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Report Sees Opportunity for Private Plans To Gain Members During 2013 Enrollment

Thursday, September 13, 2012
With a 10 percent increase in Medicare Advantage enrollment since August 2011 and an additional 3.3 million aging into Medicare in 2013, “there is ample opportunity for health plans to gain membership during the 2013 open enrollment period,” according to an analysis of Centers for Medicare & Medicaid Services data released Aug. 28.

“With the 2013 Medicare Advantage selling season just weeks away, health insurers are busy analyzing how their products and pricing strategies stacked up against competitors in 2012,” Mark Farrah Associates said in a report that looked at “snapshots” of the 2012 marketplace.

Plans may begin marketing their 2013 benefits Oct. 1, in advance of CMS's annual election period, from Oct. 15 to Dec. 7.

“Sales and marketing executives are considering various scenarios to determine how best to differentiate 2013 products from competitors and deploy sales force resources and scarce advertising dollars to maximize opportunities and win new business in key markets,” the report said.

With 50.2 million people eligible for Medicare as of August 2012, aggregate MA enrollment was about 13.7 million members as of Aug. 1, it said.

PDP Enrollment
Total standalone prescription drug plan (PDP) enrollment was 19.9 million as of Aug. 1, an increase of nearly 1.17 million members, or 6.3 percent, from August 2011.

The number of PDPs declined, however, from 1,134 in 2011 to 1,063 for 2012, while the number of MA plans (not including special needs plans or employer plans) for 2012 increased from 1,735 to 1,974.

The number of regional preferred provider organizations offered remained relatively small, with 54 plans available in 2012, down from 59 in 2011.

In comparing data on CMS's plan finder tool, the report found that the disparity in monthly premiums and out-of-pocket expense estimates “can be quite significant across plans.”

In Los Angeles County, for example, the report compared annual beneficiary cost estimates for health maintenance organization plan options with membership.

The Kaiser Permanente Senior Advantage plan covers 95,518 members, although it has a higher annual beneficiary out-of-pocket cost ($3,200) than the Health Net Healthy Heart plan ($2,900) with just 2,442 members.

“Health plan quality ratings may also play an important role in understanding why one plan does better in a specific market than another,” the report said. “Kaiser's five-star rating and the benefits that go along with exemplary rating most likely contributed to its large enrollment in the Los Angeles market.”


The analysis is at http://www.markfarrah.com/healthcare-business-strategy/Medicare-Advantage-Competition-Analysis.aspx.

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