Private Sector Participation in Medicare: Exceeding Expectations The Second National Medicare Prescription Drug Congress Washington, DC November 1, 2005 Karen Ignagni

Presentation Outline Where We Were Prior to MMA Where We Are Now Statutory Benefits Benefits Available in the Market Providing a Safety Net for Low-Income Quality Performance

Where We Were Prior to MMA

Where We Are This Year

Where We Will be in `06 Medicare Advantage plans will be available in all 50 states and the District of Columbia Medicare Advantage plans that offer zero-premium prescription drug benefits will be available in 44 states Medicare Advantage plans that provide coverage in the coverage gap will be available in 39 states and the District of Columbia Medicare Advantage regional plans will be available in 37 states and the District of Columbia There has been a 12 percent increase in enrollment in Medicare Advantage plans since enactment of MMA

75% Plan Contribution ($1,500 total) Statutory Benefits 95% Plan Contribution 5% co-pay 100% Enrollee Payment 75% Plan Contribution ($1,500 total) 25% co-pay $250 Enrollee Deductible Enrollee Out-of-Pocket Expenditures $250 $2,250 $0 $5,100+ Total Drug Expenditures $750 $3,600+

Benefits Available in Market MA Plans in 44 States Offer No Premium Plans Regional PPOs in 7 States Offer No Premium Plans MA Plans in 36 States Offer Coverage for Generic Drugs in “Donut” 18 States will have Options which Include Coverage for Brand Names and Generics in “Donut” 2/3 of MA Plans with Rx have no Deductibles 15% have Reduced Deductibles

How Do We Do It

MA: A Low Income Safety Net Source: Medicare Current Beneficiary Survey Access to Care files, 2002 (CMS). Note: Calculations based on non-institutionalized Medicare beneficiaries and living in an area with at least one Medicare Advantage plan offering.

Quality Record

Breast Cancer Screening Medicare+Choice HEDIS® 2001 vs. Medicare Fee-for-Service 2000 - 2001 Measures Median percentages of women ages 52-69 years old receiving mammograms at least every two years WA (7) M+C=80% FFS=64% NATIONAL MEDIANS (165) M+C=75% FFS=60% ND MN (3) M+C=82% FFS=67% MT NH ( 1) M+C=87% FFS=68% WI (2) M+C=75% FFS=67% ME OR (4) M+C=77% FFS=64% ID (1) M+C=69% FFS=60% SD VT MI (6) M+C=77% FFS=67% NY (12) M+C=75% FFS=58% WY IA (2) M+C=76%FFS=65% NE (1) M+C=71% FFS=63% MA (5) M+C=83% FFS=66% IL (7) M+C=79% FFS=58% OH (16) M+C=73% FFS=61% PA (8) M+C=79% FFS=60% NV (3) M+C=67% FFS=56% IN (2) M+C=67% FFS=60% CO (3) M+C=77% FFS=60% RI (2) M+C=79% FFS=62% MO (7) M+C=79% FFS=52% KS (5) M+C=74%FFS=64% WV (3) M+C=80% FFS=61% UT DE VA (1) M+C=77% FFS=60% KY (1) M+C=66% FFS=59% CT (3) M+C=80% FFS=63% CA (17) M+C=73% FFS=56% NM (2) M+C=74% FFS=56% OK (3) M+C=65% FFS=55% TN (3) M+C=77%FFS=58% NC (3) M+C=76% FFS=62% AZ (9) M+C=73% FFS=60% NJ (5) M+C=65% FFS=54% AR AL (4) M+C=72% FFS=60% SC MD (1) M+C=77% FFS=61% MS GA (2) M+C=77% FFS=57% TX (7) M+C=66% FFS=56% LA (2) M+C=71% FFS=55% DC (1) M+C=77% FFS=52% HI (2) M+C=81% FFS=57% AK FL (20) M+C=74% FFS=65% M+C indicators higher than FFS (38 states + DC) No difference (e.g. +/- 1%) between M+C and FFS (0 states) FFS indicators higher than M+C (0 states) No M+C health plans reporting this indicator (12 states) Number in parentheses indicates the count of M+C plans operating in each state and reporting HEDIS data for this specific indicator. * Medicare+Choice: Medicare+Choice HEDIS® 2001 Data FFS: Jencks, et al. JAMA (1/2003) Data Collected in 2000-2001

