January 11, 2007
TRACKING MEDICARE HEALTH AND PRESCRIPTION DRUG PLANS
Monthly Report for December 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
Enrollment and Penetration, by Plan Type / Current Month:December 2007 / Change From Previous Month* / Same Month Last Year
December 2006 / Change From December
2006- 2007
Enrollment
Total Stand-Alone
Prescription Drug Plans (PDPs):
General
Employer/Union Only Direct / 17,239,108
17,113,833
125,275 / +26,155
+25,898
+257 / 16,693,416
16,574,886
118,530 / +545,692
+538,947
+6,745
Duals Auto Enrolled in PDPs**
All others Enrolled in PDP / Not Available / (Total Enrollees)
6,270,154
10,360,026 / Not Available / Not Available
Total Medicare Advantage (MA) / 9,007,800 / +25,759 / 7,591,051 / +1,416,749
Medicare Advantage-Prescription Drug (MA-PD)
Medicare Advantage (MA) only / 7,529,773
1,478,027 / +34,409
-8,242 / 6,572,159
1,018,892 / +963,328
+475,548
Medicare Advantage (MA) by Type
MA Local Coordinated Care Plans** *
Health Maintenance Organizations (HMOs)
Provider Sponsored Organizations (PSOs)
Preferred Provider Organizations (PPOs) / 6,339,642
5,821,214
78,419
439,981 / +18,143
+14,026
-157
+4,684 / 6,007,625
5,572,480
92,726
342,418 / +332,017
+248,734
-14,307
+97,563
Regional Preferred Provider Organizations (PPO) / 235,503 / +7,647 / 98,385
Medical Savings Account (MSA) / 2,271 / -1 / Not Applicable / Not Applicable
Private Fee For Service (PFFS)
General
Employer Direct PFFS / 1,703,912
1,693,128
10,784 / +1,301
+1,279
+22 / 864,100
Not Available
Not Available / +839,812
Not Available
Not Available
Cost
Pilot****
Other***** / 309,658
109,511
307,303 / -120
-1,935
+724 / 318,274
Not Applicable
302,667 / -8,616
Not Applicable
+4,636
General vs Special Needs Plans******
Special Needs Plan Enrollees
Dual-Eligibles
Institutional
Chronic or Disabling
Other Medicare Advantage Plan Enrollees / 1,098,754
760,561
145,583
192,610
7,909,046 / +18,161
+8,777
+655
+8,729
+7,598 / Not Available
Not Available
Not Available
Not Available
Not Available / Not Available
Not Available
Not Available
Not Available
Not Available
Penetration (as percent beneficiaries)*******
Prescription Drug Plans (PDPs) / 39.1% / +0.1% / 37.9% / +1.2%
Medicare Advantage Plans (MA) / 20.4% / +0.1% / 17.2% / +3.2%
Medicare Advantage-Prescription Drug Plans (MA-PDs) / 17.1% / +0.1% / 14.9% / +2.2%
Local Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs)
Provider Sponsored Organizations (PSO) / 13.2%
1.0%
0.2% / No Change
No Change
No Change / 12.7%
0.8%
0.2% / +0.5%
+0.2%
No Change
Private Fee For Service (PFFS) / 3.9% / No Change / 2.0% / +1.9%
December 2007 data is from the 12.17.07 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 November 2007 data is from data released by CMS on 11.05.07 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 12.17.07 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 October is from the SNP Enrollment Comprehensive Monthly Report released by CMS on 12.17.07 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 December:
Plan Participation, by type /Current
Month:
December 2007*
/Same Month Last Year
December
2006
/Change From december
2006– 2007
MA Contracts (excluding SNP only contracts)Total / 605 / 512 / +93
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)
General
Employee Direct / 48
47
1 / 25
Not Available
Not Available / +23
Not Available
Not Available
Cost / 27 / 28 / -1
Medicare Savings Account (MSA) / 2 / Not Available / Not Available
Special Needs Plans
Dual-Eligible
Institutional
Chronic or Disabling Condition / 312
204
65
43 / Not Available / Not Available
Other** / 93 / 81 / +12
*Contract counts for December 2007 are from the 12.17.07 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)
NEW ON THE WEB FROM CMS
Relevant to Both Medicare Advantage and Prescription Drug Plans
