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Medicare Advantage Overview

Medicare Advantage Overview. Diane Rowland, Sc.D. Executive Vice President Kaiser Family Foundation Alliance for Health Reform July 16, 2007. Exhibit 1. What is Medicare Advantage?.

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Medicare Advantage Overview

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

  2. Exhibit 1 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

  3. Exhibit 2 The number of Medicare Advantage contracts has doubled since 2004 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 1999-2006. CMS Medicare Advantage, Cost, PACE, Demo, and Prescription Drug Plan Contract Report, Monthly Summary Report, June 2007.

  4. Medicare Advantage enrollment is concentrated among a small number of organizations Exhibit 3 UnitedHealth Care (1.4 million enrollees) Blue Cross/Blue Shield affiliates 4.6 million beneficiaries account for more than half of total Medicare Advantage enrollment (1.2 million) All Others* Humana Inc. (1.1 million) Kaiser Permanente (0.9 million) Total Medicare Advantage Enrollment= 8.7 million 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, 2007. SOURCE: Centers for Medicare and Medicaid Services (CMS), June 2007 Monthly Summary.

  5. Exhibit 4 The majority of Medicare Advantage enrollees are in Medicare HMOs 2007 Medicare Advantage Enrollment = 8.7 million 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 2007.

  6. Exhibit 5 Characteristics of Medicare Advantage enrollees and beneficiaries in traditional Medicare Medicare Advantage Traditional Medicare SOURCE: Kaiser Family Foundation analysis of the 2005 Medicare Current Beneficiary Survey (MCBS).

  7. Exhibit 6 More than one in four Medicare beneficiaries are projected to be in a Medicare Advantage plan by 2016 Percent of Total Medicare Population: 27% Actual Projected 19% SOURCE: Centers for Medicare and Medicaid Services, 2007 Medicare Trustees Report Table IV.B6.

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