2297_sejda-DYJ.pdf - TABLE 13–1 MA plan enrollment...

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Unformatted text preview: TABLE 13–1 MA plan enrollment continued to grow faster than total Medicare beneficiary growth in 2018 MA enrollment (in millions) November 2017 Total November 2018 Percent change in enrollment 2018 MA enrollment as a share of total Medicare 18.9 20.5 8% 33% 18.7 20.3 9 32 Plan type CCP HMO 12.2 13.1 7 21 Local PPO 5.1 5.9 16 9 Regional PPO 1.4 1.4 –1 2 0.2 0.1 –21 <1 SNPs* 2.5 2.8 13 4 Employer group* 3.7 4.2 12 7 PFFS Restricted availability plans included in totals above Share of Medicare population in MA Urban/rural Urban Rural Note: 16.3 17.9 10 35 2.5 2.5 3 23 MA (Medicare Advantage), CCP (coordinated care plan), HMO (health maintenance organization), PPO (preferred provider organization), PFFS (private fee-forservice), SNP (special needs plan). CCPs include HMO, local PPO, and regional PPO plans. Rural areas include counties designated as micropolitan counties and counties that are neither metropolitan nor micropolitan as defined by the Office of Management and Budget. Urban areas include metropolitan counties. The sum of column components may not equal the stated total due to rounding. *SNPs and employer group plans have restricted availability. Their enrollment is included in the statistics by plan type and location. We present them separately to provide a more complete picture of the MA program. Source: MedPAC analysis of CMS enrollment files. designated regions made up of one or more states. Regional PPOs have more flexible provider network requirements than local PPOs. Regional PPOs are also classified as CCPs. • 350 Private FFS (PFFS) plans—These plans may or may not use provider networks, depending on where they operate. The Medicare Improvements for Patients and Providers Act of 2008 mandated that, in areas with two or more network MA plans, PFFS plans have provider networks. Therefore, PFFS plans have to either locate in areas with fewer than two network plans or operate as network-based PFFS plans. The Congress anticipated that the legislation would reduce the availability of and enrollment in these plans that did not manage care as efficiently as their HMO and PPO competitors. The Medicare Advantage program: Status report • Medicare Medical Savings Account (MSA) plans— MSA plans are a combination of a high-deductible plan and a medical savings account. The plan is paid the full MA benchmark and places a deposit into the member’s account that the member can use to help meet the plan deducible on Medicare services. While these plans were introduced in 2007, they were never broadly available. In 2018, they were available in only a couple of states, and total enrollment was under 7,000 beneficiaries. New plans are being introduced for 2019 that will be available in a total of 19 states. However, because enrollment has been limited, beneficiaries dually eligible for Medicare and Medicaid are not eligible to enroll in MSA plans, and because the plans do not bid, we are not including them in our analyses. Chapter 11 Distribution List • Saab Cars North America, Inc. • Sentech, Inc. • Shandong Jinyu Industrial Co. Ltd. • SKF USA Inc. • Spartan Motors, Inc. • Stoneridge Inc. • Subaru of America, Inc. • Sumitomo Rubber Industries, Ltd. • Sumitomo Rubber USA, LLC • Suzuki Motor of America, Inc. • Tesla Motors, Inc. • TI Group Automotive Systems, LLC • Timken Company • Tireco Inc. • Tishomingo Acquisition, LLC • Tong Yang Industry Co. • Toyo Tire Holdings of Americas Inc. • Toyota Motor Engineering & Manufacturing • Toyota Motor North America, Inc. • Tread Systems, Inc., dba Diamond Back • Valeo • Vantage Mobility International, LLC • Vee Tyre and Rubber Co., Ltd. • Vision Wheel, Inc. • Vogue Tyre & Rubber Co. • Volkswagen Group of America, Inc. • Volvo Car USA LLC • Volvo Group North America • Wells Vehicle Electronics, L.P. • Westward Industries • Wheel Pros, LLC • Wilson Manifolds Inc • Yokohama Tire Corporation • ZF North America, Inc. 11-27 U.S.-Mexico-Canada Trade Agreement Bibliography Egger, Peter, and Valeria Merlo. “The Impact of Bilateral Investment Treaties on FDI Dynamics.” World Economy 30, no. 10 (October 2007): 1536–49. . Eurostat. “Foreign Control of Enterprises by Economic Activity and a Selection of Controlling Countries.” (accessed November 7, 2018). Gurevich, Tamara, and Peter Herman. “The Dynamic Gravity Dataset: 1948–2016.” U.S. International Trade Commission. Office of Economics Working Paper no. 2018–02–A, February 2018. dynamic_gravity_dataset_201802a.pdf. Oldenski, Lindsay. “What Do the Data Say about the Relationship between Investor-State Dispute Settlement Provisions and FDI?” Peterson Institute for International Economics (blog), 2015. . Organisation for Economic Co-Operation and Development (OECD). Services Trade Restrictiveness Index. (accessed various dates). Organisation for Economic Co-Operation and Development (OECD). “OECD Services Trade Restrictiveness Index.” Trade Policy Note (March 2018). . Smolyansky, Michael, Gustavo Suarez, and Alexandra Tabova. “U.S. Corporations' Repatriation of Offshore Profits.” Federal Reserve Research Notes, September 4, 2018. . U.S. Department of Commerce (USDOC). Bureau of Economic Analysis (BEA). “U.S. Direct Investment Position Abroad on a Historical-cost Basis.” (accessed November 27, 2018). U.S. Department of Commerce (USDOC). Bureau of Economic Analysis (BEA). “Foreign Direct Investment Position in the United States on a Historical-cost Basis.” (accessed November 27, 2018). U.S. International Trade Commission (USITC). Trade, Investment, and Industrial Policies in India: Effects on the U.S. Economy. USITC Publication no. 4501. Washington, DC: USITC, 2014. . U.S. International Trade Commission (USITC). Trans-Pacific Partnership Agreement: Likely Impact on the U.S. Economy and on Specific Industry Sectors. USITC Publication no. 4607. Washington, DC: USITC, 2016. . 