Download - Medicare Advantage Overview
Medicare Advantage OverviewMedicare Advantage Overview
Diane Rowland, Sc.D.Diane Rowland, Sc.D.
Executive Vice PresidentExecutive Vice President
Kaiser Family FoundationKaiser Family Foundation
Alliance for Health ReformAlliance for Health Reform
July 16, 2007July 16, 2007
What is Medicare Advantage?What is Medicare Advantage?
Health plans offered by private insurers that receive payments from Medicare to provide Medicare-covered benefits to enrollees
• Medicare pays each plan a per capita payment for each enrollee• Plans contract with the government for one year• Beneficiaries sign up during annual enrollment period
Medicare HMOs have been an option since 1982• Originally plans were paid 95% of traditional Medicare costs, with goals
of achieving savings for Medicare and improving management of care
BBA 97 – created Medicare+Choice • Authorized new types of plans (Private Fee-for-Service plans, local
PPOs)
MMA 03- renamed Medicare+Choice Medicare Advantage • Authorized new plans (Special Needs Plans, Regional PPOs, Medicare
MSAs)
Medicare Advantage enrollees • Generally pay the Part B premium• Sometimes pay a supplemental premium for additional benefits• Typically receive Part D drug coverage
Exhibit 1
407
343
253 240285 300
459512
602
1999 2000 2001 2002 2003 2004 2005 2006 2007
Note: Includes local HMOs, PSOs, and PPOs, regional PPOs, PFFS plans, Cost contracts, Demonstrations, HCPP, and PACE contracts. Source: Mathematica Policy Research, Inc. “Tracking Medicare Health and Prescription Drug Plans Monthly Report” December 1999-2006. CMS Medicare Advantage, Cost, PACE, Demo, and Prescription Drug Plan Contract Report, Monthly Summary Report, June 2007.
The number of Medicare Advantage contracts The number of Medicare Advantage contracts has doubled since 2004 has doubled since 2004
Exhibit 2
16%
14%
13%
10%
47%
Medicare Advantage enrollment is concentrated Medicare Advantage enrollment is concentrated among a small number of organizationsamong a small number of organizations
Exhibit 3
4.6 million beneficiaries account for more than half of
total Medicare Advantage enrollment
NOTE: All Other Medicare Advantage Plans includes plans with enrollment less than 230,000 beneficiaries. Total for Blue Cross/Blue Shield affiliates provided by Blue Cross/Blue Shield. Numbers rounded. Data as of May 15, 2007. SOURCE: Centers for Medicare and Medicaid Services (CMS), June 2007 Monthly Summary.
Total Medicare Advantage Enrollment= 8.7 million
(1.4 million enrollees)
(1.2 million)
(1.1 million)
(0.9 million)
UnitedHealth Care
Blue Cross/Blue Shield affiliates
Humana Inc.
Kaiser Permanente
All Others*
The majority of Medicare Advantage The majority of Medicare Advantage enrollees are in Medicare HMOsenrollees are in Medicare HMOs
Cost Plans 4%
MSA<1%
Other Demo3%
Regional PPO2%
Private Fee-for-Service18%
Local HMO/PPO71%
Notes: Local HMO/PPO also includes a small number enrolled in provider sponsored organizations. Numbers do not sum to 100 percent due to rounding.SOURCE: Centers for Medicare and Medicaid Services, Medicare Advantage, Cost, PACE, Demo and Prescription Drug Plan Contract Report, Monthly Summary Report, June 2007.
2007 Medicare Advantage Enrollment = 8.7 million
Exhibit 4
Characteristics of Medicare Advantage enrollees and beneficiaries in traditional Medicare
SOURCE: Kaiser Family Foundation analysis of the 2005 Medicare Current Beneficiary Survey (MCBS).
Exhibit 5
27%
17%
29%
48%
4%
7%
24%
50%
Percent Livingin Rural Areas
Percent UnderAge 65 withPermanentDisabilities
PercentReportingFair/Poor
Health
Percent withIncome
<$20,000
Medicare Advantage
Traditional Medicare
More than one in four Medicare beneficiaries More than one in four Medicare beneficiaries are projected to be in a Medicare Advantage are projected to be in a Medicare Advantage
plan by 2016plan by 2016
0%
5%
10%
15%
20%
25%
30%Projected
SOURCE: Centers for Medicare and Medicaid Services, 2007 Medicare Trustees Report Table IV.B6.
Actual
27%
19%
Exhibit 6
Percent of Total Medicare Population: