According to the KFF.org brief, “Medicare Advantage 2016: Enrollment Spotlight”, the number and share of Medicare beneficiaries enrolled in Medicare Advantage, or Medicare Part C, has steadily increased over the past decade.

The Data Spotlight reviewed national and state-level Medicare Advantage enrollment rends as of March 2016 and examined the variations in enrollment type.

The KFF.org briefing analyzed the most recent data on premiums, out-of-pocket limits, Medicare Part D Prescription Drug Plan cost sharing, and plans’ quality ratings. The key findings include:

  • Medicare Advantage enrollment has increased in virtually all states over the past year. Almost 1 in 3 Medicare Beneficiaries (31% or 17.6 million) is enrolled in a Medicare Advantage plan in 2016—about a 1 million beneficiary growth since 2015 with both group and individual plans.
  • Over 3 million (18%) beneficiaries are in a group plan.
  • UnitedHealthcare and Humana together account for about 39% of the enrollments in 2016
  • If Aetna acquired Humana with no divestitures in 2016, the combined firm would account for 25% of Medicare Advantage beneficiaries nationwide
  • On average, premiums paid by beneficiaries were relatively the same between 2015 and 2016 ($37 per month in 2016 vs $38 per month in 2015), although premiums vary widely across states, counties and plan types.
  • Medicare Advantage plans, unlike Original Medicare Part A & Part B, are required to provide an out-of-pocket limit ($6,700) for services covered under Original Medicare Part A & Part B. In 2016, the average beneficiary had an out-of-pocket limit of $5,223, nearly $1,000 higher than it was in 2011.
  • More than 1/3 of Medicare Advantage prescription drug plans in 2016 (37%) are in plans with limits at the maximum.

There were several trends in enrollment time, as has been the case since 2007, about 2/3 or 64% of Medicare Advantage beneficiaries are in HMOs in 2016. Almost 1/3 are in PPOs – with more in local PPOs (23%) than regional PPOs (7%) and the remained are in Private Fee-For Service (PFFS) plans (1%) and other types of plans (4%_, including cost plans and Medicare Medical Savings Accounts. Please see below for the “Total Medicare Advantage Enrollment: Distribution of Enrollment by Plan Type, 2016” model from KFF.org, labelled Figure 3.

mp-kff-briefing

Other interesting statistics include the Medicare Advantage Enrollment Growth by State. In 2016, enrollment increased in all states in 2015, with the exception of Ohio where enrollment actually declined by 8%, according to KFF.org 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. In 9 states (DE, IA, MD, ME, MS, MT, ND, NH and SD) and the District of Columbia, enrollment increased by more than 10%, double the national average, including four states (DE, IA, ND and NH) in which enrollment increased by more than 20%. All of these states have Medicare Advantage penetration rates far below the national average with relatively few beneficiaries and their grow rates are sensitive to small changes in enrollment.

