M E D I C A R E. Overview of Medicare Part D Organizations, Plans and Benefits By Enrollment in 2006 and November 2007

Transcription

1 M E D I C A R E C H A R T P A C K Overview f Medicare Part D Organizatins, Plans and Benefits By Enrllment in 26 and 27 Nvember 27 As the Medicare Part D prescriptin drug benefit appraches its third year, this chartpack presents trends in Part D enrllment in the first tw years f the prgram, and The analysis, based n data frm the Centers fr Medicare and Medicaid Services (CMS), examines enrllment in rganizatins ffering Medicare Part D plans, in Part D stand-alne prescriptin drug plans (s) and Medicare Advantage Prescriptin Drug (MA-PD) plans and by benefit design and type f gap cverage Part D enrllment increased between 26 and 27, but the share f all beneficiaries with n drug cverage remained the same (Exhibit ) Part D enrllment increased by percent in, r nearly millin beneficiaries, frm millin enrllees in t millin enrllees in In bth years, abut half f all Medicare beneficiaries were enrlled in a Part D plan In, accrding t CMS, abut percent were receiving drug cverage thrugh an emplyer/unin retiree health plan, and anther percent had drug cverage frm anther creditable surce, such as the Department f Veterans Affairs (VA), but bth surces f creditable cverage were dwn slightly frm Eleven percent abut millin beneficiaries lacked drug cverage in bth and The number f rganizatins ffering Part D plans increased slightly between 26 and 27, despite frecasts f market cnslidatin (Exhibit 2) The number f rganizatins ffering Part D plans increased by percent, frm in t in, with a larger, percent increase in the number f Part D plans, frm, plans in t, plans in (this cunt includes Puert Ric and the territries) The increase in the number f MA-PD plans accunted fr percent f the grwth in the number f Part D plans in Tw rganizatin UHC-PacifiCare and Humana captured a large share f the Part D market in 26, and retained the tp tw market psitins in 27 (Exhibit 3) Enrllment by rganizatin remains highly cncentrated Tgether, UHC- PacifiCare and Humana captured mre than percent f all Part D enrllees in bth and In each year, these tw rganizatins had the largest number and share f Part D enrllees in bth stand-alne s and MA-PD plans Nine f the ten rganizatins with the highest enrllment in were als amng the tp ten rganizatins by enrllment in Aetna made slight inrads in bth the and MA-PD plan markets fr, enugh t vertake Medc Health Slutins which was amng the tp rganizatins by enrllment in but nt in Each f the tp ten rganizatins experienced sme grwth in Part D enrllment between and, with UHC-PacifiCare reprting the largest increase (,) While the number f Medicare Advantage Prescriptin Drug plans will increase in, the number f stand-alne s will remain relatively stable

2 Mst f the tp ten rganizatins by enrllment ffered bth and MA-PD plans (Exhibit 4) Amng the tp ten rganizatins ffering Part D plans in, all but ne had enrllees in bth and MA-PD plans Kaiser Permanente exclusively ffers plans in the MA market The ther nine rganizatins ffered bth types f plans, but verall Part D enrllment fr each rganizatin is cmprised f a larger share f enrllees than MA-PD plan enrllees In additin t Kaiser Permanente, fur f the tp ten rganizatins had a substantial share f Part D enrllees in MA-PD plans: Health Net ( percent), Aetna ( percent), Humana ( percent), and UHC-PacifiCare ( percent) AARP and Humana stand-alne s remained n tp in terms f 27 planlevel enrllment (Exhibit 5) AARP s Medicare Rx Plan (ffered by UHC-PacifiCare) captured the largest percentage f enrllees in ( percent, r millin), fllwed by the Humana Standard plan ( percent, r millin) Enrllment in AARP MedicareRx actually fell between and, pssibly as a result f sme enrllees shifting t a lwer-premium AARP prduct newly ffered in, the AARP MedicareRx Saver Plan, which appears amng the tp ten plans fr Three Humana-spnsred plans were amng the tp ten plans in, tw stand-alne s and ne MA-PD plan (a private fee-fr-service (PFFS) plan) Enrllment in the Humana Gld Chice PFFS plan increased by percent between and, due in part t a dramatically expanded market presence, frm lcally available fferings in t fferings in A relatively small share f Part D enrllees verall are in plans ffering the defined standard Part D benefit (Exhibits 6 and 7) In, as in, the majrity f Part D enrllees are in plans that ffer an enhanced benefit r a benefit that is actuarially equivalent t the defined standard benefit, while nly percent are in plans with the standard benefit Abut half ( percent) are in a plan that ffers actuarially equivalent benefits and abut just ne ver-third ( percent) are in plans that prvide an enhanced benefit A substantially larger share f MA-PD plan enrllees than enrllees are in plans that ffer an enhanced prescriptin drug benefit ( percent f MA-PD enrllees versus percent f enrllees in ) Mst Part D enrllees are in plans that ffer n cverage in the gap (the dughnut hle ) (Exhibits 8 and 9) In, as in, mre than percent f Part D enrllees in bth s and MA-PD plans have n gap cverage Between and, the share f enrllees in Part D plans prviding sme gap cverage increased slightly, frm percent t percent Hwever, the verall increase was fr plans prviding gap cverage f generic drugs nly and nt brand-name drugs Only percent f Part D enrllees in are in plans that prvide cverage fr bth brand-name and generic drugs in the gap (dwn slightly frm percent in ) (Exhibit 8) Humana Gld Chice PFFS has fferings in The defined standard benefit has a deductible ($ in ) and percent cinsurance up t an initial cverage limit ($, in ttal drug csts in ), fllwed by a cverage gap (the s-called dughnut hle where enrllees pay percent f their drug csts until their ut-f-pcket spending reaches the catastrphic threshld ($, in ) Thereafter, enrllees pay percent f ttal drug csts

