When SNPs were authorized, there were few requirements beyond those otherwise required of other Medicare Advantage plans. The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 established additional requirements for SNPs, including requiring all SNPs to provide a care management plan to document how care would be provided for enrollees and requiring C-SNPs to limit enrollment to beneficiaries with specific diagnoses or conditions. As a result of the new MIPPA requirements, the number of SNPs declined in 2010. The ACA required D-SNPs to have a contract with the Medicaid agency for every state in which the plan operates, beginning in 2013. Additionally, in 2013, joint federal-state financial alignment demonstrations to improve the coordination of Medicare and Medicaid for dually eligible beneficiaries began to enroll beneficiaries. Today, financial alignment demonstrations are underway in 12 states: California, Colorado, Illinois, Massachusetts, Michigan, Minnesota, New York, Ohio, South Carolina, Texas, Virginia, and Washington. The financial alignment demonstrations could influence the availability of D-SNPs in these states, either increasing or decreasing the availability of SNPs, depending on the design of the demonstration.
Medicare Advantage and Prescription Drug Plan Fact Sheet
As of May 2013, there were 22,564,532 enrollees in Medicare Prescription Drug Plan enrollees, including 19.8% that are Employer Plan enrollees. 1 The top five states for PDP enrollment, which account for 31.9% of total PDP enrollment, are as follows: California – 1,989,753, Texas – 1,516,077, Florida – 1,324,743, New York – 1,322,296 and Illinois – 1,051,467. There are eighteen states with over a 50% penetration rate (compared to the national overall rate of 43.9%): North Dakota – 65.3%, Delaware – 63.4%, Iowa – 61.5%, South Dakota – 58.9%, Mississippi – 57.7%, Michigan – 57.5%, Nebraska – 57.5%, Vermont – 56.9%, Kansas – 56.2%, Wyoming – 55.9%, New Jersey – 55.3%, Kentucky – 53.8%, Illinois – 53.4%, North Carolina – 52.2%, Indiana – 52.2%, Maine – 51.7%, New Hampshire – 51.0% and Oklahoma – 50.1%. 3
Medicare Advantage Loses Its Advantage
In October, CMS sent letters to 575,000 beneficiaries in what it called low-performing MA and PDP plans, meaning plans that earned 2.5 stars or fewer in 2012, says a CMS spokesman. The letters urged the beneficiaries to enroll in better-performing plans. CMS made enrolling in low-performing plans more difficult by removing the button that beneficiaries would click for online enrollment. Instead, members need to call the plan to enroll. Also, five-star plans may accept new members anytime during the year. Other plans may enroll members only during open enrollment, six weeks from mid October to early December.