Kaiser Permanente’s H0524-003 Top MA Plan in 2022

August 15, 2022

As Medicare Advantage (MA) plans and the Centers for Medicare & Medicaid Services (CMS) prepare for the upcoming Annual Election Period (AEP), which begins on October 15, 2022, Mark Farrah Associates (MFA) took a closer look at the top plan in the United States in terms of membership and what attributes may have led to its success in 2022. Kaiser Permanente’s Senior Advantage Los Angeles (LA) and Orange counties plan, a Medicare Advantage (MA) health maintenance organization (HMO) − CMS plan Kaiser Permanente Senior Advantage LA, Orange Co. (HMO), identification number H0524-003 − has once again garnered the top spot nationwide, based on enrollment, for MA plans sold to individuals, without special needs. This local plan has maintained its nationwide top spot in a highly competitive market against other plans offered by Kaiser Permanente and well-established competitors’ brands. In the following brief, MFA posits what makes this plan special using information available in MFA’s Medicare Benefits Analyzer™ and Medicare Business Online™ products.

Los Angeles and Orange counties combined form one of the largest local Medicare markets in the United States, with over 2.1 million people eligible for Medicare. Despite its size, Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) plan’s (KP SALAOP’s) penetration in the area is only 11.5%. CMS reported that KP SALAOP had 241,728 people enrolled in the plan as of July 1, 2022, an increase of 2.2% from December 1, 2021. In comparison to other MA plans in the area, KP SALAOP currently has 28.1% market share, down from 29.0% in December of 2021.

Competitive Landscape

This area is a highly competitive MA market with all the national leaders and several local provider-owned plans participating. There are currently 134 MA plans, offered by 24 different parent organizations, competing for a share of the combined Los Angeles and Orange counties marketplace, up from 114 MA plans, offered by 25 parent organizations, as of December 2021. KP SALAOP is one of the oldest plans in the area. Kaiser Permanente began reporting data for H0524-003 some time prior to 2007; Medicare Advantage plans became known as such in 2003. KP SALAOP is a top-quality MA plan. This contract has earned the highest possible rating of 5 out of 5 stars for the eleventh year in a row (2012 - 2022). However, the company offers nine other plan designs, with minor enrollment, under this same 5-star contract number in Los Angeles and Orange counties. Centene also offers a WellCare contract with a 5-star rating in the area; that plan has modest enrollees, possibly due to its newness to the market.

Plan Benefits

KP SALAOP’s plan design has included a $0 (zero dollar) monthly plan premium; however, between 2021 and 2022, perhaps in recognition of the increased competition, Kaiser Permanente made several changes to KP SALAOP’s benefits in several important area:

• Reducing the maximum out-of-pocket amount, a person pays for Part A and Part B covered services, from $3,400 to $2,900.
• Decreasing doctor office visit copays for primary care visits from $5 to $0 per visit and Specialist visits from $10 per visit to $0 per visit.
• Cutting the cost per admission for inpatient hospital stays from $100 per day for days 1-7 to $0 per admission.
• Lowering the cost sharing during the Initial Coverage Stage (up to a 30-day supply) for Tier 1 and Tier 2 Part D prescription drug coverage from $3 to $0, and $10 to $5, respectively.

These changes likely helped the plan to maintain its market leading position for 2022.

About Medicare Benefits Analyzer

Medicare Benefits Analyzer™ is a time-saving database for easy comparative analysis of Medicare premiums, co-pays and benefits. Benefits and Star Quality Ratings data is collected and organized from the Medicare.gov website and is updated within days the new benefits data is posted by CMS, usually during the first and second weeks of October, with periodic data refreshes. Interactive web tables present Medicare Advantage and PDP benefits, premiums, co-pays, Rx drug tiers & cost estimates by Plan, State & County; Star Quality Ratings data for measuring relative quality of MA & Part D plans; Drug tier costs by state presents standard and preferred cost-sharing by drug tier, purchase type and supply for all MA & Part D plans; Plan Finder profiles by state and plan with screen-shots of benefit details for easy look-up and reference; Medicare Advantage & PDP enrollment figures per plan and current Summary Star Ratings; and User-friendly web interface with easy-to-navigate tables and download to Excel; Medicare Benefits Analyzer™ subscriptions include access to Medicare Business Online™ for the latest MA and PDP enrollment data.

About Mark Farrah Associates (MFA)

Mark Farrah Associates (MFA) is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry.  Our product portfolio includes Health Coverage Portal™, County Health Coverage™, Medicare Business Online™, Medicare Benefits Analyzer™, Health Plans USA™, SHCE and MLR Data and 5500 Employer Health ^plus.  For more information about these products, refer to the informational videos and brochures available under the Our Products section of the website or call 724-338-4100.

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