Health Policy Center
By the Numbers
As of 2021, more than 42% of the eligible Medicare population (27 million+ older Americans and individuals with disabilities) have made the choice to enroll in a Medicare Advantage plan. Use the interactive maps below for a closer look at the Medicare population in your state or district.
About Medicare Advantage
For over 20 years, the Medicare Advantage (MA) program has been integral to the Medicare guarantee, offering choices and meeting the comprehensive healthcare needs of American seniors. Under this public-private partnership, plans must cover the same services as fee-for-service Medicare. The savings generated through care coordination are reinvested into lowering beneficiaries’ premiums and out-of-pocket costs and providing supplemental benefits such as dental, vision, hearing, meals, and transportation.
Budget Cut Impact
The following map displays the potential impact of various proposed policy scenarios on Medicare Advantage beneficiaries. Use the ‘Policy Scenario’ filter to understand how a specific policy proposal could directly impact a selected state or district.
Budget Cut Impact
The following outlines the potential impact of a proposed policy scenario on Medicare Advantage beneficiaries in the selected state or district.
View by State and District
Select Policy Scenario Impact:
Policy Scenario
Would increase the Centers for Medicare & Medicaid Services (CMS) coding intensity adjustment from the statutory minimum of 5.9% to 7.0%. Federal law currently requires CMS to apply an across-the-board reduction to Medicare Advantage (MA) plan payments that is intended to reflect the difference in coding intensity between MA and Traditional Medicare. The adjustment is applied as a reduction to MA risk scores and reduces plan payment.
Certain counties with both low fee-for-service spending and historically high Medicare Advantage enrollment are designated as "double bonus counties." The quality bonuses applied to benchmarks in those counties are twice as high as in other counties. This policy would lower Stars quality bonus payments for qualifying plans in those counties from 10% to 5%. Qualifying plans are those that have composite quality scores with at least 4 out of 5 stars.
Would reduce Medicare Advantage (MA) benchmarks 2% across-the-board. Applies an across-the-board cut to the existing MA benchmarks.
Would remove the quartile adjustment to county fee-for-service (FFS) rates and instead use an average of the county and national FFS spend as recommended by MedPAC. Currently, the Centers for Medicare & Medicaid Services establishes county-level benchmarks and assigns those benchmarks quartile categories based on relative levels of spend. This quartile system is intended to increase the benchmarks in areas with historically low FFS costs and to achieve savings from areas with high FFS costs. For example, county benchmarks are 95%, 100%, 107.5% or 115% of projected county FFS costs, with the 25% of counties with the highest FFS costs assigned the lowest percentage (95%) and the 25% of counties with lowest FFS costs assigned the highest percentage (115%).
In their June 2021 Report to Congress, MedPAC included a number of Medicare Advantage benchmark policy recommendations. The Commission’s recommendations are as follows:
- Eliminate the quartile adjustment and replace with blended local/national benchmark
- Calculate benchmarks for Part A and Part B fee-for-service (FFS) population
- Eliminate benchmark cap
- Reduce benchmarks 2% across-the-board
- Use geographic markets (not county) to calculate the benchmarks
- Apply 75% rebate percentage
Would remove the quartile adjustment to county fee-for-service (FFS) rates and instead use an average of the county and national FFS spend as recommended by MedPAC. Currently, the Centers for Medicare & Medicaid Services establishes county-level benchmarks and assigns those benchmarks quartile categories based on relative levels of spend. This quartile system is intended to increase the benchmarks in areas with historically low FFS costs and to achieve savings from areas with high FFS costs. For example, county benchmarks are 95%, 100%, 107.5% or 115% of projected county FFS costs, with the 25% of counties with the highest FFS costs assigned the lowest percentage (95%) and the 25% of counties with lowest FFS costs assigned the highest percentage (115%).
Would also eliminate double quality bonus payments. Certain counties with both low fee-for-service spending and historically high Medicare Advantage enrollment are designated as "double bonus counties." The quality bonuses applied to benchmarks in those counties are twice as high as in other counties. This policy would lower Stars quality bonus payments for qualifying plans in those counties from 10% to 5%. Qualifying plans are those that have composite quality scores with at least 4 out of 5 stars.
Would remove the quartile adjustment to county fee-for-service (FFS) rates and instead use an average of the county and national FFS spend as recommended by MedPAC. Currently, the Centers for Medicare & Medicaid Services establishes county-level benchmarks and assigns those benchmarks quartile categories based on relative levels of spend. This quartile system is intended to increase the benchmarks in areas with historically low FFS costs and to achieve savings from areas with high FFS costs. For example, county benchmarks are 95%, 100%, 107.5% or 115% of projected county FFS costs, with the 25% of counties with the highest FFS costs assigned the lowest percentage (95%) and the 25% of counties with lowest FFS costs assigned the highest percentage (115%).
