Doctor concerned with health care law

Breaking news and expert analysis on legal and compliance issues

[Back To Home][Back To Archives]

From Health Law Daily, August 25, 2015

From California to the New York island, this land has little competition in MA plans

By Kathryn S. Beard, J.D.

In the vast majority of the United States, there is little-to-no competition in Medicare Advantage (MA) insurance markets. A new report from the Commonwealth Fund details the lack of significant competition among MA plans and reports considerably lower competition in rural counties than in urban ones. It also found that among the 100 counties with the greatest numbers of Medicare beneficiaries, 81 percent do not have competitive MA markets, and that in nearly two-thirds of those 100 counties, market power is concentrated among three nationwide insurance organizations.

MA program. The MA program, also known as Medicare Part C, is the managed care part of the Medicare program. Private companies contract with CMS to offer similar—or in some cases enhanced—Part A and Part B benefits to beneficiaries compared with traditional fee-for-service (FFS) Medicare benefits. MA plans include health maintenance organizations (HMOs), preferred provider organizations (PPOs), private FFS plans, special needs plans, and medical savings account plans. Allowing private insurers to participate in Medicare was intended to further two goals: (1) expand beneficiaries’ choices to include plans that can offer more-coordinated care and more-comprehensive benefits than those provided through traditional Medicare; and (2) take advantage of the presumed efficiencies of those plans.

MA plan market concentration. The study found that of the 2,933 counties in the U.S. with 10 or more Medicare beneficiaries enrolled in a MA plan, 97 percent—2,852 counties—meet the criterion for highly concentrated markets under the Herfindahl-Hirschman Index (HHI), a standard measure of market concentration. These counties have 77 percent of total MA enrollment; they serve 84 percent of all Medicare beneficiaries nationwide. The criterion for moderately concentrated markets was met in 80 counties, representing 22 percent of MA enrollees and 15 percent of Medicare beneficiaries. Only one county met the criterion for a non-concentrated market—Riverside, California.

MA plan markets are highly concentrated in both urban and rural counties; the report found that although the average HHI score is well above the highly concentrated market criterion in urban counties, rural counties have even more highly concentrated MA plan markets.

Top 100. The report also studied the 100 counties with the largest number of Medicare beneficiaries, which represent 3 percent of all counties, but 47 percent of all MA plan enrollees. It found that although the 100 largest counties generally have a larger number of MA plans than smaller counties, 81 of them have HHI scores that indicate a highly concentrated market and low level of competition. Further, despite the 100 largest counties not being geographically concentrated, six major insurers dominate them in terms of number of beneficiaries enrolled. Across these counties, UnitedHealth is the dominant firm, with the largest number of MA plan enrollees in 38 counties; Blue Cross affiliates, including WellPoint, have the largest MA enrollment in 13 counties; and Humana has the largest enrollment in 12.

No findings on benefits of competition. The study cautioned, “the benefits of competition can be relied on only in markets where the elements of competition exist.” Therefore, its authors presented no opinion on whether expanding the role of private plans would improve Medicare’s ability to serve its beneficiaries, either in terms of the quality or cost of care.

Companies: Commonwealth Fund; UnitedHealth; Blue Cross; WellPoint; Humana

MainStory: TopStory GeneralNews PartCNews QualityNews

Health Law Daily

Introducing Wolters Kluwer Health Law Daily — a daily reporting service created by attorneys, for attorneys — providing same-day coverage of breaking news, court decisions, legislation, and regulatory activity.


A complete daily report of the news that affects your world

  • View full summaries of federal and state court decisions.
  • Access full text of legislative and regulatory developments.
  • Customize your daily email by topic and/or jurisdiction.
  • Search archives for stories of interest.

Not just news — the right news

  • Get expert analysis written by subject matter specialists—created by attorneys for attorneys.
  • Track law firms and organizations in the headlines with our new “Who’s in the News” feature.
  • Promote your firm with our new reprint policy.

24/7 access for a 24/7 world

  • Forward information with special copyright permissions, encouraging collaboration between counsel and colleagues.
  • Save time with mobile apps for your BlackBerry, iPhone, iPad, Android, or Kindle.
  • Access all links from any mobile device without being prompted for user name and password.