% of Medicare Advantage by State

[REWahoo]

I ran across this graphic from 2018 showing the percentage of Medicare recipients by state who choose Medicare Advantage plans. Surprised to see there is such a wide distribution - from 3% or less in Alaska and Wyoming to a high of 56% in Minnesota.

Lots of interesting Medicare Advantage facts at this link: A Dozen Facts About Medicare Advantage

 

[Midpack]

Interesting, I've wondered. My sister is MA and thinks it's a no brainer. I am Original + Medigap + Part D + Dental, I also think it's a no brainer.

The wide range of MA acceptance is puzzling as the OP noted.

 

[ShokWaveRider]

IMHO for people who cannot afford or justify a monthly payment, the MA is a no brainer. For those who can afford the monthly payment and like the No Copays, No Networks, Nationwide Coverage, No Customer Support Rep making coverage decisions, No MOOP etc. Then Medigap Part G is also a no Brainer.

 

[Brat]

Kaiser Permanente has Medicare Advantage plans that cover Oregon's population centers. Providence also has Medicare Advantage plans covering most of the same counties. Based on the data above almost half of Medicare recipients choose one of them.

 

[steelyman]

That’s an interesting chart and links to additional information from Kaiser, who’ve posted a lot of studies recently (I guess due to enrollment periods).

I’m a pre-Medicare retiree with health coverage from employer (state) that seems to resemble an Advantage plan. I’m thinking of it as a taste-test/training wheels period until a choice will have to be made at age 65. My use of the coverage (medical and prescription) has been increasing this year.

[ADDED] Currently my plan is administered by Aetna, which takes the place of Medicare until age 65, after which it becomes secondary payer. Aetna replaced Cigna in 2017. I have no say in insurer choice.

Reading about experiences of others in these threads helps to learn about possible surprises down the road.

 

[saydiver]

A further breakdown of the data by state/county is on Medicare's website along with a lot of other statistics.

https://www.cms.gov/Research-Statis...rtDEnrolData/MA-State-County-Penetration.html

 

[MichaelB]

Here’s an analysis by Kaiser Health showing insurer margins for Medicare Advantage, twice the level of other policies. https://www.kff.org/medicare/issue-...ndividual-and-group-health-insurance-markets/

 

[CardsFan]

IMHO for people who cannot afford or justify a monthly payment, the MA is a no brainer. For those who can afford the monthly payment and like the No Copays, No Networks, Nationwide Coverage, No Customer Support Rep making coverage decisions, No MOOP etc. Then Medigap Part G is also a no Brainer.

^^^^This, at least in the beginning. But, interestingly, there are more than a few in my retiree lunch group that have changed to MA after several years on Medicare. The difference might be they were using a retiree secondary plan, not a standardized Medigap. One complained the rates for he and his wife had increased to $1,000/month (they are in their young 70's). Not sure he ever really looked at Medigap, but his Essence plan is "free".

 

[REWahoo]

Here’s an analysis by Kaiser Health showing insurer margins for Medicare Advantage, twice the level of other policies.

So the biggest advantage to Medicare Advantage is that it is far more profitable for the insurance company.

No wonder we get bombarded with every marketing strategy under the sun each year, trying to sell us an Advantage plan.

 

[steelyman]

Following the link labeled “Issue Brief” in the article MichaelB posted provides more information about Kaiser’s study of differences in margins between the (I think) three broad markets. It looks like the overall picture is evolving but the summary history is not that long of a period that includes a volatile period post-PPACA.

I’m not sophisticated enough to understand completely. As Consumer Joe, I care about coverage for me and of course cost to me.

[ADDED] Right now I haven’t run into any network-related provider issues, but I live in an area with a lot of quality providers, including my PCP (primary care physician, not required by the PPO plan) who is in private practice but in-network. Who knows how long I will stay in the area?

I have run into a prescription issue that arises from CVS/Caremark, the Aetna PBM (pharmacy benefit manager).

 

[MichaelB]

The real eye opener for me is fact #1 in the link provided by REWahoo. Medicare Advantage has increased from 13% to 34% of Medicare enrollees since ‘04.

Here’s another data heavy KFF Medicare Advantage brief https://www.kff.org/medicare/fact-sheet/medicare-advantage/

 

[Telly]

Lots of interesting Medicare Advantage facts at this link: A Dozen Facts About Medicare Advantage

REW, thanks for posting the link and graphic!

I did not realize how many "work" retirement medical plans were MAs, I see there they are a significant portion of the MA pie. Since those people are pretty much captive, that distorts the overall OM vs. MA decision, it's not all "user choice".

DW, if she ever retires, is eligible for a giant custom-made MA plan that has a $140 premium, but has a low deductible, seems to be no-network go anywhere, premium hasn't risen, has an ever-growing captive group coming in each year (unless they want to turn their back on it and go Original Medicare, never to return to this MA plan), and the number of members is tightly linked to our fast-growing state population. It's got to be a MA-insurer's dream catch. From everything I've seen and read and dug in to regular MAs, I have no interest in them. But if I were DW, I would seriously consider the designed-for-them special MA plan!

