Jeannie Fuglesten Biniek Follow @jeanniebin on
Twitter, Meredith Freed,
Anthony Damico, and Tricia Neuman Follow @tricia_neuman on
Twitter Published: Oct 29, 2020
·
APPENDIX
Over the last decade, Medicare Advantage, the
private plan alternative to traditional Medicare, has taken on a larger role in
the Medicare program. In 2020, more than 24 million Medicare beneficiaries are
enrolled in a Medicare Advantage plan. This brief provides an overview of the
Medicare Advantage plans that are available for 2021 and key trends over time.
Plan Offerings in 2021
Number of Plans
Number of Plans Available to
Beneficiaries. For 2021, the
average Medicare beneficiary has access to 33 Medicare Advantage plans, the
largest number of options available in the last decade (Figure 1).
Figure 1: The average
Medicare beneficiary has access to 33 Medicare Advantage plans in 2021, an
increase from prior years
Among the 33 Medicare Advantage plans
generally available for individual enrollment to the average Medicare
beneficiary, 27 of the plans include prescription drug coverage (MA-PDs). These
numbers exclude employer or union-sponsored group plans, Special Needs Plans
(SNPs) and PACE plans, which are only available to select populations.
Total Number of Plans. In total, 3,550 Medicare Advantage plans
are available nationwide for individual enrollment in 2021 – a 13 percent
increase (402 more plans) from 2020 and the largest number of plans ever
available (Figure 2; Appendix Table 1). The vast majority (89 percent) of all
Medicare Advantage plans offered include prescription drug coverage in 2021.
As in prior years, HMOs continue to account
for about two-thirds (62%) of all plans offered in 2021. The availability of
local PPOs has increased rapidly over recent years. In 2021, one-third of plans
offered are local PPOs, compared to a quarter in 2018. Between 2020 and 2021,
the number of regional PPOs has remained constant, while the number of private
fee-for-service plans has continued to decline.
The growth in number of plans varies across
states and counties, with the preponderance of the growth occurring in Florida
and California (41 more and 30 more plans, respectively; data not shown).
Virginia has 6 fewer plans available for 2021 than in 2020, while South
Carolina has 3 fewer plans, and Maryland and Nebraska each have one fewer plan
available in 2021 than in 2020.
While many employers and unions also offer
Medicare Advantage plans to their retirees, no information about these 2021
plan offerings is made available by CMS to the public during the Medicare open
enrollment period because these plans are not available to the general Medicare
population.
One notable change for 2021 is that people
with end-stage renal disease (ESRD) are eligible to enroll in Medicare
Advantage plans. Prior to this change, people with ESRD were not able to enroll
in most Medicare Advantage plans, subject to limited exceptions, such as C-SNPS
for people with ESRD.
Special Needs Plans
(SNPs). More SNPs are
available for 2021 than in any year since they were authorized, increasing from
855 plans in 2020 to 975 plans in 2021, a 14 percent increase (Figure 3).
.
The rise in SNPs for people who require an institutional-level of care (I-SNPs)
has been particularly notable, more than doubling from 83 plans in 2017 to 174
plans in 2021. I-SNPs may be attractive to insurers because they tend to have
much lower marketing costs than other plan types since they are often the only
available option for people to receive their Medicare benefits in certain
retirement communities and nursing homes. The number of SNPs for people dually
eligible for Medicare and Medicaid (D-SNPs) has also increased sharply over the
past five years, rising from 373 dual SNPs in 2017 to 598 dual SNPs in 2021, a
60% increase, suggesting insurers’ continue to be interested in
managing the care of this high-need population.
The number of SNPs offered for people with
chronic conditions (C-SNPs) is also increasing in 2021, most of which focus on
people with diabetes, heart disease, or lung conditions, as has been the case
since the inception of C-SNPs. For 2021, three firms are offering C-SNPs for
people with dementia (the same as 2020), two firms are offering a C-SNP for
people with mental health conditions (up one from 2020), three firms are
offering C-SNPs for people with end-stage renal disease (one fewer than 2020)
and two firms are offering C-SNPs for people with HIV/AIDS (similar to 2020).
