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.
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,
|Percent Change in Enrollment,
|2015 Penetration Rate||2016 Penetration Rate|
|District of Columbia||11,033||12,292||1,259||11%||13%||14%|
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.
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.