Medicare Advantage Overview Diane Rowland, Sc.D. Executive Vice President Kaiser Family Foundation Alliance for Health Reform July 16, 2007.

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Presentation transcript:

Medicare Advantage Overview Diane Rowland, Sc.D. Executive Vice President Kaiser Family Foundation Alliance for Health Reform July 16, 2007

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

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 CMS Medicare Advantage, Cost, PACE, Demo, and Prescription Drug Plan Contract Report, Monthly Summary Report, June The number of Medicare Advantage contracts has doubled since 2004 Exhibit 2

Medicare Advantage enrollment is concentrated among a small number of organizations Exhibit 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, 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 enrollees are in Medicare HMOs 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 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 Medicare Advantage Traditional Medicare

More than one in four Medicare beneficiaries are projected to be in a Medicare Advantage plan by 2016 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: