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2021 AEP
Findings Report

October 24, 2020       Report

With a vast range of Medicare Advantage offerings designed to cater to the masses, developing the right mix of design features and costs is a daunting task for each participating organization. As of October 2020, enrollment in Medicare Advantage plans exceeds 25 million, a 9.3% increase over the 22.9 million (Part C) last year. To meet the needs of the market, the 2021 Annual Enrollment Period (AEP) saw an addition of 563 net new plans in total, a rise of 12.8%. While slightly lower than the 15% increase seen last AEP, a significant increase none the less. This report was developed to highlight the major changes in plan type, cost structures and benefit trends within the Medicare Advantage market as well as demonstrate how the market has evolved over the past 5 years.

The analysis begins with an overview of national level variations for each primary plan type before diving deeper into plan design where we examine beneficiary cost factors and benefit inclusions.

National Overview

  • Florida has introduced the highest number of new plans this year (90) followed by California (48).
  • Texas recorded the highest increment of 60 plans this year, a 25% increase for their state.
  • Texas also overtook Pennsylvania and New York to have the third highest number of MA plans (294).

Medicare Advantage (MA) &
Medicare Advantage Prescription Drug (MAPD) Overview

  • MA plans have shown a remarkable rise in 2021 (19.5%) compared to the historical trend.
  • Florida recorded the highest number of new MAPD plans with 79 followed by California with 47.
  • Florida also introduced the highest number of new MA plans with 11 followed by Illinois with 7.

Special Needs Plans (SNP) Overview

  • Texas registered the highest increase in Dual Special Needs Plans (DSNP), with a net gain of 19, while Florida saw a decrease in this category.
  • With this increase, Texas overtook New York for the second highest DSNP offering total (67), a 39.5% YoY increase for their state.
  • In the Chronic Condition Special Needs Plan (CSNP) category, Florida overtook California to become the state with the most plans being offered (63), a 50% increase YoY.
  • Second only to Florida with new CSNP offerings, California recorded a growth of 7 new plans.
  • Florida also overtook New York in the Institutional Special Needs Plan (ISNP) for the highest numbers of plans offered (20), a 17.6% YoY increase, while California and Texas overtook Pennsylvania with 8 (60% increase) and 7 (40% increase) respectively.

Non-SNP Overview

  • While the number of non-SNP plans available in the market continues to rise YOY, the percentage growth has been trending down since 2018.
  • Florida introduced the highest number of new Non-SNP plans with 57 new plans followed by California with 34 new plans.

HMO vs PPO Overview

  • Local HMO continues to be king both in terms of total share of market offerings and in YoY growth with 327 net new plans this year.
  • Local PPO plans continue to experience a higher relative growth rate vs Local HMO, having more than doubled over the last five years (142%), with a 2021 growth of 22.6%.
  • Florida moved to the third largest Local PPO market with a total of 70 plans, up 29% YoY.
  • Florida also introduced the highest number of Local HMO plans with 73 followed by California with 45.
  • Georgia introduced the highest number of Local PPO plans with 18 followed by Texas and Florida with 16 new Local PPO plans each.
  • Virginia and North Carolina each introduced 1 new Regional PPO plan, a market which has seen little to no growth over the past five years.

Other Plan Type Overview

  • The number of Medicare Cost (Cost), Private Fee for Service (PFFS), Medicare-Medicaid Plans (MMP), and Medicare Medical Savings Account (MSA) plans have each declined compared to last year.
  • Illinois dropped 1 MMP plan (16% reduction) to tie Ohio with 5 total offerings each.
  • Illinois and Arkansas both dropped 1 MSA plan while Indiana and Hawaii each added one plan.
  • Virginia dropped 3 PFFS plans (50% decrease YoY) while New York stayed constant with 4 plans.
  • Wisconsin introduced the highest number of Cost plans with 3 new followed by Kansas with 2 new.
  • There were no new MMP plans introduced this year.

National Premium Overview (Non-SNP Only)

  • Florida introduced the highest number of new $0 premium plans with 64 followed by California with 34.
  • In the >$0 and <=$25 premium range, Florida dropped from 64 to 35 plans, falling to third most in this segment (-45% reduction).
  • Even with the reduction in total plans in the >$0 and <=$25 range, Florida introduced the most new plans (15) in this category followed by California with 7.
  • Florida overtook New York and California as the state with the highest number of plans in the >$25 and <=$50 premium range with 106 total plans (31% YoY growth).
  • In the >$25 and <=$50 premium range, California introduced 20 new plans, the largest increase of any state, followed by Florida with 13.
  • In the >$50 and <=$100 premium range, California led all states with 8 new plans followed by Minnesota and Ohio with 4 new plans each.
  • Lastly, in the >$100 premium range, Nebraska introduced 5 new plans while Illinois added 3, the top two states with the most new plans for this segment.