Variation in the Number of
Plans, by Geographic Area. On average, beneficiaries in metropolitan areas can choose from
about twice as many Medicare Advantage plans as beneficiaries in
non-metropolitan areas (36 plans versus 20 plans, respectively).
In 11 percent of counties (accounting for 41%
of beneficiaries), beneficiaries can choose from more than 35 plans in 2021,
including eleven counties in Ohio and five counties in Pennsylvania where more
than 60 Medicare Advantage plans are available (Figure 4). In contrast, in 4
percent of counties (accounting for 1% of beneficiaries), beneficiaries can
choose from two or fewer Medicare Advantage plans. The number of counties with
no Medicare Advantage plans for 2021 is 82, similar to 2020. As in prior years,
there are no Medicare Advantage plans offered in Alaska. Additionally, no
Medicare Advantage plans are available in territories other than Puerto Rico.
.
Access to Medicare Advantage Plans, by Plan Type
As in recent years, virtually all Medicare beneficiaries
(99%) have access to a Medicare Advantage plan as an alternative to traditional
Medicare, including almost all beneficiaries in metropolitan areas (99.9%) and
the vast majority of beneficiaries in non-metropolitan areas (97.7%). In
non-metropolitan counties, a smaller share of beneficiaries have access to HMOs
(87% in non-metropolitan versus 99% in metropolitan counties) or local PPOs
(89% in non-metropolitan versus 96% in metropolitan counties), and a slightly
larger share of beneficiaries have access to regional PPOs (77% in
non-metropolitan counties versus 72% in metropolitan counties).
Number of Firms
The average Medicare beneficiary is able to
choose from plans offered by 8 firms in 2021, one more than in 2020 (Figure 5).
Despite most beneficiaries having access to plans operated by several different
firms, enrollment is concentrated in
plans operated by UnitedHealthcare, Humana, and Blue Cross Blue Shield
affiliates.
Figure 5: More than
one-quarter of beneficiaries can choose among Medicare Advantage plans offered
by 10 or more firms
More than one-quarter of beneficiaries (27%)
are able to choose from plans offered by 10 or more firms. Fifteen or more
firms are offering Medicare Advantage plans in three counties: Orange County,
California and Summit and Medina Counties in Ohio. In contrast, in 109
counties, most of which are rural counties with relatively few Medicare
beneficiaries (1% of total), only one firm will offer Medicare Advantage plans
in 2021. Over the past several years, the number of counties with a single firm
offering Medicare Advantage plans has fallen substantially. As recently as
2019, there was a single firm offering plans in nearly 200 counties.
UnitedHealthcare and Humana, the two firms
with the most Medicare Advantage
enrollees in 2020, have large footprints across the country,
offering plans in most counties. Humana is offering plans in 84 percent of
counties and UnitedHealthcare is offering plans in 66 percent of counties in
2021 (Figure 6). More than 8 in 10 (87%) Medicare beneficiaries have access to
at least one Humana plan and 86 percent have access to at least one
UnitedHealthcare plans.
.
Most major Medicare Advantage firms have also expanded the number of counties
where they are offering plans. UnitedHealthcare is offering plans in 2,117
counties in 2021, an increase of 245 from 2021, while Humana is offering plans
in 2,703 counties in 2021, an increase of 33 from 2020. Centene is offering
plans in 1,129 counties in 2021, an increase of 261 plans from 2020; Blue Cross
Blue Shield Affiliates are offering plans in 1,181 counties, an increase of 152
plans; CVS Health is offering plans in 1,759 counties, an increase of 119
plans; and Cigna is offering plans in 369 counties, an increase of 67 plans.
Kaiser Permanente had the smallest growth and is offering plans in 109
counties, an increase of 4 plans.
