2011 AEP Winners and Losers

The 2011 Medicare Advantage and Part D selling season was shorter than ever this year, but it certainly wasn’t any less eventful. We witnessed carriers leaving the market (CIGNA), mergers (Bravo and HealthSpring), CMS sanctions (Aetna, Arcadian, and Universal American), and some very aggressive moves by the largest carriers (Humana and United Healthcare).

So, with all of the maneuvering and the changes, what were the results? Now that the dust has settled, it’s time to take a look back and see what carriers grew enrollment and what carriers saw membership decline.

Part D Membership

Let’s start with Part D plans. According to data released recently by CMS, Part D enrollments grew for the top 20 carriers by 668,000 in 2011, for a total PDP membership of 17.5 million. Roughly 93 percent of the membership in PDP falls under individual plans, and group plans now represent only 7 percent of the top players’ totals. Here is how the top seven PDP carriers performed for the latest selling period:

The seven carriers above represent 75 percent of the market. CVS/Caremark’s pending purchase of Universal American’s PDP business will leapfrog them to more than 3 million members, making CVS/Caremark No. 2 in terms of enrollment. The big winner is no surprise. Humana’s program with Wal-Mart and their low premiums garnered significant gains in terms of enrollments by both agent-sold and auto-assigned dual-eligible business.

The fascinating aspect of the PDP business is how carriers position themselves for the auto-assigned business. Carriers position themselves to be below the benchmark premium in selected states. A miscalculation by an actuary can result in gains or losses of tens of thousands of dual-eligible clients.

Medicare Advantage Membership

For Medicare Advantage business, the industry grew despite a shortened selling season. Membership in MA-PD plans for the top 20 carriers now stands at 8.4 million, up from 8.1 million a year ago. Additional regulation, increased premiums, and co-pays slowed the growth of MA plans, but did not decrease the size of the market. Here’s how the top carriers performed:

With the exception of Aetna, which was under CMS sanctions, the top carriers saw membership growth for Medicare Advantage plans. The big losers in terms of membership were Universal American (down 109,000) and, of course, CIGNA, which exited the PFFS market without a network-based plan.

Perhaps the real winner last year was Medicare Supplement. With the introduction of modernized Med Supp plans, including the popular Plan N, and the service area reductions by MA carriers, Medicare Supplement carriers saw a significant spike in enrollments during the enrollment period.

Looking Ahead …