3 A larger share f MA-PD plan enrllees than enrllees are in plans ffering sme type f gap cverage in ( percent versus percent, respectively) (Exhibit 9) Hwever, even amng MA-PD plan enrllees, nly percent are in plans that prvide cverage f brand-name drugs in the gap (up slightly frm percent in ) Nearly half (49 percent) f Part D enrllees - 8 millin beneficiaries re at risk f having spending in the cverage gap in 27 because they are in plans that ffer n gap cverage and are nt receiving lw-incme subsidies (LIS) fr Part D cverage (Exhibit ) The number f at-risk enrllees in is almst ne millin mre than the number at risk f falling int the cverage gap in ( millin in ) Just ver millin Part D enrllees wh are nt receiving LIS have cverage fr brand and generic drugs in the gap in Nearly fur in ten Part D enrllees ( millin ut f millin) had full r partially subsidized cverage in the gap in because they receive LIS Part D enrllees receiving LIS, including beneficiaries enrlled in bth Medicare and Medicaid ( dual eligibles ) and thers with incmes belw percent f pverty have subsidized cverage in the gap Part D enrllees with incmes between and percent f pverty receiving lw-incme subsidies (LIS) have partially subsidized cverage in the gap Anther millin Part D enrllees have limited gap cverage fr generic drugs nly in The number f Part D plans ffering full gap cverage fr brand-name and generic drugs increased between 26 and 27, but the actual number f enrllees in plans prviding full gap cverage drpped by 29 percent (Exhibit ) Humana Cmplete, the ne widely-available Part D plan in that ffered full gap cverage and attracted mre enrllees than any ther plan ffering full gap cverage that year, did nt ffer full gap cverage in but instead cvered generic drugs nly Largely as a result f this shift, enrllment in plans ffering cverage f brand-name and generic drugs in the gap fell frm almst, enrllees in t under, in In, eight f the tp ten Part D plans ffering full cverage in the gap were MA-PD plans The SierraRx Plus, newly available in a large number f regins in and ffering full gap cverage this year, will nt be ffered in In, nly ne natinwide (in Flrida) has elected t ffer full cverage in the gap

4 ABOUT THE DATA The analysis is based n Part D plan enrllment and benefits data frm the Centers fr Medicare and Medicaid Services fr and : Medicare Advantage, Cst, PACE, Dem, and Prescriptin Drug Plan Organizatins - Annual Reprt by Plan July (v) and July (v), and Landscape f Lcal Plans Surce File and MA Landscape f Lcal Plans Surce File, and Ntes t the Exhibits Ttal Part D enrllment includes emplyer/unin-nly direct cntract prescriptin drug plans (s) and series plans ffered nly t retirees in emplyer/unin plans, and enrllees in Medicare Advantage Special Needs Plans Plan-level enrllment is aggregated at the natinal level fr plans ffered in multiple cunties, states, r regins Enrllment in plans ffered by the same parent rganizatins but marketed under different names in different areas is nt included in the plan-level ttals The number f area-specific plan fferings is indicated in parentheses fllwing the name f the parent rganizatin Analysis f enrllment by benefit design and gap cverage fr excludes s with, enrllees and MA plans with,, millin enrllees fr which plan-level benefit design infrmatin is unknwn Analysis f enrllment by benefit design and gap cverage fr excludes s with, enrllees and, MA plans with,, millin enrllees (primarily emplyer -series plans and Medicare Advantage Special Needs Plans) fr which plan-level benefit design infrmatin is unknwn Plan Definitins is Health Maintenance Organizatin MA-PD is Medicare Advantage Prescriptin Drug is Prescriptin Drug Plan PFFS is Private Fee-fr-Service plan PPO is Preferred Prvider Organizatin ("reg" dentes "reginal") PSO is Prvider Service Organizatin Other plans (in Exhibit ) include Natinal PACE, Cst plans, Demnstratins, and PSOs This chartpack was prepared by Juliette Cubanski and Tricia Neuman f the Kaiser Family Fundatin