Would also reduce Medicare Advantage (MA) benchmarks 2% across-the-board. Applies an across-the-board cut to the existing MA benchmarks.
Select Policy Scenario Impact:
Policy Scenario
Would increase the Centers for Medicare & Medicaid Services (CMS) coding intensity adjustment from the statutory minimum of 5.9% to 7.0%. Federal law currently requires CMS to apply an across-the-board reduction to Medicare Advantage (MA) plan payments that is intended to reflect the difference in coding intensity between MA and Traditional Medicare. The adjustment is applied as a reduction to MA risk scores and reduces plan payment.
Certain counties with both low fee-for-service spending and historically high Medicare Advantage enrollment are designated as "double bonus counties." The quality bonuses applied to benchmarks in those counties are twice as high as in other counties. This policy would lower Stars quality bonus payments for qualifying plans in those counties from 10% to 5%. Qualifying plans are those that have composite quality scores with at least 4 out of 5 stars.
Would reduce Medicare Advantage (MA) benchmarks 2% across-the-board. Applies an across-the-board cut to the existing MA benchmarks.
In their June 2021 Report to Congress, MedPAC included a number of Medicare Advantage benchmark policy recommendations. The Commission’s recommendations are as follows:
- Eliminate the quartile adjustment and replace with blended local/national benchmark
- Calculate benchmarks for Part A and Part B fee-for-service (FFS) population
- Eliminate benchmark cap
- Reduce benchmarks 2% across-the-board
- Use geographic markets (not county) to calculate the benchmarks
- Apply 75% rebate percentage
Would remove the quartile adjustment to county fee-for-service (FFS) rates and instead use an average of the county and national FFS spend as recommended by MedPAC. Currently, the Centers for Medicare & Medicaid Services establishes county-level benchmarks and assigns those benchmarks quartile categories based on relative levels of spend. This quartile system is intended to increase the benchmarks in areas with historically low FFS costs and to achieve savings from areas with high FFS costs. For example, county benchmarks are 95%, 100%, 107.5% or 115% of projected county FFS costs, with the 25% of counties with the highest FFS costs assigned the lowest percentage (95%) and the 25% of counties with lowest FFS costs assigned the highest percentage (115%).
Would remove the quartile adjustment to county fee-for-service (FFS) rates and instead use an average of the county and national FFS spend as recommended by MedPAC. Currently, the Centers for Medicare & Medicaid Services establishes county-level benchmarks and assigns those benchmarks quartile categories based on relative levels of spend. This quartile system is intended to increase the benchmarks in areas with historically low FFS costs and to achieve savings from areas with high FFS costs. For example, county benchmarks are 95%, 100%, 107.5% or 115% of projected county FFS costs, with the 25% of counties with the highest FFS costs assigned the lowest percentage (95%) and the 25% of counties with lowest FFS costs assigned the highest percentage (115%).
Would also eliminate double quality bonus payments. Certain counties with both low fee-for-service spending and historically high Medicare Advantage enrollment are designated as "double bonus counties." The quality bonuses applied to benchmarks in those counties are twice as high as in other counties. This policy would lower Stars quality bonus payments for qualifying plans in those counties from 10% to 5%. Qualifying plans are those that have composite quality scores with at least 4 out of 5 stars.
Would remove the quartile adjustment to county fee-for-service (FFS) rates and instead use an average of the county and national FFS spend as recommended by MedPAC. Currently, the Centers for Medicare & Medicaid Services establishes county-level benchmarks and assigns those benchmarks quartile categories based on relative levels of spend. This quartile system is intended to increase the benchmarks in areas with historically low FFS costs and to achieve savings from areas with high FFS costs. For example, county benchmarks are 95%, 100%, 107.5% or 115% of projected county FFS costs, with the 25% of counties with the highest FFS costs assigned the lowest percentage (95%) and the 25% of counties with lowest FFS costs assigned the highest percentage (115%).
Would also reduce Medicare Advantage (MA) benchmarks 2% across-the-board. Applies an across-the-board cut to the existing MA benchmarks.
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TOPIC: LOREM IPSUM
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TOPIC: LOREM IPSUM
Notes
*Estimates based on Humana analysis of proposed policy scenarios on Medicare Advantage (MA) beneficiaries.
