By the Division of Insurance
Medicare Membership by plan by county:
Total Medicare Supplement Plans
Total Medicare HMO and Medicare Advantage Plans
Total Medicare Stand-Alone Prescription Drug Plans
Membership according to prescription drug coverage:
Total Medicare Plans - Difference Between 2016 and 2017
Total Medicare Plans - Group and Individual Members
Total Medicare Supplement Plans - Group and Individual Members
Total Medicare Supplement Plans - Group Members
Total Medicare Supplement Plans - Individual Members
Total Medicare HMO and Medicare Advantage Plans - Group and Individual Members
Total Membership by county and prescription drug coverage:
Total Medicare Plans
Total Medicare Supplement Plans - Members 65 Years Old or Older
Total Medicare Supplement Plans - Members Less Than 65 Years Old
Total Medicare HMO and Medicare Advantage Plans - Members 65 Years Old or Older
Total Medicare HMO and Medicare Advantage Plans - Members Less Than 65 Years Old
Total Medicare Stand-Alone Prescription Drug Plans - Members 65 Years Old or Older
Total Medicare Stand-Alone Prescription Drug Plans - Members Less Than 65 Years Old
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. |
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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. |
· Medicare Supplement Core (Medicare coinsurance and other benefits); · Medicare Supplement 1 (Core product plus Medicare deductibles and other benefits) |
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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 $3,700 (in 2017) in total drug costs until the member spends $4950 out-of-pocket. Other Medicare Stand-Alone Prescription Drug plans offer some coverage during the gap. In addition, in 2017, the Patient Protection and Affordable Care Act provided for a 60% discount on brand-name prescription drugs, as well as a 49% discount on generic drugs for those members that had reached the coverage gap. |
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Medicare Supplement Plans: 1. 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. 2. 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. 1. Pre-Standardized - individual Medicare Supplement Policies issued on or prior to July 30, 1992. 2. Standardized - individual Medicare Supplement Policies issued between July 31, 1992 and December 31, 1994. 3. Post 12/31/94 - individual Medicare Supplement Policies issued on or after January 1, 1995. This category is differentiated by the four products allowed to be offered in Massachusetts after January 1, 1995. a. Core. b. Med Supp 1 - Medicare Supplement 1 Plan c. Med Supp 2 - Medicare Supplement 2 Plan d. Select – Plan offered since 2014, currently only offered by Blue Cross Blue Shield of e. Massachusetts HMO Blue, Inc. |
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1. 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. 2. 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. 3. Med-Wrap - an HMO product providing supplemental coverage for the costs of HMO-provided services not reimbursed by Medicare. 4. 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. 5. 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. 6. 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: · · · · |