Medicare Advantage Enrollment and Penetration Rate, by State, 2015-2016
State 2015 Total Enrollment 2016 Total Enrollment Change in Total Enrollment,
2015-2016
Percent Change in Enrollment,
2015-2016
2015 Penetration Rate 2016 Penetration Rate
Total U.S. 16,761,673 17,625,200 863,527 5% 31% 31%
Alabama 238,091 257,218 19,127 8% 25% 26%
Alaska 56 93 N/A N/A <1% <1%
Arizona 425,454 442,282 16,828 4% 38% 38%
Arkansas 114,326 121,543 7,217 6% 19% 20%
California 2,127,666 2,244,709 117,043 6% 38% 39%
Colorado 281,467 293,275 11,808 4% 37% 36%
Connecticut 157,692 165,722 8,030 5% 25% 26%
Delaware 13,841 16,792 2,951 21% 8% 9%
District of Columbia 11,033 12,292 1,259 11% 13% 14%
Florida 1,570,845 1,670,266 99,421 6% 40% 41%
Georgia 460,670 508,161 47,491 10% 31% 33%
Hawaii 110,465 113,451 2,986 3% 46% 46%
Idaho 87,837 90,435 2,598 3% 32% 31%
Illinois 371,007 405,756 34,749 9% 18% 19%
Indiana 264,104 279,338 15,234 6% 23% 24%
Iowa 81,541 98,790 17,249 21% 14% 17%
Kansas 61,600 67,733 6,133 10% 13% 14%
Kentucky 212,948 229,916 16,968 8% 25% 26%
Louisiana 232,445 249,920 17,475 8% 30% 31%
Maine 66,307 75,116 8,809 13% 22% 24%
Maryland 76,375 88,998 12,623 17% 8% 9%
Massachusetts 233,084 246,018 12,934 6% 19% 20%
Michigan 595,239 621,118 25,879 4% 32% 32%
Minnesota 480,474 510,713 30,239 6% 53% 55%
Mississippi 76,776 85,208 8,432 11% 14% 15%
Missouri 311,364 337,119 25,755 8% 28% 29%
Montana 34,758 39,200 4,442 13% 18% 19%
Nebraska 34,982 37,169 2,187 6% 11% 12%
Nevada 146,094 157,379 11,285 8% 33% 34%
New Hampshire 17,295 20,756 3,461 20% 7% 8%
New Jersey 222,846 245,651 22,805 10% 15% 16%
New Mexico 113,807 120,099 6,292 6% 31% 32%
New York 1,212,239 1,243,714 31,475 3% 37% 37%
North Carolina 512,924 547,079 34,155 7% 29% 30%
North Dakota 17,878 21,627 3,749 21% 15% 18%
Ohio 811,503 748,125 -63,378 -8% 38% 34%
Oklahoma 111,013 116,489 5,476 5% 17% 17%
Oregon 323,765 339,461 15,696 5% 44% 44%
Pennsylvania 1,001,864 1,022,462 20,598 2% 40% 40%
Rhode Island 71,009 72,954 1,945 3% 35% 35%
South Carolina 209,812 224,130 14,318 7% 23% 23%
South Dakota 26,400 31,158 4,758 18% 17% 20%
Tennessee 412,042 440,394 28,352 7% 34% 35%
Texas 1,098,678 1,174,621 75,943 7% 31% 32%
Utah 113,034 120,237 7,203 6% 33% 34%
Vermont 8,984 9,671 687 8% 7% 7%
Virginia 206,427 219,382 12,955 6% 16% 16%
Washington 348,467 360,712 12,245 4% 30% 30%
West Virginia 99,454 103,805 4,351 4% 24% 25%
Wisconsin 388,732 410,771 22,039 6% 38% 38%
Wyoming 2,071 2,079 N/A N/A 2% 2%
NOTE: Includes employer-sponsored plans, special needs plans, and other private plans. N/A indicates based on too few (less than 50) enrollees to report. Total U.S. includes Puerto Rico. Between March 2015 and March 2016, the CMS Division of Consumer Assessment and Plan Performance improved the determinations used to assign Medicare beneficiaries to geographic areas in their monthly Medicare Advantage Penetration files. This edit fixed an undercount of approximately 1% of actual Medicare enrollment, potentially making prior-year penetration rates look comparatively higher.

SOURCE: Authors’ analysis of CMS Medicare Advantage enrollment and Landscape files, 2015-2016.

According to KFF.org, most states, the majority of beneficiaries are in HMOs; however in 9 states (AK, HI, IL, IN, IA, KY, MI, MT and WV), the majority of beneficiaries are enrolled in local PPOs. Most of these states (MI, IL, and HI being exceptions) are heavily rural and also have Medicare Advantage penetration rates below national average. Additionally, in a few states, according to KFF.org, (MN, ND, SD), the preponderance of private plan beneficiaries are in cost plans, which are paid differently from Medicare Advantage plans and allow beneficiaries to see any Medicare provider (and pay the cost-sharing they would pay in Original Medical). See the Share of Medicare Beneficiaries enrolled in Medicare Private Plans by state from KFF.org in Figure 6.

8873-figure-6

To read more on beneficiaries Medicare Advantage premiums, totals, plan types, click here to read the briefing in it’s entirety. For more information on your local Medicare Advantage options, contact a licensed sales agent for a no-obligation consultation by calling 866-466-9118.