New Market Entrants and Exits
Medicare Advantage continues to be an
attractive market for insurers, with 14 firms entering the market for the first
time in 2021, collectively accounting for about 6 percent of the growth in the
number of plans available for general enrollment and about 10 percent of the
growth in SNPs (Appendix Table 2). Nine new entrants are offering HMOs
available for individual enrollment. Five of the new entrants are offering
SNPs; three firms are offering D-SNPs for people dually eligible for Medicaid,
three firms are offering C-SNPs for people with select chronic conditions, and
one firm is offering an I-SNPs Four of the new firm entrants are offering plans
in California, two are offering plans in Indiana, and the remainder are offering
plans in at least one of ten other states (Colorado, Georgia, Illinois,
Mississippi, Missouri, Ohio, Texas, Utah, and Wisconsin).
Six firms that previously participated in the
Medicare Advantage market are not offering plans in 2021. Two of the firms
(ApexHealth, Inc. and Clarion Health) offered plans for the first time in 2020,
but did not appear to enroll any participants. The other four firms had very
low enrollment in 2020. Three of the six exiting firms offered plans in New
York.
Premiums
The vast majority of Medicare Advantage plans
for individual enrollment (89%) will include prescription drug coverage
(MA-PDs), and 54 percent of these plans will charge no premium, other than the
Part B premium, similar to 2020. More than nine out of ten beneficiaries (96%)
have access to a MA-PD with no monthly premium in 2021. However, in Wyoming,
beneficiaries do not have access to a zero-premium MA-PD, and in Idaho, less
than half of beneficiaries have access to a zero-premium MA-PD.
In 2020, 60 percent of enrollees in MA-PD
plans pay no premium other
than the Medicare Part B premium of $144.60 per month. Based on enrollment in
March 2020, nearly one in five enrollees (18%) pay at least $50 a month, and 6
percent pay $100 or more. CMS announced that
the average monthly plan premium among all Medicare Advantage enrollees in
2021, including those who pay no premium for their Medicare Advantage plan, is
expected to decrease 11 percent from 2020 to $21 a month. CMS does not disclose
the methods or assumptions used in deriving their calculations, but since most
Medicare Advantage enrollees pay no additional premium, the average they report
is heavily influenced by zero-premium plans, and does not reflect the average
premium paid by those who are in plans with an additional premium.
Extra Benefits
Medicare Advantage plans may provide extra
benefits that are not available in traditional Medicare, are considered
“primarily health related,” and can use rebate dollars (including bonus
payments) to help cover the cost of these extra benefits. Beginning in 2019,
CMS expanded the definition of “primarily health related” to allow Medicare
Advantage plans to offer additional supplemental benefits. Medicare Advantage
plans may also restrict the availability of these extra benefits to certain
subgroups of beneficiaries, such as those with diabetes or congestive heart
failure, making different benefits available to different enrollees.
Beginning in 2020, Medicare Advantage plans
have also been able to offer extra benefits that are not primarily health
related for chronically ill beneficiaries, known as Special Supplemental
Benefits for the Chronically Ill (SSBCI). Information on the availability of
SSBCI for 2021 has not yet been published by CMS, but may include services such
as pest control, food and produce (beyond a limited basis), and non-medical
transportation. Since plans are permitted to offer these benefits non-uniformly
to enrollees, it will be important to examine how these benefits are
distributed across subgroups of enrollees.
Availability of Extra Benefits
in Plans for General Enrollment. Historically, the most offered extra benefits were
fitness, dental, vision, and hearing; nearly two-thirds of plans (68%) provide
all four of these benefits for 2021. Though these benefits are widely
available, the scope of specific services varies. For example, a dental benefit may
include cleanings only or more comprehensive coverage. As of 2020, Medicare
Advantage plans have also been allowed to offer more telehealth benefits than
traditional Medicare (though Medicare has temporarily expanded these
benefits during the pandemic). The vast majority (98%) of Medicare Advantage
plans are offering telehealth in 2021 (up from 91% in 2020) (Figure 7).
