Summary pdf format of medsup2013-summary.pdf

Medicare Membership by plan by county:

Total Medicare Supplement Plans pdf format of medsup2013p3.pdf
Total Medicare HMO and Medicare Advantage Plans pdf format of medsup2013p4.pdf
Total Medicare Stand-Alone Prescription Drug Plans pdf format of medsup2013p5.pdf

Membership according to prescription drug coverage:

Total Medicare Plans - Difference Between 2012 and 2013 pdf format of medsup2013p6.pdf
Total Medicare Plans - Group and Individual Members pdf format of medsup2013p2.pdf
Total Medicare Supplement Plans - Group and Individual Members pdf format of medsup2013p7.pdf
Total Medicare Supplement Plans - Group Members pdf format of medsup2013p8.pdf
Total Medicare Supplement Plans - Individual Members pdf format of medsup2013p9.pdf
Total Medicare HMO and Medicare Advantage Plans - Group and Individual Members pdf format of medsup2013p10.pdf
Total Medicare HMO and Medicare Advantage Plans - Group Members pdf format of medsup2013p10.pdf
Total Medicare HMO and Medicare Advantage Plans - Individual Members pdf format of medsup2013p10.pdf

Total Membership by county and prescription drug coverage:

Total Medicare Plans pdf format of medsup2013p1.pdf
  
Total Medicare Supplement Plans - Members 65 Years Old or Older pdf format of medsup2013p11.pdf
Total Medicare Supplement Plans - Members Less Than 65 Years Old pdf format of medsup2013p12.pdf
Total Medicare HMO and Medicare Advantage Plans - Members 65 Years Old or Older pdf format of medsup2013p13.pdf
 
Total Medicare HMO and Medicare Advantage Plans - Members Less Than 65 Years Old pdf format of medsup2013p14.pdf
  
Total Medicare Stand-Alone Prescription Drug Plans - Members 65 Years Old or Older pdf format of medsup2013p15.pdf
  
Total Medicare Stand-Alone Prescription Drug Plans - Members Less Than 65 Years Old  pdf format of medsup2013p16.pdf
  

Introduction

The Division of Insurance ("Division") and the MassHealth Program provide the Legislature with a report regarding the number of seniors who do not have any outpatient prescription drug coverage. In order to collect a comprehensive set of statistics, the Division of Insurance requested that all Medicare Supplement insurance carriers, Medicare Health Maintenance Organizations ("HMOs"), Medicare Advantage Plans, and Medicare Stand-Alone Prescription Drug Plans submit a detailed report to the Division regarding their Medicare membership as of the end of the prior calendar year.


What are Medicare Supplement, Medicare HMO, Medicare Advantage, and Medicare Stand-Alone Prescription Drug Plans?

A Medicare Supplement plan (also known as a Medigap plan) is specifically designed to supplement Medicare benefits. Medicare Supplement plans may pay for costs that Medicare does not cover, including deductibles and coinsurance amounts, and may pay for some services not covered by Medicare. However, Medicare Supplement plans do not cover all the gaps in Medicare coverage.


With the passage of M.G.L. c. 176K, Medicare products offered in Massachusetts on or after January 1, 1995 to individuals, are required to be offered according to the provisions of 211 CMR 71.00. Carriers offering Medicare Supplement plans are allowed to offer the following two products:

  • Medicare Supplement Core (Medicare coinsurance and other benefits);
  • Medicare Supplement 1 (Core product plus Medicare deductibles and other benefits)

    [Due to provisions in the federal Medicare Prescription Drug Improvement and Modernization Act of 2003, Medicare Supplement 2 Plans are no longer available for offer as of January 1, 2006.]


    All Medicare Supplement insurers must sell the Medicare Supplement Core and may also sell the Medicare Supplement 1 plan in the market.


    A Medicare Health Maintenance Organization (HMO) or Medicare Advantage plan is offered by a Health Maintenance Organization or an insurance carrier usually based on a contract that the HMO or insurance carrier has with Medicare. These Medicare HMO and Medicare Advantage plans provide Medicare benefits, cover the Medicare deductible and coinsurance amounts, and may cover other services (including benefits you cannot get through a Medigap plan), while charging limited copayments for certain benefits covered by the plan. The federal government approves and monitors the HMOs and insurance carriers that offer plans for people with Medicare and there are state laws and regulations that apply to these products.


    Although all Medicare HMO plans offered unlimited prescription drug coverage from January 1, 1995 through December 31, 1998, those with Medicare+Choice contracts began to limit prescription drug coverage beginning on January 1, 1999 due to provisions in the federal Balanced Budget Act of 1997. Some of these Medicare+Choice HMOs offered need-based pharmacy assistance programs in 1999, but did not continue them in 2000.

    A Medicare Stand-Alone Prescription Drug plan (also known as a Part D plan) is insurance that covers both brand-name and generic prescription drugs and is offered by a designated organization based on a contract they have with Medicare. These Medicare Stand-Alone Prescription Drug plans were established on January 1, 2006, at which time everyone with Medicare, regardless of income, health status, or prescription drug usage, was given access to prescription drug coverage. These Medicare Stand-Alone Prescription Drug plans generally include cost-sharing in the form of a yearly deductible (between $0 and $325 in 2013 and a copayment or coinsurance for each prescription.

