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Median Medicare Advantage out-of-pocket max to rise 3.5%

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A closer look at the government’s 2016 Medicare Advantage plan spreadsheet data hints at how insurers are using increases in enrollee out-of-pocket costs to help hold the monthly premiums down.

The Centers for Medicare & Medicaid Services (CMS) has squeezed government support for private Medicare plan issuers in recent years in an effort to close what government analysts believe to be a troubling gap between what the government spends on traditional Medicare enrollees and what it spends on Medicare Advantage plan enrollees.

CMS officials say insurers have found ways to keep the enrollees’ monthly premiums low. This year, when they released the plan data for the 2016 open enrollment period, which is set to start Oct. 15 and run until Dec. 7, they announced that 95 percent of Medicare enrollees will have access to a “zero-premium” plan option.

See also: Medicare Advantage plan count rises

A LifeHealthPro analysis suggests that the number of zero-premium plans will increase about 2 percent, to 9,751 of the 34,930 ordinary plan options, and the number with a monthly premium of $100 or less will increase 2.9 percent, to 27,238.

The spreadsheet also gives an in-network out-of-pocket (OOP) annual spending maximum for most of the plan options. The in-network OOP maximum caps the amount a plan issuer expects an enrollee to spend on deductibles, co-payments, coinsurance amounts and other amounts for in-network medically necessary care.

An analysis of the OOP data shows that the median OOP maximum for a Medicare Advantage plan will increase 3.5 percent this year, to $5,800.

The highest annual OOP spending caps are set at $6,700 for this year and will again be set at $6,700 in 2016.

The number of plan options with $6,700 OOP maximums will increase 16 percent, to 12,800.

About 40 percent of the plans that have annual OOP maximum information in the 2016 plan spreadsheet will have $6,700 annual OOP maximums. The share of plans with OOP maximums at the $6,700 level will be increasing from 36 percent this year.

See also: GAO: Medicare Advantage Carriers Picked Cherries


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