Influenza Immunization Medicare+Choice HEDIS 2001 Measures vs. Medicare Fee-for-Service 2000-2001 Measures Median percentages of individuals ages 65 years or older who reported receiving an influenza immunization every year WA (4) M+C=84% FFS=72% MT MN (4) M+C=86% FFS=78% NATIONAL MEDIANS (192) M+C=75% FFS=72% ND ME WI (3) M+C=79% FFS=77% OR (6) M+C=78% FFS=77% SD VT ID (1) M+C=75% FFS=72% MI (4) M+C=73% FFS=72% NY (13) M+C=70% FFS=70% NH WY IA (3) M+C=78% FFS=78% MA (4) M+C=75% FFS=79% NE (1) M+C=82% FFS=79% IL (9) M+C=78% FFS=69% OH (12) M+C=74% FFS=69% PA (6) M+C=71% FFS=74% NV (3) M+C=66% FFS=62% IN (4) M+C=82% FFS=73% RI (2) M+C=78% FFS=73% CO (3) M+C=85% FFS=78% MO (7) M+C=80% FFS=70% WV (3) M+C= 78% FFS=70% UT KS (3) M+C=77% FFS=72% DE CT (1) M+C=76% FFS=72% VA (1) M+C=77% FFS=74% KY (1) M+C=71% FFS=66% NJ (3) M+C=70% FFS=68% CA (13) M+C=74% FFS=73% OK (1) M+C=76% FFS=78% TN (4) M+C=78% FFS=74% NC (3) M+C=74% FFS=72% AZ (4) M+C=76% FFS=69% NM (2) M+C=78% FFS=72% AR MD (1) M+C=76% FFS=72% GA (2) M+C=73% FFS=71% MS SC AL (2) M+C=72% FFS=65% TX (3) M+C=78% FFS=69% DC (1) M+C=77% FFS=61% LA (2) M+C= 69% FFS=65% HI (1) M+C=82% FFS=78% AK FL(12) M+C=68% FFS=66% M+C indicators higher than FFS (29 states + DC) No difference (e.g. +/- 1%) between M+C and FFS (5 states) FFS indicators higher than M+C (3 states) No M+C health plans reporting this indicator (13 states) Number in parentheses indicates the count of M+C plans operating in each state and reporting HEDIS data for this specific indicator. *Medicare+Choice: Data Source: Consumer Assessment of Health Plans Study (CAHPS) survey FFS: Jencks, et al. JAMA (1/2003) Data Source: CDC’s Behavioral Risk Factor Surveillance System Survey (BRFSS)

Pneumococcal Immunization Medicare+Choice HEDIS 2001 Measures vs. Medicare Fee-for-Service 2000-2001 Measures Median percentage of individuals ages 65 years or older who reported receiving an pneumococcal immunization at least once WA (4) M+C=77% FFS=67% MT MN (4) M+C=79% FFS=68% ND NATIONAL MEDIANS (192) M+C=65% FFS=65% ME WI (3) M+C=73% FFS=68% OR (6) M+C=70% FFS=67% SD VT ID (1) M+C=66% FFS=59% MI (4) M+C=64% FFS=63% NY (13) M+C=57% FFS=64% NH WY IA (3) M+C=72% FFS=68% MA (4) M+C=68% FFS=71% NE (1) M+C=75% FFS=70% IL (9) M+C=71% FFS=59% OH (12) M+C=64% FFS=63% PA(6) M+C=58% FFS=66% NV (3) M+C=68% FFS=65% IN (4) M+C=71% FFS=61% RI (2) M+C=65% FFS=62% CO (3) M+C=77% FFS=69% MO (7) M+C=66% FFS=60% WV (3) M+C=63% FFS=64% UT KS (3) M+C=65% FFS=67% DE VA (1) M+C=68% FFS=63% CT (1) M+C=66% FFS=66% KY (1) M+C=58% FFS=58% CA (13) M+C=67% FFS=66% OK (1) M+C=68% FFS=69% TN (3) M+C=72% FFS=68% NC (3) M+C=66% FFS=70% AZ (4) M+C=69% FFS=68% NM (2) M+C=71% FFS=64% NJ (3) M+C=59% FFS=60% AR GA (2) M+C=65% FFS=63% MS SC MD (1) M+C=68% FFS=67% AL (2) M+C=63% FFS=54% TX (3) M+C=62% FFS=62% LA (2) M+C= 61% FFS=59% DC (1) M+C=68% FFS=48% HI (1) M+C=70% FFS=75% AK FL (12) M+C=58% FFS=61% M+C indicators higher than FFS (20 states + DC) No difference (e.g. +/- 1%) between M+C and FFS (10 states) FFS indicators higher than M+C (7 states) No M+C health plans reporting this indicator (13 states) Number in parentheses indicates the count of M+C plans operating in each state and reporting HEDIS data for this specific indicator. *Medicare+Choice: Data source: Consumer Assessment of Health Plans Study (CAHPS) FFS: Jencks, et al. JAMA (1/2003) Data source: CDC’s Behavioral Risk Factor Surveillance System Survey (BRFSS)

Beta-Blockers After Heart Attack Medicare+Choice HEDIS 2001 Measures vs. Medicare Fee-for-Service 2000-2001 Measures Median percentages of individuals who received beta-blockers following a heart attack WA (6) M+C=94% FFS=78% MN (3) M+C=91% FFS=87% NATIONAL MEDIANS (121) M+C=93% FFS=79% MT ND WI (2) M+C=86% FFS=79% ME OR (4) M+C=96% FFS=80% SD VT ID MI (4) M+C=97% FFS=93% WY NY (9) M+C=95% FFS=85% NH IA (1) M+C=95% FF=89% MA (5) M+C=98% FFS=88% NE OH (10) M+C=96% FFS=79% PA (7) M+C=97% FFS=79% NV (1) M+C=85% FFS=69% IL (6) M+C=87% FFS=75% IN (2) M+C=79% FFS=83% CO (3) M+C=95% FFS=92% RI (2) M+C=93% FFS=95% UT MO (5) M+C=93% FFS=78% KS (2) M+C=94% FFS=74% DE WV VA (1) M+C=100% FFS=88% KY (1) M+C=72% FFS=80% CT (3) M+C=92% FFS=83% CA (10) M+C=91% FFS=66% AZ (7) M+C=91% FFS=84% NM (3) M+C= 78% FFS=74% OK (1) M+C=81% FFS=76% TN (1) M+C=95% FFS=75% NC (2) M+C=89% FFS=81% NJ (5) M+C=90% FFS=68% AR AL(1) M+C=60% FFS=78% SC MS TX (5) M+C=74% FFS=72% GA (2) M+C=90% FFS=74% MD (1) M+C=100% FFS=77% LA (2) M+C=75% FFS=71% HI (1) M+C=97% FFS=84% DC (1) M+C=100% FFS=85% AK FL (20) M+C=93% FFS=79% M+C indicators higher than FFS (30 states + DC) No difference (e.g. +/- 1%) between M+C and FFS (0 states) FFS indicators higher than M+C (4 states) No M+C health plans reporting this indicator (16 states) Number in parentheses indicates the count of M+C plans operating in each state and reporting HEDIS data for this specific indicator. * Medicare+Choice: Medicare+Choice HEDIS 2001 Data FFS: Jencks, et al. JAMA (1/2003)

