While Medicare Advantage enrollment is increasing in many states, in 6 states (AK, DE, MD, NH, VT and WY) less than 10% of beneficiaries are enrolled in Medicare Advantage plans in 2015, which was also the case in at least the prior three years (Figure 5). In contrast, in 22 states (versus 18 states in 2014 and 15 states in 2013) more than 30 percent of beneficiaries are enrolled in Medicare Advantage plans in 2015. Additionally, in 5 states (FL, HI, MN, OR, and PA) more than 40 percent of beneficiaries are enrolled in Medicare Advantage plans, and Medicare Advantage enrollment these states account for 6% of all Medicare beneficiaries and 21% of all Medicare Advantage enrollees. This variation reflects the urban origins of health maintenance organizations (HMOs) in Medicare Advantage and other factors, such as the history of managed care in the state and the prevalence of employer sponsored insurance for retirees. Within states, Medicare Advantage penetration varies across counties. For example, 43 percent of beneficiaries in Los Angeles County, California are enrolled in Medicare Advantage plans compared to only 8 percent of beneficiaries in Santa Cruz County, California.
Medicare Advantage/Part D Contract and Enrollment Data
Medicare Advantage 2016 Spotlight: Enrollment Market Update
Medicare Advantage enrollees are responsible for paying the Part B premium, in addition to any premium charged by the plan. The Medicare Advantage premium paid by enrollees reflects the difference between the plan’s costs of providing Part A and B benefits and any supplemental benefits offered, and the federal payment to the plan for Part A and B benefits. Plans receive a percentage of the difference between their bid and the maximum federal payment (known as a rebate) and are required to use this amount to offer extra benefits, reduce cost sharing, or reduce the Part B premium. If the plan includes the Medicare Part D prescription drug benefit, as most plans do, the plan may also use the rebate to reduce the Part D premium. This brief analyzes premiums for Medicare Advantage plans that offer prescription drug benefits (MA-PDs) because the vast majority (89%) of Medicare Advantage enrollees is in MA-PDs and Medicare Advantage enrollees who seek Part D prescription drug benefits are, for the most part, required to get them through their plan if the plan offers prescription drugs.
Compare Medicare Advantage & Supplemental Plans
Medicare Advantage insurance is offered by private insurance companies with a Medicare contract, and replaces Original Medicare Part A and Part B. You must continue to pay your Part B premiums. Medicare Advantage plans typically offer additional benefit options and have less cost-sharing than Original Medicare, and you may have to pay a monthly premium in return for the extra benefits. Medicare Advantage plans come in a variety of formats, such as HMO, PPO and PFFS plans, as well as special needs plans. Medicare beneficiaries can enroll in Medicare Advantage plans if they have Medicare Part A and Part B, but only during designated enrollment periods. These enrollment periods change from time-to-time, so please call us to get the most-up-to-date information.
Medicare Advantage California
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