Separately, REW, you may be overjoyed to hear that MoO has a big push on to increase their penetration of the MA business. They are running full-page back of the front section newspaper ads over and over about easy to attend convenient group talks on their MA plan. They're plastering the Metroplex with them. One line is a plan "could reduce your Part B premium by $50".

 

[CardsFan]

On a related note, does anyone know how much medicare pays to an MA plan? I assume it is more than just the individuals medicare payment. I have done a search, and can't (easily) find anything.

 

[MichaelB]

On a related note, does anyone know how much medicare pays to an MA plan? I assume it is more than just the individuals medicare payment. I have done a search, and can't (easily) find anything.

From the KFF analysis

In 2019, Medicare payments to Medicare Advantage plans (including bonus payments) are roughly equal to the per capita costs in traditional Medicare, 100.4 percent, on average, according to the Medicare Payment Advisory Commission.

 

[Telly]

On a related note, does anyone know how much medicare pays to an MA plan? I assume it is more than just the individuals medicare payment. I have done a search, and can't (easily) find anything.

As per the book written by Philip Moeller "Get what's yours for Medicare" (2016), he says it's around $10k that CMS hands over to the MA insurer for each insured. The Part B payment goes to CMS, they act as collector. So every $ that the MA insurer doesn't have to spend on an individual (including administration), is profit for them.

 

[CardsFan]

From the KFF analysis

As per the book written by Philip Moeller "Get what's yours for Medicare" (2016), he says it's around $10k that CMS hands over to the MA insurer for each insured. The Part B payment goes to CMS, they act as collector. So every $ that the MA insurer doesn't have to spend on an individual (including administration), is profit for them.

MichaelB: I missed that, but still no numbers. Apparently the companies bid for the program, and the average is 100.4%. So, unless I am missing something, there is NO savings to medicare, and the plans make more profit. FYI, I am all for the free market, just making a point.

Telly: I guess that supports your comment that the companies keep the difference, and that is why they love these plans.

 

[Richard4444]

So the biggest advantage to Medicare Advantage is that it is far more profitable for the insurance company.

I have Medicare, Part B, Part D, and Concierge. A whole lot of dollars.

Why is the Advantage plan so much more profitable for the insurer ?

Rich

 

[CRLLS]

I was talking to 2 people today who are on Advantage plans. They insisted their costs were ~20 and ~50 each. One had a HMO plan and the other was a PPO. I asked if they still paid the Part B monthly premium. They insisted the only thing they paid was the 20 and 50. I know that is wrong. They are fairly intelligent people. I wonder if the low premium cost promoted by the providers lulls them into forgetting about the Part B payment?



2ndly, did anyone else notice that the graph shown earlier on participation by state has the colors in the legend mixed up?

 

[steelyman]

The retiree plan offered by my employer requires Medicare enrollment and payment of Part B premium. If not, no Advantage soup for you. Those MA premiums, if any, are separate.

 

[copyright1997reloaded]

I wonder how some states (like NY) with Medigap guaranteed issue affects things? In NY I could potentially go on a Medicare Advantage plan with low/no copays (but with restrictions in terms of doctors and location). As time goes on, if want to travel more or my health requires non-HMO/PPO specialists, switch to a medicap plan at the same rate as the poor saps that have been paying it all along.

 

[CardsFan]

I wonder how some states (like NY) with Medigap guaranteed issue affects things? In NY I could potentially go on a Medicare Advantage plan with low/no copays (but with restrictions in terms of doctors and location). As time goes on, if want to travel more or my health requires non-HMO/PPO specialists, switch to a medicap plan at the same rate as the poor saps that have been paying it all along.

One word: Underwriting.

 

[CRLLS]

One word: Underwriting.

NY is a guaranteed issue state. No underwriting is allowed. a waiting period may be applied to preexisting conditions. I think copyright1997reloaded may be in the clear.

 

[copyright1997reloaded]

NY is a guaranteed issue state. No underwriting is allowed. a waiting period may be applied to preexisting conditions. I think copyright1997reloaded may be in the clear.

You are correct. No underwriting. "seniors cannot be denied or charged any more for health status, claims experience, medical condition or whether the applicant is receiving health care services."

The above is part of the reason that Medigap rates in my area are significantly higher than in Tennessee.

Which brings up another strategy:
While young and in relatively good health (65) move to a state with age-based policies. When old, move back.

 

[homestead]

We just renewed our Oregon Regence Blue Cross PPO Advantage Plan for 2020. Premiums went down 1$ to 47/mo plus part B. They added Acupuncture, Mental Health, Hearing health & hearing aids, Meal delivery, Naturopathy, Podiatry, and Therapeutic massage to the 2020 coverage.
We also use the Vision, Dental & free gym membership coverage.

 

[CardsFan]

NY is a guaranteed issue state. No underwriting is allowed. a waiting period may be applied to preexisting conditions. I think copyright1997reloaded may be in the clear.

Well then, that makes a difference. I missed the guaranteed issue comment. Of course, as noted, the rates are higher for this reason.

No Free Lunch.

In MO, we are not guaranteed issue, but we can change providers, in the same plan, each year on our anniversary (NOT open enrollment) with no underwriting. Seems a no brainer to always take the lowest cost provider, we intend to go plan G. Am I missing something?