An Analysis of 2017 Medicare Business Competition
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1 An Analysis of 2017 Medicare Business Competition 10/14/2016 by Mark Farrah Associates The Annual Election Period (AEP), or open enrollment, for Medicare Advantage and prescription drug plans (PDPs) will begin on October 15, 2016 and organizations have already begun to market 2017 products. Managed Medicare Advantage (MA) plans continue to solidify a strong foothold in the industry, providing medical coverage for more than 18.5 million seniors. In the last three years, MA plans picked up approximately 3.4 million members and these carriers currently cover 32% of all those eligible for Medicare benefits. With the Medicare market comprising roughly 57.4 million people, there is plenty of opportunity for health plans to gain membership during the open enrollment period. This brief presents a snapshot of the 2017 Medicare Advantage market with insights from the CMS Medicare landscape reports and discusses the plans that will be vying for business during the upcoming AEP. In addition, as Medicare companies finalize sales and marketing strategies, they analyze data from Medicare Plan Finder (MPF), an online tool that makes it easy for seniors to review options and shop for new Medicare plans. Medicare Benefits Analyzer, a Mark Farrah Associates' database helps simplify the analysis of the Medicare Plan Finder data for companies competing in this segment. Overview of the Medicare Landscape Source: Mark Farrah Associates' Medicare Business Online presenting data from CMS monthly enrollment reports. Between October 15 th and December 7 th, MA plans, along with stand-alone PDPs (prescription drug plans), will be competing for market share across the competitive spectrum of beneficiary choices. Many companies will offer zero or low premium plans, appealing to more price-sensitive seniors while others will present higher premium plans with richer benefits and possibly lower cost-sharing. As beneficiaries begin to shop for a 1/5
2 Medicare plan that best meets their health needs and budget, Medicare plans are immersed in competitive assessments. Analysts often use Plan Finder benefits data from the Medicare.gov website to compare plan premiums, copays and star rating awards, market by market. Based on an aggregate analysis of CMS landscape reports, a total of 2,900 distinct Medicare Advantage (MA) plan offerings are in the market lineup for the onset of the 2017 AEP. MFA's analysis of CMS landscape data found a total of 2,311 distinct MA plans being offered for 2017, including Medicare Medicaid plans, up from 2,240 this year. In addition, a total of 589 Special Needs Plans (SNPs) are available in 2017, up from 554 in During the AEP, Medicare beneficiaries can choose to change MA plans or switch from Original Medicare to MA, and plan benefits will become effective on January 1, Many plans are designed to be marketed in select, targeted geographic regions while others are approved to be offered on a broader, nationwide basis. In line with prior years, the HMO is the most prevalent plan type with over 2,000 offerings, representing 71% of all MA plans and SNPs being offered for next year. Stand-alone PDPs nationwide continue to decline each year. For 2017, the number of PDP's offered is 757, a decrease from 897 in The decline is due in part to fewer competitors as a result of M&A's and companies discontinuing PDPs that were similar to others. Although seniors will generally have fewer PDPs to choose from, the increase in MA plan choices results in a healthy level of competition in most markets. Medicare Advantage Plan Counts (MA & MAPD) Year Cost Local HMO Local PPO MMP MSA PFFS Regional PPO Total , , , ,311 Special Needs Plan Counts (SNPs) Year Local HMO Local PPO Regional PPO Total Stand-alone Prescription Drug Plan Counts (PDPs) Year PDP Source: Mark Farrah Associates' Medicare Benefits Analyzer presenting data from CMS Medicare Plan Finder and Landscape Source Files; excludes employer-sponsored plans. For this assessment, plans were counted as distinct company records by Contract-Plan-Segment ID without geographic distribution. The majority, 88% for a total of 2,034 MA plans, include Part D benefits and monthly premiums range from $0 to $364. Thirty-nine percent of 2017 MA plans (excluding SNPs), are available at the $0 plan premium level Medicare Advantage Part D Coverage Count Percent Total Number of Plans 2, % Plans without Part D % Plans with Part D 2,034 88% 2/5