Figure 7: Most
Medicare Advantage plans provide fitness and dental benefits but much fewer
provide in-home or caregiver support
Other extra benefits that are frequently
offered for 2021 include over the counter items (75%), meal benefits, such as a
cooking class, nutrition education, or meal delivery (55%), and transportation
benefits (36%).
Less than 10 percent of plans provide bathroom
safety devices (6%) or in-home support (6%).
Availability of Extra Benefits
in Special Needs Plans. SNPs are designed to serve a disproportionately high-need
population, and a somewhat larger percentage of SNPs than plans for other
Medicare beneficiaries provide their enrollees with over the counter items
(91%), transportation benefits (85%) and meal benefits (63%). Similar to plans
available for general enrollment, a relatively small share of SNPs provide
bathroom safety devices (11%) or in-home support (18%).
Access to Extra Benefits. Virtually all Medicare beneficiaries
live in a county where at least one Medicare Advantage plan available for
general enrollment has some extra benefits not covered by traditional Medicare,
with 98% having access to some dental, fitness, vision, and hearing benefits for
2021. The vast majority of beneficiaries also have access to telehealth
benefits (99%), over the counter items (99%), transportation assistance (95%)
and a meal benefit (98%), but far fewer have access to bathroom safety (55%) or
in-home support (62%).
Discussion
More Medicare Advantage plans are being
offered for 2021 than in any other year. Fourteen insurers are entering the
Medicare Advantage market for the first time, and six insurers are exiting the
market, suggesting thatMedicare Advantage remains an attractive, profitable market for
insurers. As in prior years, some (mostly non-metropolitan) counties are less
attractive to insurers, with fewer firms and plans available, though the number
of areas where this is the case has declined over time. Overall, more than 99
percent of beneficiaries will have access to one or more Medicare Advantage
plans in 2021, similar to prior years. With more firms offering SNPs and the
number of SNPs rapidly growing, there may be greater focus on how
well high-need, vulnerable beneficiaries are being served by Medicare Advantage
plans, including SNPs as well as plans for general enrollment. As Medicare
Advantage enrollment continues to grow, insurers seem to be responding by
offering more plans and choices to the people on Medicare.
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Methods |
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This analysis focuses on the
Medicare Advantage marketplace in 2021 and trends over time. The analysis
includes more than 24 million enrollees in Medicare Advantage plans in 2020. Data on Medicare Advantage plan
availability, enrollment, and premiums were collected from a set of data
files released by the Centers for Medicare & Medicaid Services (CMS): ·
Medicare Advantage
plan landscape files, released each fall prior to the annual enrollment
period ·
Medicare Advantage
plan and premium files, released each fall ·
Medicare Advantage
plan crosswalk files, released each fall ·
Medicare Advantage
contract/plan/state/county level enrollment files, released on a monthly
basis ·
Medicare Advantage
plan benefit package files, released each fall ·
Medicare Enrollment
Dashboard files, released on a monthly basis In previous years,
KFF has used the Medicare Advantage Penetration Files to calculate the number
of Medicare beneficiaries eligible for Medicare. The Medicare Advantage
Penetration Files includes people who were previously, but no longer covered
by Medicare (e.g., people who obtained employer-sponsored health insurance
coverage after initially enrolling in Medicare). It also includes people
within 5 months of their 65th birthday, but not yet age 65. In addition, CMS
has identified an issue where beneficiaries with multiple addresses were
double counted in the Penetration File. KFF has refined its approach this
year and is using the Medicare Enrollment Dashboard to calculate the number
of Medicare beneficiaries because it only includes Medicare beneficiaries
with either Part A or Part B coverage, which is a more accurate estimate of
the Medicare population. The numbers published here supersede all prior
estimates by KFF of the number of Medicare beneficiaries. Jeannie Fuglesten
Biniek, Meredith Freed, and Tricia Neuman are with KFF. |
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