Medicare Advantage Enrollment Up, Premiums Down, CMS Says

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By Mindy Yochelson

Sept. 21 — Medicare Advantage enrollment is expected to keep rising in 2016 while premiums will be slightly less, the Centers for Medicare & Medicaid Services said Sept. 21.

Despite $200 billion in cuts that were made to the program under the Affordable Care Act, average premiums will drop from $32.91 per month in 2015 to $32.60 in 2016, the Medicare agency said in a statement that accompanied its annual release of the MA (managed care) and Part D (outpatient drug benefit) information, known as the “landscape files.”

The files show in tables, state-by-state, information on which plans will serve each county and what premiums will be.

Most Will Have No Increase 

More than half of enrollees (59 percent) will not have a premium increase, the CMS said.

Last year, the CMS said that the average premium would rise by about $3.

MA plans expect to enroll 17.4 million people in 2016, up from 16.5 million in 2015, the agency said. This would represent about a third—32 percent—of Medicare beneficiaries. The CMS said that, since 2010, enrollment is expected to increase by 50 percent.

Open enrollment will take place between Oct. 15 and Dec. 7, and plans may begin marketing Oct. 1.

According to the agency, 99 percent of beneficiaries will have access to a MA plan. There are no MA plans, however, in Alaska and in some of the territories, such as the Virgin Islands, Guam and American Samoa.

The CMS offers a release about each state, indicating the number of MA and stand-alone prescription drug plans available, and the lowest monthly premium available for a prescription drug plan, among other data.

Enrollees in Higher-Rated Plans

The CMS said that about 65 percent of MA enrollees will be in plans with four or more stars on a one-to-five scale. At the same time last year, the CMS said that 60 percent would be in at least a four-star plan.

Star ratings will be posted on Medicare.gov starting Oct. 8.

Avalere Health, a Washington-based consultant company, speculated that MA sponsors may have decided to discontinue plans that received low star ratings in previous years, under threat by the CMS to terminate such plans in 2016.

Medical Inflation 

Tom Kornfield, a vice president at Avalere, told Bloomberg BNA Sept. 21 that MA premiums are down in part because “medical inflation has been very low during the past several years.”

In addition, he said, “plans have been able to bid below the administratively set county rates that are based on Medicare fee for service cost.”

In addition, as quality increases, more plans are eligible for bonus payments available to those with at least four stars, and they “can use these bonus payments to lower premiums,” Kornfield said.

Tricia Neuman, a senior vice president at Kaiser Family Foundation, told Bloomberg BNA that because beneficiaries focus first on premiums when comparing plans, “plans may be working hard to keep premiums relatively low to maintain enrollees and grow their market share.”

However, she added, “plans may be making other changes that have cost implications for consumers” but are less visible, such as increasing limits on out of-pocket-spending, “which tends to shift costs onto enrollees with significant health needs.”

AHIP Comment

Marilyn Tavenner, president and chief executive officer of America's Health Insurance Plans, said in a Sept. 21 statement that, although a growing number of seniors are choosing MA, “recent policy changes could jeopardize health plans' efforts to care for the chronically ill and vulnerable populations who increasingly rely on the program for their health needs.”

Tavenner, a former CMS administrator, urged passage of various legislative initiatives, including the Medicare Advantage Coverage Transparency Act (H.R. 2505), which would require the annual reporting of data on enrollment in Medicare Advantage plans. The House passed the bill by voice vote in June.

To contact the reporter on this story: Mindy Yochelson in Washington at myochelson@bna.com

To contact the editor responsible for this story: Janey Cohen at jcohen@bna.com