· This month, CMS released a press release titled “Medicare beneficiaries should act now to meet their prescription drug coverage and health plan needs for 2008.” The press release serves as a reminder that the MA-PD and PDP enrollment period runs until December 31, 2007. In the press release CMS states that since the beginning of the open enrollment period on November 15, 2008 over 115,000 beneficiaries have either enrolled into a new plan or switched plans. However, CMS does not provide a breakdown on this number. In the press release, CMS also describes what they have done in terms of outreach, which has included a bus tour (“Medicare’s Mobile Office Tour”) as well as providing consumers with the online tool, the Medicare Prescription Drug Plan Finder, and a plan ratings system in which CMS rates plans on a five-star quality score based on customer service and drug pricing. This press release is available at: http://www.cms.hhs.gov/apps/media/press_releases.asp
Relevant to Medicare Advantage
· None
Relevant to Prescription Drug Plans
· None
Of General Interest
· The Medicare, Medicaid, and SCHIP Extension Act of 2007 (P.L. 110-173) passed this month with several issues relevant to SNPs. The Act 1) extends SNPs through December 31, 2009; 2) prohibits SNPs from expanding service areas through 2009 and 3) prohibits new SNPs from entering the program until 2009 as well. The Act does not change current MA payment rates. http://thomas.loc.gov/cgi-bin/bdquery/z?d110:s.02499
Relevant to Special Needs Plans Specifically
· This month, CMS released an updated 2008 SNP comprehensive report. The report provides both aggregated information on 2008 SNPs as well as a breakdown by contract number, plan name as well as SNP type by specialty disease. For 2008, as of December 2007, there are a total of 444 SNP contracts and 772 plans. The breakdown by SNP type includes the following: For 1) Chronic or Disabling Condition SNPs there are 108 contracts and 244 plans; 2) Dual Eligible SNPs there are 270 contracts and 439 plans; 3) Institutional SNPs there are 66 contracts and 89 plans. This report is available under the December 2007 Monthly SNP data on CMS’s website at: http://www.cms.hhs.gov/MCRAdvPartDEnrolData/SNP/list.asp#TopOfPage
· On December 14, 2007, CMS released a press release stating that a proposed set of structure and process measures for Medicare Special Needs Plans have been released for public comment on NCQA’s website (www.ncqa.org). The public comment period will run through January 18, 2008. NCQA will then summarize the comments and submit the proposed finalized requirements for the SNP measures to CMS for final approval in March 2008. Specifically, the measures include how SNPs set up case management programs as well as clinical care improvements and patient experience. The press release also states that SNPs will also be required to begin reporting on 13 HEDIS measures by June 20, 2008. This press release, titled: “CMS, NCQA seek public comment on proposed quality measures for Medicare Special Needs Plans” is available at: http://www.cms.hhs.gov/apps/media/press_releases.asp.
OTHER ITEMS OF RELEVANCE
Briefings and Hearings:
· None
Other
· On December 6-7, 2007 MedPAC held a public meeting with three relevant MA and PDP sessions:
· “Increasing participation in the Medicare savings programs and the low-income drug subsidy” by MedPAC staff Joan Sokolovsky and Hannah Neprash. In this session, MedPAC discusses reasons for low participation rates in the Medicare savings programs and the low-income drug subsidy. MedPAC stated that one of the main barriers to enrollment has been lack of awareness by beneficiaries as well as a difficult application process. MedPAC staff provided three draft recommendations for increasing program participation, which were voted on and approved: 1) that the Secretary should increase SHIP funding for outreach to low-income beneficiaries; 2) Congress should raise MSP income and asset criteria to conform to LIS criteria; and 3) Congress should change program requirements so that SSA screens LIS applicants for Federal MSP eligibility and enrolls them if they qualify.
