Medicare Information and Plan Comparisons
While health care was not central to the 2016 Presidential campaign, the election’s outcome will be a major determining factor in the country’s future health care policy. A number of issues have garnered media attention, including the future of the Affordable Care Act (ACA), rising prescription drug costs, and the opioid epidemic.
Medicare Advantage 2015 Data Spotlight: Overview of Plan Changes
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.
Financial Security of Elderly Americans at Risk: Proposed changes to Social Security and Medicare could make a majority of seniors ‘economically vulnerable’
To better measure the economic vulnerability of older adults, they suggest using the Elder Economic Security Standard Index (Elder Index) developed by Wider Opportunities for Women (WOW). The Elder Index estimates how much it costs seniors to live in different communities across the country, accounting for an elder household’s housing type, transportation type, health status, and geography-specific cost of living. The index is more comprehensive than the SPM in its appraisal of costs, including food, housing, healthcare, and transportation costs, as well as miscellaneous expenses such as telephone, clothing, and personal care costs and relevant sales taxes. At the time we began our analysis, the measure had only been produced for 17 states, and therefore could not be used to assess elderly vulnerability nationwide. However, when we compared the index’s state-level thresholds to SPM thresholds for those same areas, we found a measurable pattern: The Elder Economic Security Standard Index threshold (the line below which the elderly are considered economically insecure) is roughly 200 percent of, or twice, the SPM threshold, on average. (Note that WOW has since released Elder Index values for states, counties, and cities throughout the United States; the data are available at www.basiceconomicsecurity.org/EI)
Medicare Advantage 2014 Spotlight: Plan Availability and Premiums
While many organizations offer Medicare Advantage plans, a few – particularly Humana, United Healthcare, and the Blue Cross and Blue Shield (BCBS) affiliates – have particularly large geographic spread and these organizations historically account for a disproportionate share of enrollment. In 2014, 44 percent of available plans are being offered by one of these three firms or affiliates (Table A4). Plans offered by these firms are available to most beneficiaries. Nationwide, 83 percent of Medicare beneficiaries will have access to one or more Humana plans, 73 percent will have access to a BCBS affiliated plan (including BCBS plans offered by Wellpoint), and 68 percent will have access to a United Healthcare plan (Exhibit 5; Table A5). The general availability of these firms’ products has not noticeably changed from 2013 to 2014. However, the similarities in BCBS offerings from 2013 to 2014 obscure a decline in availability of BCBS branded Wellpoint plans (declining from 88 plans to 55 plans between 2013 and 2014), which is mostly offset by the growth in plans offered by other BCBS affiliates (growing from 205 plans to 233 plans between 2013 and 2014).