†Impacts estimated for a MA beneficiary of average age and health status. Assumes all plans bid below the benchmark and generate a rebate, providing additional benefits to MA beneficiaries.
‡Based on July 2020 CMS Individual MA plan-county enrollment, 2020 MA benchmarks, Bonus Year 2020 Star Ratings, and U.S. Department of Housing and Urban Development (HUD) USPS zip code crosswalk files.
**Dollar impacts estimated by calculating revised benchmarks based on the policy scenario selected, comparing to current benchmarks and adjusting by the average rebate percentage.
††Beneficiary impacts determined using allocation of 2020 national average rebate dollar by category (e.g. cost sharing, non-Medicare-covered supplemental benefits, etc.) published in MedPAC March 2021 Report to Congress.
Sources
Centers for Medicare & Medicaid Services. Medicare Advantage ratebook and Prescription Drug rate information. 2020. Baltimore, MD: Centers for Medicare & Medicaid Services, 2020. Accessed October 7, 2020.
https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Ratebooks-and-Supporting-Data-Items/2020Rates
Centers for Medicare & Medicaid Services. Monthly Enrollment by Contract/Plan/State/County. July 2020. Baltimore, MD: Centers for Medicare & Medicaid Services, 2020. Accessed October 7, 2020.
https://www.cms.gov/research-statistics-data-and-systemsstatistics-trends-and-reportsmcradvpartdenroldatamonthly/monthly-enrollment-cpsc-2020-07
Centers for Medicare & Medicaid Services. Part C and D Performance Data. 2019 Star Ratings Spring Release. Baltimore, MD: Centers for Medicare & Medicaid Services, 2019. Accessed October 7, 2020.
https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData
Medicare Payment Advisory Commission. Report to the Congress: Medicare Payment Policy. Washington, DC: MedPAC, March 2021, 367. Accessed September 13, 2021.
https://www.medpac.gov/document/march-2021-report-to-the-congress-medicare-payment-policy/
U.S. Department of Housing and Urban Development's Office of Policy Development and Research. HUD-USPS ZIP Crosswalk Files. Third Quarter 2020. Washington, DC: U.S Department of Housing and Urban Development, 2020. Accessed August 31, 2021.
https://www.huduser.gov/portal/datasets/usps_crosswalk.html
Notes
*Estimates based on Humana analysis of proposed policy scenarios on Medicare Advantage (MA) beneficiaries.
†Impacts estimated for a MA beneficiary of average age and health status. Assumes all plans bid below the benchmark and generate a rebate, providing additional benefits to MA beneficiaries.
‡Based on July 2020 CMS Individual MA plan-county enrollment, 2020 MA benchmarks, Bonus Year 2020 Star Ratings, and U.S. Department of Housing and Urban Development (HUD) USPS zip code crosswalk files.
**Dollar impacts estimated by calculating revised benchmarks based on the policy scenario selected, comparing to current benchmarks and adjusting by the average rebate percentage.
††Beneficiary impacts determined using allocation of 2020 national average rebate dollar by category (e.g. cost sharing, non-Medicare-covered supplemental benefits, etc.) published in MedPAC March 2021 Report to Congress.
Sources
Centers for Medicare & Medicaid Services (CMS). Medicare Advantage ratebook and Prescription Drug rate information. 2020. Baltimore, MD: Centers for Medicare & Medicaid Services, 2020. Accessed October 7, 2020.
https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Ratebooks-and-Supporting-Data-Items/2020Rates
CMS. Monthly Enrollment by Contract/Plan/State/County. July 2020. Baltimore, MD: Centers for Medicare & Medicaid Services, 2020. Accessed October 7, 2020.
https://www.cms.gov/research-statistics-data-and-systemsstatistics-trends-and-reportsmcradvpartdenroldatamonthly/monthly-enrollment-cpsc-2020-07
CMS. Part C and D Performance Data. 2019 Star Ratings Spring Release. Baltimore, MD: Centers for Medicare & Medicaid Services, 2019. Accessed October 7, 2020.
https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData
Medicare Payment Advisory Commission. Report to the Congress: Medicare Payment Policy. Washington, DC: MedPAC, March 2021, 367. Accessed September 13, 2021.
https://www.medpac.gov/document/march-2021-report-to-the-congress-medicare-payment-policy/
U.S. Department of Housing and Urban Development's Office of Policy Development and Research. HUD-USPS ZIP Crosswalk Files. Third Quarter 2020. Washington, DC: U.S Department of Housing and Urban Development, 2020. Accessed August 31, 2021.
https://www.huduser.gov/portal/datasets/usps_crosswalk.html