5 Exhibit Drug Cverage Amng Medicare Beneficiaries, % 8% % % 3% % 6% 24% 23% N Drug Cverage Other Creditable Cverage 4% 2% 52% (225 millin) 55% (242 millin) Emplyer/Unin Plans Part D Plans ( and MA-PD) % Ttal = 43 millin beneficiaries Ttal = 44 millin beneficiaries SOURCE: Kaiser Family Fundatin analysis f data frm Centers fr Medicare and Medicaid Services, and Number f rganizatins: Number f Medicare Part D Organizatins and Plans, % 249 Exhibit 2 3,873 2,95 MA-PD plans +25% 4,847 2,746 MA-PD plans Number f plans: 5, 4,5 4, 3,5 3, 2,5 2, 5,678 s 2, s,5, Organizatins Part D Plans SOURCE: Kaiser Family Fundatin analysis f data frm Centers fr Medicare and Medicaid Services, and

6 Exhibit 3 Tp Ten Organizatins Offering Medicare Part D Plans ( and MA-PD), By Enrllment, Part D enrllees (millins) 27 Part D enrllees (millins) Parent rganizatin Ttal Standalne MA- PD plan Percent f ttal 26 Part D enrllment Ttal Standalne MA- PD plan Percent f ttal 27 Part D enrllment Tp ten, in rank rder fr 27 UHC Pacificare % % Humana Inc Wellpint, Inc Member Health, Inc % WellCare Health Plans, Inc Kaiser Permanente Cventry Health Care Inc Universal American Financial Crp Health Net, Inc Aetna Inc b All ther parent rganizatins TOTAL ENROLLMENT NOTES: a N enrllment in specific plan type b Aetna was nt amng the tp ten plans by enrllment in ; therefre enrllment ttals fr are nt included here SOURCE: Kaiser Family Fundatin analysis f data frm Centers fr Medicare and Medicaid Services, and Exhibit 4 Distributin f Enrllment in Tp Ten Organizatins Offering Medicare Part D Plans, By Type f Plan, 27 Percent f Enrllment by Type f Plan Parent rganizatin Standalne MA-PD plan Lcal PPO Reg PPO PFFS Other Tp ten, in rank rder by enrllment: UHC-Pacificare (n=537 plans) Humana Inc (n=483) Wellpint, Inc (n=242) Member Health, Inc (n=) WellCare Health Plans, Inc (n=259) Kaiser Permanente (n=34) Cventry Health Care Inc (n=243) Universal American Financial Crp (n=89) Health Net, Inc (n=55) Aetna Inc (n=279) All ther parent rganizatins (n=239; 2,36 plans) TOTAL (n=249; 4,847 plans) NOTES: Number f area-specific plan fferings is indicated in parentheses fllwing name f parent rganizatin Enrllment by type f plan may nt sum t ttals due t runding a N enrllment in specific plan type SOURCE: Kaiser Family Fundatin analysis f data frm Centers fr Medicare and Medicaid Services, and

7 Exhibit 5 Tp Ten Medicare Part D Plans, By Enrllment, 27 Name f Plan (in rank rder by 27 enrllment) Parent Organizatin 27 Enrllees Enrllment Change, Type f Plan Percent f Ttal 27 Part D Enrllment Cumulative Percent AARP MedicareRx Plan UHC - Pacificare (n=),, -, % % Humana Standard Humana Inc (n=),, +, Humana Enhanced Humana Inc (n=),, +, Cmmunity Care Rx BASIC Member Health, Inc (n=), +, AARP MedicareRx Saver Plan UHC - Pacificare (n=), +, WellCare Signature WellCare Health Plans, Inc (n=), +, Kaiser Permanente Senir Advantage Kaiser Permanente (n=), -, Humana Gld Chice PFFS Humana Inc (n=), +, PFFS MedicareRx Rewards Value Wellpint, Inc (n=), +, UnitedHealth Rx Basic UHC - Pacificare (n=), - All ther Part D plans 2,96,32 +,, TOTAL (n=4,847) 24,5,382 +,66,25 NOTES: Number f area-specific plan fferings is indicated in parentheses fllwing name f parent rganizatin Offered in as PacifiCare Saver Plan Nt ffered in SOURCE: Kaiser Family Fundatin analysis f data frm Centers fr Medicare and Medicaid Services, and Exhibit 6 Share f Enrllment in Medicare Part D Plans, By Type f Benefit Design, Millins f enrllees: % 27 4% Defined Standard Actuarially Equivalent Enhanced 5 52% 5% 5 3% 35% 24 millin Part D enrllees 2,8 Part D plans 24 millin Part D enrllees 3,562 Part D plans NOTES: Shares f enrllment might nt add t percent because f runding SOURCE: Kaiser Family Fundatin analysis f data frm Centers fr Medicare and Medicaid Services, and