· “Part D data recommendation” by MedPAC staff Rachel Schmidt. This session was a continuation of the November 2007 session (see last month’s monitoring report for details) in which Schmidt reviewed 2008 PDP and MA-PD offerings. The December session focused on questions raised by the Commission at the end of the November session. The Commission then approved the draft recommendation presented in the November session, which states: Congress should direct the Secretary to make Part D claims data available regularly and in a timely manner to Congressional support agencies and selected executive branch agencies for purposes of program evaluation, public health and safety.
· “Special needs plans recommendations and an update on Medicare Analysis” by MedPAC staff Jennifer Podulka and Scott Harrison. This session was also a continuation of the November 2007 session in which MedPAC staff presented eight draft recommendations to improve and evaluate SNP performance within the next three years. At the December session, these recommendations were approved. Specifically, these recommendations include that the Congress should 1) extend the SNP authority for three more years given recommendations 2-8 are also followed. 2) require the Secretary to require SNPs to report additional, tailored performance measures and evaluate their performance within three years. 3) That the Secretary should provide specific information to beneficiaries that compare SNPs to other MA plans. 4) That all SNPs link enrollees to a care coordinator and evaluate enrollees awareness and satisfaction with this service; 5) that the Secretary report annually on the number and circumstances of SNPs that are granted a waiver to enroll a disproportionate share of their target population and to require them to report at least 95 percent of their members from their target population; 6) Chronic condition SNP designations should be determined by expert panels including clinician input; 7) Require dual eligible SNPs to contract with states in their service area to coordinate Medicaid benefits; and 8) eliminate dual eligible beneficiaries ability to enroll in MA plans outside of open enrollment with exception of allowing them to disenroll and return to Medicare fee-for-service at anytime.
· More information on this meeting as well as the meeting transcript and presentation material is available on MedPAC’s website at: http://www.medpac.gov/meeting_search.cfm?SelectedDate=2007-11-08%2000:00:00.0. The next MedPAC public meeting is scheduled for January 10-11, 2008 at the Ronald Reagan in Washington DC. An agenda is available on MedPAC’s website. (see: www.medpac.gov)
· In addition to the two Kaiser Family Foundation Spotlight reports released last month by the foundation, the Kaiser Family Foundation released two additional spotlights this month (http://www.kff.org/medicare/med102507pkg.cfm)
· “Medicare Part D Data Spotlight: Specialty Tiers.” This report provides information on the trends in plans using specialty tiers for high-cost and injectible drugs. Findings include that the number of Medicare prescription drug plans using specialty tiers has nearly doubled from 21 in 2006 to 41 in 2008. In addition, in 2008 more plans are also charging higher coinsurance for drugs on the specialty tier with more than half of the plans with a specialty tier charging more than 25 percent coinsurance for that tier. The report states that relatively high coinsurance rates for drugs in specialty tiers will mean that enrollees taking those drugs will have high out-of-pocket monthly costs. The report goes on to state that this in particular could be of concern for enrollees prescribed a specialty tier drug mid-year, when enrollees are generally not allowed to switch plans. The report concludes that there is a need for more clear and consistent labeling of tiers with explanations and the differences between them on Medicare’s online tool the Medicare Prescription Drug Plan Finder.
· “Medicare Part D Data Spotlight: Benefit Design.” This report provides information on the benefit design of Medicare’s national PDPs. The report states that due to the flexibility in the Medicare Modernization Act, benefit designs of PDPs have varied substantially across plans and years. The report states that only about 10 percent of the national prescription drug plans offer the defined standard benefit. The findings also include (as discussed above as well), there is a shift to more PDPs offering a three tier plus specialty tier cost-sharing structure. In addition, tiered, flat dollar copayments are the most common, however, the use of coinsurance is rising. There has also been an upward trend in cost sharing for brand-name drugs. Since 2006, nearly half of national PDPs have increased cost sharing for brand-name drugs. The report concludes that such changes can lead to sizable increases in the out-of-pocket costs that enrollees are required to pay for their medications if they remain in the same PDP over time. In addition, because of the wide range in variation among plans, beneficiaries face an increasing challenge in comparing benefits and choosing among the plans to find the best one to meet their needs.