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

2. 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

3. Where We Were Prior to MMA

4. Where We Are This Year

5. 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

6. 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+

7. 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

8. How Do We Do It

9. 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.

10. Quality Record

11. Breast Cancer Screening
Medicare+Choice HEDIS® 2001 vs. Medicare Fee-for-Service Measures
Median percentages of women ages 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

12. Influenza Immunization
Medicare+Choice HEDIS 2001 Measures vs. Medicare Fee-for-Service 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)

13. Pneumococcal Immunization
Medicare+Choice HEDIS 2001 Measures vs. Medicare Fee-for-Service 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)

14. Beta-Blockers After Heart Attack
Medicare+Choice HEDIS 2001 Measures vs. Medicare Fee-for-Service 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)

15. Diabetes Care: Lipid Screening
Medicare+Choice HEDIS 2001 Measures vs. Medicare Fee-for-Service 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)

16. Diabetes Care: A1C Testing
Medicare+Choice HEDIS 2001 Measures vs. Medicare Fee-for-Service 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)

17. Conclusion