (PDPs): 17,137,966 +35,965 16,439,246 +698,720
General 17,013,281 +35,574 16,321,547 +691,734
Employer/Union Only Direct 124,685 +391 114,699 +9,986
Not Available (Total Enrollees) Not Available Not Available
Duals Auto Enrolled in PDPs** 6,270,154
All others Enrolled in PDP 10,360,026
Total Medicare Advantage (MA) 8,919,710 +54,384 7,484,724 +1,434,986
Medicare Advantage-Prescription Drug (MA-PD) 7,416,865 +56,551 6,471,096 +945,769
Medicare Advantage (MA) only 1,502,845 -2,166 1,013,628 +489,217
Medicare Advantage (MA) by Type
MA Local Coordinated Care Plans** * 6,267,459 +28,813 5,951,003 +316,456
Health Maintenance Organizations (HMOs) 5,767,578 +17,732 5,530,490
Provider Sponsored Organizations (PSOs) 78,701 +128 92,142
Preferred Provider Organizations (PPOs) 421,151 +10,949 328,361
Regional Preferred Provider Organizations (PPO) 209,542 +26,611 91,996 +117,546
Medical Savings Account (MSA) 2,267 -5 Not Applicable Not Applicable
Private Fee For Service (PFFS) 1,709,782 -3 820,146 +889,636
General 1,699,054 -45 Not Available Not Available
Employer Direct PFFS 10,728 +42 Not Available Not Available
Cost 310,084 +810 317,721 -7,637
Pilot**** 114,045 -1,844 Not Applicable Not Applicable
Other***** 306,531 +3 303,858 +2,673
General vs Special Needs Plans******
Special Needs Plan Enrollees 1,021,800 +32,688 Not Available Not Available
Dual-Eligibles 722,286 +12,621 Not Available Not Available
Institutional 143,905 +361 Not Available Not Available
Chronic or Disabling 155,609 +19,706 Not Available Not Available
Other Medicare Advantage Plan Enrollees 7,897,910 +21,697 Not Available Not Available
Penetration (as percent beneficiaries)*******
Prescription Drug Plans (PDPs) 38.9% +0.1% 37.3% +1.6%
Medicare Advantage Plans (MA) 20.2% +0.1% 17.0% +3.2%
Medicare Advantage-Prescription Drug Plans (MA-PDs) 16.8% +0.1% 14.7% +2.1%
Local Health Maintenance Organizations (HMOs), 13.0% No Change 12.5% +0.5%
Preferred Provider Organizations (PPOs) 1.0% +0.1% 0.7% +0.3%
Provider Sponsored Organizations (PSO) 0.2% No Change 0.2% No Change
Private Fee For Service (PFFS) 3.9% No Change 1.9% +2.0%
1
October 10, 2007
September 2007 data is from the 9.11.07 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/MCRAdvPartDEnrolData/)
* The August 2007 data is from data released by CMS on 8.10.07 also on its website
**The data for dual eligibles automatically enrolled in PDPs comes from CMS released data "State Enrollment in Prescription
Drug Plans"-January 2007 also on its wesbite.
***The data for the breakdown of MA Local Coordinated Care Plans is from the 9.11.07 Medicare Advantage, Cost, PACE,
Demo, and Prescription Drug Plan Organizations-Monthly Report by Contract. The total for each CCP plan by type does not
sum to the total CCP because the breakdown totals do not include enrollment numbers for contracts whose enrollment is less than
10. ((http://www.cms.hhs.gov/MCRAdvPartDEnrolData/)
****CMS is now including Pilot enrollees in this count. The Pilots refer to contracts to provide care management services for
fee-for-service beneficiaries with chronic condition. CMS reports that this data is being included in their monthly count since
they are part of the total monthly Medicare payment. However, beneficiaries for whom such payments are made are in the
traditional Medicare program. Hence, users probably should exclude these enrollees from analysis and trending.
*****Other includes Demo contracts, HCPP and PACE contracts.
******The SNP total for September is from the SNP Enrollment Comprehensive Monthly Report released by CMS on 911.07
and includes counts of 10 or less. (See: (http://www.cms.hhs.gov/MCRAdvPartDEnrolData/)
*******Penetration is calculated using the number of eligible beneficiaries reported in the December 2005 State/County File.
DEFINITIONS: Coordinated Care Plans, or CCPs, include health maintenance organizations (HMOs), provider-sponsored
organizations (PSOs) and preferred provider organizations (PPOs). The Medicare preferred provider organization
demonstration began in January 2003. PFFS refers to private fee-for-service plans. Cost plans are HMOs that are reimbursed on a
cost basis, rather than a capitated amount like other private health plans. Other Demo refers to all other demonstration plans that
have been a part of the Medicare+Choice / Medicare Advantage program. "Special needs individuals" were defined by
Congress as: 1) institutionalized; 2) dually eligible; and/or 3) individuals with severe or disabling chronic conditions.
Summary of MA contracts in September:
SAME MONTH LAST YEAR
CURRENT
Plan Participation, by type MONTH: SEPTEMBER CHANGE FROM
SEPTEMBER 2006 SEPTEMBER
2007* 2006 2007
MA Contracts (excluding SNP only contracts)
Total 601 512 +89
Local Coordinated Care Plan 408 367 +41
Health Maintenance Organizations (HMOs) 289 239 +50
Preferred Provider Organizations (PPOs)
(Includes Physician Sponsored Organizations
(PSOs)) 119 128 -9
Regional Preferred Provider Organizations (rPPOs) 14 11 +3
Private Fee For Service (PFFS) 48 25 +23
General 47 Not Available Not Available
Employee Direct 1 Not Available Not Available
Cost 27 28 -1
Medicare Savings Account (MSA)
2 Not Available Not Available
Special Needs Plans 312
Dual-Eligible 204 Not Available Not Available
Institutional 65
Chronic or Disabling Condition 43
Other** 89 81 +8
*Contract counts for September 2007 are from the 9.11.07 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/MCRAdvPartDEnrolData/)) and the SNP Comprehensive Monthly Report also released on its
website at: ((http://www.cms.hhs.gov/MCRAdvPartDEnrolData/)
**Other includes Demo contracts, Health Care Prepayment Plans (HCPP), and Program for all-inclusive care of Elderly (PACE)
2
October 10, 2007
NEW ON THE WEB FROM CMS
Relevant to Both Medicare Advantage and Prescription Drug Plans
· On September 27, 2007, CMS released fact sheets for each state and Washington DC
on 2008 MA-PD and PDP offerings. As in previous years, the fact sheets include
limited information in a consistent format for each state on offerings beginning in
January. The fact sheets include information on the number of PDPs available in the
state; the number of PDPs offering enhanced benefits or services; the percentage of
people with Medicare that could switch to a PDP with a lower premium in 2008; the
total number of PDPs with $0 deductibles; the total PDPs with premiums under $20;
the percentage of people with MA-PDs that will have access to a plan with $0
premium; the percentage of people with MA-PDs with access to a plan with a $0 drug
premium among other items. For examples:
· West Virginia has the largest total available PDPs (63) and Alaska has the
lowest amount available (47) of all the 50 states or DC. The average
number of PDP offerings is 53.
· Pennsylvania and West Virginia have the highest number of $0 deductable
PDP plans (36) and Hawaii and Alaska have the lowest (28).
· The lowest cost PDP plan in each state varies from a low of $9.80 in
Arizona to the highest amount of $18.00 in Alabama and Tennessee.
· The total beneficiaries for all the states and DC with the low-income
subsidy is 9,632,124.
· CMS also provided the data used in these fact sheets in two excel
spreadsheets. Both the fact sheets and the excel background data are
available on CMS's website but they are not easy to find. They can be
accessed at: http://www.cms.hhs.gov/Partnerships/STDrugPlanInfo/list.asp
and http://www.cms.hhs.gov/center/openenrollment.asp
· On September 24, 2007, CMS released a press release titled "Seven Medicare PFFS
Plans are Approved Following Rigorous Marketing Review." These plans had their
marketing suspended in June 2007 (some voluntarily) so that CMS could review their
marketing strategies. The press release announced that CMS had approved a
resumption of marketing (an important approval with the upcoming open enrollment
seasons). Four of the plans had voluntarily suspended marketing of PFFS products: 1)
United Health Group. 2) Blue Cross Blue Shield of Tennessee; 3) Humana; and 4)
Sterling Life Insurance Co. The other three plans CMS reviewed and now approved
for marketing are: 5) Coventry; 6) Universal American Financial Corp; and 7)
Wellcare Health Plans. The press release is available at:
http://www.cms.hhs.gov/apps/media/press_releases.asp
3
October 10, 2007
Relevant to Medicare Advantage
· None
Relevant to Prescription Drug Plans
· CMS released information on 2008 Part D national stand-alone prescription drug
plans. There will be 17 companies offering such products including Aetna; Cigna;
Coventry Health Care; CVS-Caremark; ENVISIONRX PLUS INC; Health Net;
Humana; Longs Drug Stores Corporation; Medco Health Solutions; Member Health;
NewQuest Health Solutions LLC; Sterling Insurance Group; Torchmark Group;