HMO Premium Overview (Non-SNP Only)

  • Continuing the national trend of pushing towards lower premiums holistically, both segments that include a premium of >$50 showed a decline in total offerings, a consistent reduction over the last two years.
  • In the >$0 and <=$25 premium range, Florida dropped from 62 to 34 plans, falling to third position in the segment.
  • For the segment of plans in the >$25 and <=$50 premium range, Florida became the top state with 98 plans (30% increase), Ohio jumped to fourth with a total of 43 plans (86% increase), while California dropped from 81 to 73, sliding to third.
  • In the >$0 and <=$25 range, California introduced 9 new plans, the most in any state, followed by Nevada with 6.
  • Florida introduced the highest number of new $0 premium HMO plans with 53 followed by California with 32.
  • Florida also introduced the highest number of new plans in the >$25 and <=$50 premium range (20) followed by New York with 10.
  • Virginia, New York and Missouri were the only states to introduce a new plan in the >$100 premium range with 1 each.

PPO Premium Overview

  • Florida introduced the highest number of new $0 premium PPO plans (15) followed by Texas (11).
  • In the >$0 and <=$25 premium range, Oregon dropped from 11 plans to 4, the steepest decline in any state.
  • Georgia become the state with the most offerings in >$25 and <=$50 premium range with 29 plans (45% YoY increase).
  • New York introduced the most number of plans in >$0 and <=$25 premium range (6) followed by Texas (5).
  • In the >$25 and <=$50 range, Georgia introduced the most new plans with 7 followed by New Jersey with 5.

Deductible Overview

  • The only two segments with consistent YoY growth over the past 4 years have been $0 deductible and >$100 deductible plans. All others have seen YoY variability.
  • Zero deductible plans displayed a growth rate of 17%, matching the relative increase in 2020.
  • While plans with over a $100 deductible have also grown, the relative increase was far less than $0 deductible plans, and the slowest growth for this segment over the past 4 years.
  • Florida introduced the highest number of new $0 deductible plans in 2021 with 67 followed by California with 40.
  • New York introduced the most new >$100 deductible plans with 33, followed by Texas with 24.

Maximum Out-of-Pocket (MOOP) Overview

  • While plans in the four lowest MOOP segments have each shown consistent growth over the past 4 years, the growth of plans with >$3000 is significantly higher than the other three.
  • In the >$500 and <=$1500 range, California has introduced the most new plans with 7, followed by Nevada with 4.
  • Florida realized the highest growth in new plans in the >$1500 and <=$3000 range with 15 followed by California with 8.
  • In the over $3000 MOOP segment, Florida led with the highest number of new plans (72) while New York introduced the second highest (41).

Supplemental Benefit Overview

  • All supplemental benefits, except for SNF, saw an increase in the percentage of plans offering the benefits, the first time this widespread increase was noticed over the past 4 years.
  • Eye Exams and Enhanced Benefits (b14c) are the two most common Supplemental Benefits, each present in ~97% of plans in 2021.
  • Emergency, Hearing Exam, Eye Wear and Preventive Dental benefits are the next most common benefits, each offered in over 90% of plans.
  • Both Meals & Over the Counter (OTC) benefits saw a significant increase in coverage, jumping to 56.1% (up from 46.9%) and 77.5% (up from 70%) respectively.

Enhanced Benefit Overview

  • Fitness benefit is now present in over 90% of all plans, for the first time. It has the highest coverage percentage among all Enhance Benefits, a consistent five-year trend.
  • Remote Access Technologies, which saw a steep decline from 2019 (85%) to 2020 (66.8%), has slightly rebounded to 70.4% in 2021.
  • Personal Emergency Response System has grown steadily in the past 4 years and is now present in almost 20% of all plans.
  • Therapeutic Message, initially present in 5.3% of plans last year, reduced to 3.4% in 2021, while In-home Support Service, with initial coverage of 5.1% in 2020, increased to 8.7%.

2021 AEP Findings Report Conclusions

  • While MAPD plans still own the market, MA plans saw a sharper increase this year (19.5%).
  • DSNP continues a steady growth trend while CSNP registered a 40% growth over the last two years.
  • Non-SNP plan growth has followed a consistent five-year trend, increasing 11.5% in 2021.
  • Other than slight YoY variation, all “Other” plan types (excludes HMO & PPO) has declined over the past five years.
  • $0 premium plans continue to have a rapid growth (24.2% in 2021) with a decline in non-$0 premium plans.
  • $0 PPO plans have seen a rapid growth compared to the straight growth of $0 HMO plans.
  • Plans with $0 deductible and those with >$100 deductible have continued to grow over the past five years.
  • Plans with MOOP >$3000 dominate the market and have grown at a steady rate.
  • Except SNF, which had a decrease of 1%, all other supplemental benefits have registered an increase in 2021.
  • Enhanced Benefits continue to gain traction as offerings with Fitness having 90% coverage in 2021 and PERS growing from 3.6% (2017) to 19.8% (2021).

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