Diabetes Care: Lipid Screening Medicare+Choice HEDIS 2001 Measures vs. Medicare Fee-for-Service 2000-2001 Measures Median percentages of people with diabetes who had Lipid (LDL-C) profile tests every two years WA (7) M+C=84% FFS=78% NATIONAL MEDIANS (167) M+C=83% FFS=74% ND MN (3) M+C=81% FFS=76% MT NH ( 1) M+C=78% FFS=77% WI (1) M+C=85% FFS=76% ME OR (4) M+C=82% FFS=74% ID (1) M+C=78% FFS=75% SD VT MI (6) M+C=81% FFS=70% WY NY (12) M+C=88% FFS=76% IA (2) M+C=84%FFS=74% NE (1) M+C=81% FFS=69% MA (5) M+C=83% FFS=69% IL (7) M+C=81% FFS=69% OH (17) M+C=80% FFS=75% PA (8) M+C=86% FFS=78% NV (3) M+C=79% FFS=77% IN (2) M+C=75% FFS=73% CO (3) M+C=81% FFS=74% MO (8) M+C=78% FFS=59% KS (6) M+C=75%FFS=70% UT WV (3) M+C=82% FFS=75% DE RI (2) M+C=87% FFS=76% VA (1) M+C=86% FFS=74% KY (2) M+C=78% FFS=74% CA (17) M+C=83% FFS=77% CT (3) M+C=90% FFS=76% NM (3) M+C=73% FFS=66% OK (3) M+C=85% FFS=68% TN (3) M+C=86% FFS=71% NC (3) M+C=86% FFS=75% AZ (9) M+C=85% FFS=72% AR AL (4) M+C=67% FFS=65% SC NJ (5) M+C=74% FFS=79% MS GA (2) M+C=84% FFS=67% TX (7) M+C=83% FFS=77% MD (1) M+C=86% FFS=79% LA (1) M+C=85% FFS=71% HI (2) M+C=92% FFS=82% DC (1) M+C=86% FFS=68% AK M+C indicators higher than FFS (36 states + DC) No difference (e.g. +/- 1%) between M+C and FFS (1 state) FFS indicators higher than M+C (1 state) No M+C health plans reporting this indicator (12 states) FL (20) M+C=89% FFS=83% Number in parentheses indicates the count of M+C plans operating in each state and reporting HEDIS data for this specific indicator. * Medicare+Choice: Medicare+Choice HEDIS 2001 Data FFS: Jencks, et al. JAMA (1/2003)

Diabetes Care: A1C Testing Medicare+Choice HEDIS 2001 Measures vs. Medicare Fee-for-Service 2000-2001 Measures Median percentage of people with diabetes who received a Hemoglobin A1C Test every year WA (7) M+C=93% FFS=86% NH (1) M+C=88% FFS=87% MT MN (3) M+C=93% FFS=87% NATIONAL MEDIANS (176) M+C=84% FFS=78% ND ME WI (1) M+C=93% FFS=86% OR (4) M+C=89% FFS=85% ID (1) M+C=89% FFS=82% SD VT MI (6) M+C=85% FFS=78% NY (12) M+C=84% FFS=76% WY IA (2) M+C=92% FFS=85% MA (5) M+C=90% FFS=83% NE (1) M+C=89% FFS=77% IL (7) M+C=83% FFS=74% OH (17) M+C=81% FFS=78% PA(8) M+C=90% FFS=80% NV (3) M+C=82% FFS=78% IN (2) M+C=78% FFS=77% RI (2) M+C=87% FFS=80% CO (3) M+C=85% FFS=84% MO (8) M+C=85% FFS=65% WV (3) M+C=80% FFS=77% UT KS (6) M+C=88% FFS=83% DE VA (1) M+C=81% FFS=80% KY (2) M+C=82% FFS=75% CT (3) M+C=86% FFS=80% CA (17) M+C=81% FFS=73% OK (3) M+C=88% FFS=72% TN (3) M+C=91% FFS=78% NC (3) M+C=86% FFS=81% AZ (9) M+C=83% FFS=71% NM (3) M+C=78% FFS=71% AR NJ (5) M+C=72% FFS=73% GA (2) M+C=88% FFS=74% MS SC AL (4) M+C=75% FFS=70% MD (1) M+C=81% FFS=77% TX (7) M+C=80% FFS=75% LA (1) M+C= 89% FFS=69% DC (1) M+C=81% FFS=65% HI (2) M+C=92% FFS=82% AK FL (20) M+C=84% FFS=79% M+C indicators higher than FFS (33 states + DC) No difference (e.g. +/- 1%) between M+C and FFS (5 states) FFS indicators higher than M+C (0 states) No M+C health plans reporting this indicator (12 states) Number in parentheses indicates the count of M+C plans operating in each state and reporting HEDIS data for this specific indicator. * Medicare+Choice: HEDIS 2001 Data FFS: Jencks, et al. JAMA (1/2003)

Conclusion