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% of Medicare Advantage by State
Old 10-29-2019, 10:21 AM   #1
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% of Medicare Advantage by State

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
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Old 10-29-2019, 11:16 AM   #2
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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.
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Old 10-29-2019, 11:28 AM   #3
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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.
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Old 10-29-2019, 12:00 PM   #4
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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.
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% of Medicare Advantage by State
Old 10-29-2019, 12:06 PM   #5
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% of Medicare Advantage by State

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.
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Old 10-29-2019, 12:10 PM   #6
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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-Statist...netration.html
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Old 10-29-2019, 01:47 PM   #7
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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-b...rance-markets/
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Old 10-29-2019, 02:14 PM   #8
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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".
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Old 10-29-2019, 02:21 PM   #9
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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.
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% of Medicare Advantage by State
Old 10-29-2019, 02:45 PM   #10
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% of Medicare Advantage by State

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).
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Old 10-29-2019, 02:55 PM   #11
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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-sh...are-advantage/
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Old 10-29-2019, 03:32 PM   #12
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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".
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Old 10-29-2019, 04:01 PM   #13
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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.
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Old 10-29-2019, 04:06 PM   #14
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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
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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.
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Old 10-29-2019, 04:17 PM   #15
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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.
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Old 10-29-2019, 04:42 PM   #16
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From the KFF analysis
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Originally Posted by Telly View Post
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.
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Old 10-29-2019, 04:55 PM   #17
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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 ?

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Old 10-29-2019, 05:05 PM   #18
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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?
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Old 10-29-2019, 05:17 PM   #19
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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.
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Old 10-29-2019, 05:22 PM   #20
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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.
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