La Agrupación Espacio y la radicalización de las vanguardias

Companies with fewer than 100 enrollees not shown here. CMS reports do not list enrollment when there are fewer than ten enrollees in a county for a particular health plan. Source: Author’s analysis of CMS State County/Contract/Medicare Advantage Monthly Enrollment report for July 2007.

service members, more than 80 percent of that market statewide in New York (although both HealthNet and WellCare are making inroads as well). Finally, mirroring national trends, enrollment in MA Special Needs Plans (SNPs) has also grown rapidly in New York.

SNPS

Added to the menu of managed care options in the Modernization Act, Medicare Advantage Special Needs Plans were

authorized to provide coordinated care to three special needs populations: 1) dual eligibles; 2) patients and residents of institutions; and 3) the chronically ill. SNPs for Medicare recipients have become a growing subset of the MA program nationally. The number of plans grew from just eleven in 2004 to almost 500 in September 2007, and enrollment nearly doubled to over 1 million beneficiaries between 2006 and 2007.155 In New York State, enrollment grew from 70,000 to 90,000 between 2007 and 2008.156 Nationally, over 70 percent of Medicare Advantage SNP enrollees are dual eligibles, 17 percent suffer from chronic or disabling conditions, and 11 percent are institutionalized.157 In New York, the vast majority of enrollees — nearly 73 percent — are dual eligibles; institutionalized persons account for 26 percent of enrollment, and beneficiaries with chronic conditions, mainly diabetes, make up almost 2 percent.

Five health plans represent more than 90 percent of total SNP enrollment in New York: Managed Health with over 37,000, Elderplan with over 16,000 institutionalized enrollees, UnitedHealth Group with over 10,000, Wellcare with over 8,900, and HIP with over 7,800.

In a spirited national debate over the future of the Medicare Advantage program,

critics charge that MA plans are paid far more than the payments for original Medicare enrollees. Too great a share of health plan rebates goes toward profits rather than toward additional benefits to beneficiaries, they claim, and MA payments are boosting the cost to original Medicare enrollees. Defenders say the program has enhanced benefits and reduced out-of-pocket expenses for enrollees, particularly those in rural areas, and repre- sents a significant improvement over original Medicare. One thing is certain: the MA payment system has been very profitable for plans participating in New York.

New York HMOs alone earned over $400 million in net income from their MA business in 2006. On average, MA revenues represent- ed over 40 percent of net income for all lines of business for HMOs — ranging from a low of 22 percent for Empire, which posted positive results in nearly all product lines in 2006, to over 80 percent for Independent Health.

Medigap

Until the enactment of the Medicare Modernization Act, Medigap or “Med Supp” policies were the only game in town for Medicare beneficiaries wishing to purchase a drug benefit, insurance to cover Medicare cost-sharing for Part A and Part B services, or certain additional benefits not covered by Medicare. Although state insurance regulators refer to it as a “declining block of business,” Medigap policies were purchased by nearly 400,000 New Yorkers in 2007,158despite the introduction of the Part D drug benefit. UnitedHealthcare (through its joint arrange- ment with AARP) and Empire BlueCross BlueShield are two of the leading providers

155 _{Milligan CJ and CH Woodcock. February 2008. Medicare Advantage special needs plans for dual eligibles: A primer.}

New York: The Commonwealth Fund.

156 _{Centers for Medicare & Medicaid Services. July 2007 and July 2008. Special needs plan comprehensive report.} 157 _Ibid.

of Medigap coverage in New York, reporting $19 million and $18 million in net income, respectively, from their Medigap products in 2006.

Within the federally mandated standard- ized benefit packages (designated A through L, and distinguished by different levels and combinations of benefits), state regulators, trade groups, and consumer advocates report that Products B, C, and F are the most popular Med Supp offerings.159 Generally, eight to ten carriers currently offer those three types of policies in various regional markets across the state, at monthly premiums ranging from $127.29 for a Plan B offered by Empire in Albany, to $343 monthly for a State Farm Mutual Auto Plan F purchased in Long Island.160 Plans B, C, and F cover some or all of Medicare Part A coinsurance and Part B co-payments, Part A and Part B deductibles, and, to various degrees, addition- al services such as care in a skilled nursing facility. Premiums paid for coverage are in addition to enrollees’ responsibility for Part B premiums.

Medigap products in New York are community-rated, so premiums are the same for all New York policyholders, regardless of their ages. Some states allow “issue-age rated” policies that allow younger purchasers to lock in lower rates, and policies with automatic increases as policyholders age, known as “attained-age rating.”

Part D

Almost one million New York Medicare beneficiaries are enrolled in stand-alone Part D prescription drug plans (Table 25). Like the Medicare Advantage market, health plans active in New York’s commercial or

159 _{America’s Health Plans, Center for Policy and Research.}

March 2008. Trends in Medigap policies, December 2004 to December 2006 reports that 40 percent of 10 million Medigap enrollment nationally is in Plan F and 20 percent is in Plan C.

160 _{New York State Insurance Department. Rates as of}

January 1, 2008.