New Avalere Analysis Shows that Medicare Advantage Market Will Remain Strong, Despite ACA's Payment Cuts

New Avalere Analysis Shows that Medicare Advantage Market Will Remain Strong, Despite ACA's Payment Cuts

Contact: Erica Garland, 202-745-5119, egarland@gymr.com

10.02.12

Washington D.C. - A new analysis by Avalere Health shows the number of Medicare Advantage (MA) plans available in 2013 will increase by 7 percent, from 2,430 in 2012 to 2,600 in 2013. Local health maintenance organizations (HMOs), local preferred provider organizations (PPOs), and regional PPO plan offerings will increase in 2013, as well. The number of local HMOs will also increase by 7 percent from 1,510 to 1,613 while the number of local PPOs will increase by 16 percent from 553 to 640.

In addition, the special needs plan (SNP) market—which focuses on beneficiaries with specialized needs—will expand significantly, with the number of SNPs offered in 2013 increasing by 15 percent (from 486 in 2012 to 561 in 2013). Dual-eligible SNPs (D-SNPs) remain the most numerous SNP type; however, the number of D-SNPs will decrease by 9 percent from 311 in 2012 to 284 in 2013. The number of chronic or disabling condition SNPs (C-SNPs) will nearly double from 110 in 2012 to 210 in 2013.

MA benefits also appear to remain fairly stable going into 2013. On average, monthly MA premiums will increase by only $1.47 (a 5 percent increase) to $32.59 in 2013. MA plans project that enrollment will increase by 11 percent, totaling approximately 15 million MA enrollees in 2013.

"Seniors are looking for predictability and stability in medical expenses," said Dan Mendelson, founder and CEO of Avalere Health. "With premiums going up only 5 percent and more plans available, we are seeing a recipe of growth in the MA market."

The Affordable Care Act (ACA) included significant payment cuts for MA plans by more closely aligning payment to local fee-for-service spending levels, with the cuts phased in over two-six years, depending on the locale. The administration has moderated these payment cuts with quality bonus payments for high-performing plans in recent years. On balance, the result has been a stable market for 2013, and health plans are reacting accordingly.

Avalere Health is an advisory services company whose core purpose is to create innovative solutions to complex healthcare problems. Based in Washington DC, the firm delivers research, analysis, insight, and strategy for leaders in healthcare business and policy. Avalere's experts span 170 staff drawn from the federal government (e.g., CMS, OMB, CBO, and the Congress), Fortune 500 healthcare companies, top consultancies, and nonprofits. The firm offers deep substance in areas ranging from healthcare coverage and financing to the changing role of evidence in healthcare decision-making. Its focus on strategy is supported by a rigorous, in-house analytic research group that uses public and private data to generate quantitative insight. Through events, publications, and interactive programs, Avalere also translates real-time healthcare developments into actionable information.

Learn more at www.avalerehealth.net.

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