United HealthCare Group, Inc; Universal American Financial Corp; WellCare Health
Plans, Inc; and Wellpoint, Inc. Wellpoint Inc will offer low-income subsidy (LIS)
plans nationally. Although there were also 17 national plan sponsors in 2007, NMHC
Systems and Express Scripts are no longer national sponsors and instead Universal
American Financial Corp and Sterling Insurance Group are first time sponsors in
2008. This information is available on CMS's website at (for 2008 information see:
http://www.cms.hhs.gov/Partnerships/downloads/2008MedicarePartDNationalStand.p
df) and for 2007 information on Part D stand-alone prescription plan sponsors see:
http://www.medicare.gov/medicarereform/mapdpdocs2007/2007NationalPDPs.pdf)
Of General Interest
· None
Relevant to Special Needs Plans Specifically
· This month, SAMHSA/CMS held a three-day Medicare Advantage Special Needs
Plans conference in Baltimore, Maryland. The conference included a one-day
workshop for those operating and managing SNPs including an overview of the SNP
business model; working with Medicare Part D and understanding the regulatory
environment. The second day of the workshop included a one-day track session
broken out by type of SNP (dual eligibles; institutional and chronic care). Jim
Verdier, Senior Fellow at MPR, spoke at the dual-eligible portion of the conference.
His presentation, "Mental Health Services in Special Needs Plans; Integrated Care for
Persons with Mental Disorders," provided an overview of MA SNPs; information on
SNP enrollment and state contractual issues as well as challenges for SNPs. The final
day of the conference included presentations of 4 case studies including lessons
learned from Blue Cross Blue Shield (one of the country's earliest and largest SNP
programs) as well as case studies on HIV and ESRD SNPs. More information on
Verdier's presentation as well other information on the event, including the
conference overview and brochure as well as each session and presenter information
is available at: www.iirusa.com/SNPs.
4
October 10, 2007
OTHER ITEMS OF RELEVANCE
Briefings and Hearings:
· None
Other
· The Kaiser Family Foundation released a summary this month on how the House-
passed Children's Health and Medicare Protection CHAMP act (H.R 3162) would
affect low-income Medicare beneficiaries. Specifically, the summary provides a side-
by-side comparison of the current law and key provisions in the new legislation
(including eligibility requirements; verification of income and resources; automatic
reenrollment; among others). For example, while there is no change in the income
requirement for the Part D low-income subsidy program, there is an increase in the
resource limit (from $10,210/individual and $20,410/couple in 2007 to
$17,000/individual and $34,000/couple beginning in 2009). This summary is
available on the KFF website at: http://www.kff.org/medicare/7695.cfm
· The Kaiser Family Foundation also released a study this month titled "The Burden of
Out-of-Pocket Health Spending Among Older Versus Younger Adults: Analysis from
the Consumer Expenditure Survey, 1998-2003." The study used data from the
Consumer Expenditures Survey from 1998 to 2003 to analyze senior and younger
adults' share of income spent on out of pocket costs for health care. Findings included
that seniors spent more than five times the share of income on out of pocket costs
than young people. The authors suggest that even with the new Part D program,
narrowing the gap in out of pocket spending between younger adults and seniors is
unlikely. The full report is available online at: http://www.kff.org/medicare/7686.cfm
· A study in Health Services Research by Boyd H. Gilman and John Kautter titled
"Impact of Multitiered Copayments on the Use and Cost of Prescription Drugs among
Medicare Beneficiaries (September 2007)" provides findings of an analysis on
beneficiary cost sharing on the cost and use of prescription medications. Primary
findings included that higher tiered drug plans reduce overall expenditures and the
number of prescriptions purchased by Medicare beneficiaries. Other findings include
that beneficiaries are less responsive to cost sharing incentives when using drugs to
treat chronic conditions. The full version of this article is available at:
(http://www.blackwell-synergy.com/doi/abs/10.1111/j.1475-6773.2007.00774.x)
· This month, America's Health Insurance Plans (AHIP) held a conference on
Medicare and Medicaid. Relevant to MA and Part D, conference speakers included:
· Julie Goon, Special Assistant to the President for Economic Policy: "The
Administrations Perspective for 2008: The Road Ahead for the Part D and
Medicare Advantage Programs."
· Peter Orszag, Congressional Budget Office: "Medicare's short-term and long-
term financial outlook and implications"
5
October 10, 2007
· More information on this conference, including a web video of the conference
and transcript is available at: http://www.ahip.org/links/mcmc2007/
6