3 Source: Mark Farrah Associates' Medicare Benefits Analyzer presenting data from CMS Medicare Plan Finder and Landscape Source Files; excludes employer-sponsored plans. For this assessment, plans were counted as distinct company records by Contract-Plan-Segment ID without geographic distribution. Per the breakdown in the table below, twenty-five percent of all plans will be charging monthly premiums ranging from $2 to $50 while 21% of plan premiums are in the $51 to $100 range Medicare Advantage Premium Spread Count Percent Total Number of Plans 2, % $0 Premium % $2-$50 Premium % $51 - $100 Premium % $101 - $200 Premium % Greater than $200 Premium 65 3% Null Premium Value 4 0% Only 3% or 65 plans are charging monthly premiums greater than $200. These benefits-rich plans typically have low copays and as a result estimated out-of-pocket expenses are often minimal. The highest premium plan for 2017 is HealthPartners Freedom Ultimate with Enhanced Rx cost plan being offered in Minnesota. This plan promotes no copays for in-network PCP and specialist office visits. EmblemHealth VIP Gold Plus (HMO) in New York is the 2 nd highest priced MA plan for This plan also features no copays for in-network PCP and specialist office visits in addition to $0 copays across several medical benefits. The 2017 MA Plan Competition The 2017 Medicare Advantage marketplace is comprised of national health plans, Blue Cross Blue Shield organizations, prominent regional health plans and specialized Medicare companies. Based on the 2017 CMS landscape reports, Humana continues to market more MA plans nationwide than any other company with 376 distinct plans identified in MFA's assessment. UnitedHealth significantly increased its MA plan offerings for the 2017 calendar year with 282 distinct plans identified, up 203 plans from last year, and exceeding Aetna's offerings. Aetna (including Coventry and other affiliates) is offering 214 plans. Anthem affiliates and the vast majority of other Blue Cross Blue Shield plans offer Medicare Advantage products in their respective markets and some MA plans are collaborative Blues offerings. Cigna, WellCare, Centene (Health Net) and Kaiser also have a notable presence with respect to the number of plan offerings. 3/5
4 Source: Mark Farrah Associates' Medicare Benefits Analyzer presenting data from CMS Plan Finder and Landscape Source Files; excludes employer-sponsored plans. For this assessment, plans were counted as distinct company records by Contract-Plan-Segment ID without geographic distribution. Medicare Benefits Analyzer for Comparing Medicare Benefits Drilling into benefit details, plan by plan, such as Annual Out-of-Pocket Limits and Deductibles; Primary Care Doctor Visit Copays; Specialist Doctor Visit Copays; Inpatient Hospital Copays; Ambulance and Emergency Room Copays; and Drug Tier Copays helps companies to identify competitive advantages across markets. This type of comparative analysis provides invaluable intelligence that prepares Medicare plans to promote and sell their products. In order to make it easier for Medicare plans to access and use MPF data, Mark Farrah Associates (MFA) maintains data in a comparative database format. MFA's Medicare Benefits Analyzer (/products/medicarebenefits-analyzer.aspx) provides customers with access to the latest Medicare Plan Finder data Plan Finder data is online now and 2017 Star Quality Ratings just released by CMS will complement the benefits detail. Subscribers may query tables presenting plan benefit comparisons by state and county or download large datasets using the file export interface. Subscribers may query tables presenting plan benefit comparisons by state and county or download large datasets using the file export interface. Subscribers also have access to Medicare Business Online for tracking month-to-month MA and PDP enrollment changes. Visit our website at (/Default.aspx) or call for more information. About Mark Farrah Associates (MFA) Mark Farrah Associates (MFA) is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry. We are a licensed redistributor of NAIC statutory financial data and use other credible industry data reports in our products. Our product portfolio includes Health Coverage Portal, County Health Coverage, Medicare Business Online, Medicare Benefits Analyzer, and Health Plans USA. Visit our website at (/Default.aspx) to learn more about our product offerings. 4/5
5 Healthcare Business Strategy is a free monthly brief that presents analysis of important issues and developments affecting healthcare business today. If you would like to be added to our distribution list, click here (/ -options/subscribe-to-healthcare-business-strategy.aspx) to subscribe now. Mark Farrah Associates Phone: Web: Copyright All rights reserved. Unauthorized use is prohibited. Healthcare Business Strategy is the product of Mark Farrah Associates. No part of this product may be reproduced, in any form or by any means, including posting in its entirety in blogs or other media applications, without permission in writing from Mark Farrah Associates - (724) /5
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