    Some Medicare Stand-Alone Prescription Drug plans include a coverage gap. Once prescription drug costs reach an initial coverage limit, then the member pays 100% of the prescription costs until they reach a certain dollar amount. This "gap" in coverage is generally above ($2,970 in 2013) in total drug costs until the member spends  $4,750 out-of-pocket. Other Medicare Stand-Alone Prescription Drug plans offer some coverage during the gap.  In addition, in 2013, the Patient Protection and Affordable Care Act provided for a 52.5% discount on brand-name prescription drugs, as well as a 21% discount on generic drugs for those members that had reached the coverage gap.


    The next section of this guide describes the types of plans available in the market in 2012 and what is included in the categorical headings used in the accompanying membership charts.


    Types of Medicare Supplement, Medicare HMO, Medicare Advantage, and Medicare Stand-Alone Prescription Drug Plans

    Medicare Supplement Plans:

    Group - policyholders enrolled with a carrier's Medicare Supplement Plan through an employer, labor organization or trustees of a fund established by one or more employers or labor organizations, or combination thereof, for employees, former employees or a combination thereof paying premiums to the carrier to cover members of the group. This does not include those enrolling through an association or trust. Individual - policyholders enrolled in a carrier's Medicare Supplement Plan either by purchasing insurance directly from a carrier and, for the purposes of this report, does include those enrolling through an association or trust (e.g. the American Association of Retired Persons). Statistics for this category are separated into three areas depending on when the policy was purchased. Pre-Standardized - individual Medicare Supplement Policies issued on or prior to July 30, 1992. Standardized - individual Medicare Supplement Policies issued between July 31, 1992 and December 31, 1994. Post 12/31/94 - individual Medicare Supplement Policies issued on or after January 1, 1995. This category is differentiated by the three products allowed to be offered in Massachusetts after January 1, 1995. Core. Med Supp 1 - Medicare Supplement 1 Plan Med Supp 2 - Medicare Supplement 2 Plan

    Medicare HMO and Medicare Advantage Plans:

    Group - policyholders enrolled with the carrier's Medicare HMO or Medicare Advantage Plan through an employer, labor organization or trustees of a fund established by one or more employers or labor organizations, or combination thereof, for employees, former employees or a combination thereof paying premiums to the carrier to cover eligible members of the group. This does not include those enrolling through an association or trust that are reported as individual plan members.

    Medicare Advantage – a contract with the federal Centers for Medicare and Medicaid Services that provides reimbursement to an HMO or insurance carrier based on the number of members enrolled in the plan each month. The Medicare Advantage ("MA") plans provide all Medicare-covered benefits under Part A and Part B and serve as an alternative to traditional Medicare fee-for-service. Medicare Advantage HMO-based plans offer a lower cost alternative to the fee-for-service plans with the condition that members seek services from network providers.

    Med-Wrap - an HMO product providing supplemental coverage for the costs of HMO-provided services not reimbursed by Medicare.

    Individual - policyholders enrolled in a carrier's Medicare HMO or Medicare Advantage Plan either by purchasing insurance directly from a carrier or, for the purposes of this report, enrolling through an association or trust.

    Medicare Advantage - a contract with the federal Centers for Medicare and Medicaid Services that provides reimbursement to an HMO or insurance carrier based on the number of members enrolled in the plan each month. The Medicare Advantage ("MA") plans provide all Medicare-covered benefits under Part A and Part B and serve as an alternative to traditional Medicare fee-for-service. Medicare Advantage HMO-based plans offer a lower cost alternative to the fee-for-service plans with the condition that members seek services from network providers.

    Med-Wrap - an HMO product providing supplemental coverage for the costs of HMO-provided services not reimbursed by Medicare. This statistic reflects those individuals who were issued a certificate of coverage prior to July 31, 1992.

     

    Medicare Stand-Alone Prescription Drug Plans:

    A. Group - Massachusetts residents enrolled with the organization's Medicare Stand-Alone Prescription Drug Plan through an employer, labor organization or trustees of a fund established by one or more employers or labor organizations, or combination thereof, for employees, former employees or a combination thereof to cover eligible members of the group. This does not include those enrolling through an association or trust.

    B. Individual - Massachusetts residents enrolled in the organization's Medicare Stand-Alone Prescription Drug Plan either by purchasing the plan directly from the organization or through an association or trust.

    IV. Questions
    The report of Massachusetts Membership in Medicare Supplement Plans, Medicare HMO Plans, Medicare Advantage Plans, and Medicare Stand-Alone Prescription Drug Plans as of December 31, 2013 was developed by the Health Care Access Bureau of the Division of Insurance with the assistance of the MassHealth Program and the Executive Office of Elder Affairs. All questions regarding this report or its contents should be directed to  Niels Puetthoff, Research Analyst, at (617) 521- 7326.