8 Share f Enrllment in Medicare Part D Plans, By Type f Benefit Design, Millins f enrllees: Defined Standard % 6% 7% 55 millin enrllees,446 plans s 27 8% 6% 2% Exhibit 7 62 millin enrllees,99 plans 73% Actuarially Equivalent Enhanced % 24% 2% % 49 millin enrllees,365 plans MA-PD plans 79% 53 millin enrllees,653 plans NOTES: Shares f enrllment might nt add t percent because f runding SOURCE: Kaiser Family Fundatin analysis f data frm Centers fr Medicare and Medicaid Services, and Share f Enrllment in Medicare Part D Plans, By Type f Gap Cverage, Millins f enrllees: 25 Brands/Generics % 4% Exhibit % 3% Generics Only N Gap Cverage 89% 85% 5 24 millin Part D enrllees 2,8 Part D plans 24 millin Part D enrllees 3,562 Part D plans NOTES: Shares f enrllment might nt add t percent because f runding SOURCE: Kaiser Family Fundatin analysis f data frm Centers fr Medicare and Medicaid Services, and

9 Share f Enrllment in Medicare Part D Plans, By Type f Gap Cverage, Millins f enrllees: % 3% 3% Exhibit % % 92% 55 millin enrllees 62 millin enrllees,446 plans,99 plans s 7% Brands/Generics Generics Only N Gap Cverage 26 6% 27 22% 26% 49 millin enrllees,365 plans MA-PD plans 66% 8% 53 millin enrllees,653 plans NOTES: Shares f enrllment might nt add t percent because f runding SOURCE: Kaiser Family Fundatin analysis f data frm Centers fr Medicare and Medicaid Services, and Exhibit Share f Part D Enrllment, By Type f Gap Cverage, 27 Enrllees with FULL gap cverage = 98 millin LIS (Dual Eligibles/SSI) 29% LIS (Others) % N Gap Cverage 49% Enrllees with NO gap cverage = 8 millin Brand/ Generic 2% Generic Only % Enrllees with LIMITED gap cverage = 26 millin Ttal = 242 millin Part D enrllees NOTES: Shares f enrllment might nt add t percent because f runding SOURCE: Kaiser Family Fundatin analysis f data frm Centers fr Medicare and Medicaid Services, and

10 Exhibit Tp Ten Medicare Part D Plans Offering Brand/ Generic Gap Cverage, By Enrllment, Name f Plan (in rank rder by 27 enrllment) Parent Organizatin 27 Enrllees Enrllment Change, Type f Plan Percent f Ttal 27 Part D Enrllment in Plans Offering Brand/Generic Gap Cverage MedicareBlue Rx Optin 3 Wellmark, Inc, +, % Humana Gld Plus Humana Inc (n=), Senir Dimensins Suthern Nevada Plan Sierra Health Services, Inc (n=), + SierraRx Plus Sierra Health Services, Inc (n=), Blue Shield 65 Plus Blue Shield f Califrnia, Chices 65 Tenet Healthcare Crpratin, -, SecureHrizns MedicareCmplete Value UHC-Pacificare, CareOne Plan Humana Inc (n=), PSO Health Plan Preferred Care Partners Inc (n=), PSO CareCenters Plan Humana Inc, All ther Part D plans ffering brand/generic gap cverage (n=82) 78,24 38 TOTAL (n=9) 56, ,82 NOTES: Number f area-specific plan fferings is indicated in parentheses fllwing name f parent rganizatin a Nt ffered in r nt amng the tp ten plans ffering brand/generic gap cverage SOURCE: Kaiser Family Fundatin analysis f data frm Centers fr Medicare and Medicaid Services, and

11 The Henry J Kaiser Family Fundatin Headquarters 24 Sand Hill Rad Menl Park, CA 9425 (65) Fax: (65) Washingtn Offices and Barbara Jrdan Cnference Center 33 G Street, NW Washingtn, DC 25 (22) Fax: (22) wwwkffrg Additinal cpies f this publicatin (#77) are available n the Kaiser Family Fundatin s website at wwwkffrg The Kaiser Family Fundatin is a nn-prfit, private perating fundatin dedicated t prviding infrmatin and analysis n health care issues t plicymakers, the media, the health care cmmunity, and the general public The Fundatin is nt assciated with Kaiser Permanente r Kaiser Industries