374 | Two additional plan classifications cut across plan types: special needs plans (SNPs) and employer group plans. SNPs offer benefit packages tailored to specific populations (those beneficiaries who are dually eligible for Medicare and Medicaid, are institutionalized, or have certain chronic conditions). SNPs must be CCPs. Employer group plans are available only to Medicare beneficiaries who are members of employer or union groups that contract with those plans. SNPs are included in our plan data, with the exception of plan availability figures because these plans are not available to all beneficiaries. (See the Commission’s March 2013 report to the Congress, available at , for more detailed information on SNPs.) As we recommended in an earlier report, employer plans no longer submit bids (since 2016), so we have only enrollment data for them. Therefore, they are not included in our access and payment analyses. (See the Commission’s March 2015 report to the Congress for more detailed information on employer plans.) How Medicare pays MA plans Plan payment rates are determined by the MA plan bid—which represents the dollar amount that the plan estimates will cover the Part A and Part B benefit package for a beneficiary of average health status—and the benchmark for the county in which the beneficiary resides, which is the maximum amount of Medicare payment set by law for an MA plan to provide Part A and Part B benefits. (Medicare also pays plans for providing the Part D drug benefit, but Medicare’s Part D payments are determined through the Part D bidding process, and not all plans include the Part D benefit.) Plans with higher quality ratings are rewarded with a higher benchmark. The benchmark that is compared with an individual plan’s bid is a plan-specific risk-adjusted average, weighted by the plan’s projected enrollment from counties in its service area. If a plan’s bid is above the benchmark, its MA payment rate is equal to the benchmark and enrollees have to pay a premium (in addition to the usual Part B premium) equal to the difference. If a plan’s bid is below the benchmark, its payment rate is its bid plus a share (between 50 percent and 70 percent, depending on a plan’s quality ratings) of the difference between the plan’s bid and the benchmark; the beneficiary pays no additional premium to the plan for Part A and Part B benefits (but continues to be responsible for payment of the Medicare Part B premium and may pay premiums to the plan for additional benefits). The added payment based on the difference between the bid and the benchmark is referred to as the “rebate.” Plans must use the rebate to provide additional benefits to enrollees in the form of lower cost sharing, lower premiums, or supplemental benefits. Plans can also devote some of the rebate to administration costs and margins. Plans may also choose to include additional supplemental benefits in their packages and charge premiums to cover those additional benefits. (A more detailed description of the MA program payment system can be found at payment-basics/medpac_payment_basics_18_ma_final_ sec.pdf?sfvrsn=0.) MA plan enrollment continued to grow faster than total Medicare beneficiary growth in 2018 Between November 2017 and November 2018, enrollment in MA plans grew by 8 percent—or 1.6 million enrollees—to 20.5 million enrollees (compared with 5 percent growth in the same period for the total Medicare population, and about 3 percent growth in FFS enrollment). During this period, MA enrollment rose from 32 percent to 33 percent of all Medicare beneficiaries (Table 13-1). The Commission’s previous work suggests that, although many beneficiaries enroll in MA immediately upon becoming eligible, most MA enrollees initially enroll in FFS Medicare and subsequently move to MA. For more on enrollment patterns, see our March 2015 report (Medicare Payment Advisory Commission 2015). Among plan types, although enrollment grew more slowly in HMOs (7 percent) than in local PPOs (16 percent), HMOs continued to enroll the most beneficiaries (13.1 million) in 2018, with 21 percent of all Medicare beneficiaries in HMOs. Between 2017 and 2018, enrollment in regional PPOs stayed about level. At the same time, PFFS enrollment dropped by 21 percent as more efficient HMOs and PPOs have captured some PFFS enrollment (Table 13-1). In 2018, SNP enrollment grew by 13 percent, and employer group enrollment grew by 12 percent. Enrollment patterns differ in urban and rural areas. Over a third of urban beneficiaries are enrolled in MA compared with less than a quarter of beneficiaries residing in rural counties. In 2018, about 35 percent of rural MA enrollees were in HMO plans compared with about 70 percent of urban enrollees (not shown in Table 13-1). By contrast, 3 percent of rural enrollees were in PFFS plans compared with less than 1 percent of urban enrollees. Report to the Congress: Medicare Payment Policy  |  March 2019 351 ...
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  • Fall '19
  • preferred provider organization, Health maintenance organization, MA plan enrollment

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