Table 1.
Medicare+Choice HMO Market Penetration, Overall HMO Penetration, and Medicare Payment Rates in Twelve Urban Communities
| Medicare HMO Penetration (%)1 | Overall HMO Penetration (%) | Medicare Payment Rate ($)2 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Markets by Level of Medicare HMO Penetration | 1996 | 1998 | 20011 | 1996 | 1998 | 2000 | 1996 | 1998 | 2000 | 2002 |
| High penetration3 | ||||||||||
| Orange County4 | 41.7% | 43.1% | 42.1% | 40.5% | 45.3% | 47.1% | $545 | $584 | $610 | $640 |
| Phoenix | 38.1 | 43.4 | 43.8 | 33.1 | 34.2 | 34.7 | 472 | 499 | 524 | 553 |
| Miami | 37.2 | 43.4 | 45.7 | 52.9 | 61.1 | 43.8 | 687 | 763 | 794 | 834 |
| Moderate penetration3 | ||||||||||
| Seattle | 30.5% | 33.4% | 26.3% | 20.8% | 25.9% | 19.2% | $410 | $437 | $483 | $553 |
| Boston | 15.5 | 23.0 | 22.0 | 36.9 | 47.7 | 43.1 | 532 | 581 | 604 | 635 |
| Cleveland | 11.6 | 22.2 | 19.3 | 19.8 | 28.9 | 30.6 | 516 | 553 | 576 | 605 |
| Limited penetration3 | ||||||||||
| Lansing | 8.7% | 12.1% | 12.3% | 39.5% | 41.1% | 33.4% | $477 | $500 | $520 | $553 |
| Little Rock | 4.6 | 9.9 | 8.7 | 18.1 | 26.2 | 21.7 | 444 | 477 | 498 | 553 |
| Northern New Jersey | 4.1 | 10.0 | 8.5 | 21.1 | 23.9 | 31.5 | 518 | 554 | 579 | 608 |
| Minimal penetration3 | ||||||||||
| Indianapolis | 4.0% | 6.2% | 5.0% | 20.2% | 24.4% | 21.9% | $456 | $486 | $506 | $553 |
| Greenville | 0.2 | 0 | 0 | 5.6 | 11.1 | 11.2 | 327 | 367 | 405 | 553 |
| Syracuse | 0 | 1.1 | 0 | 18.0 | 19.4 | 15.5 | 368 | 375 | 418 | 553 |
| NATIONAL AVERAGE | 11.0% | 16.1% | 14.9% | 24.0% | 29.2% | 28.1% | $436 | $468 | $500 | $570 |
Data are December for 1996 and 1998 and March for 2001. Enrollment is Coordinated Care Plans (CCP) unless otherwise noted.
Payment rate for largest county in Metropolitan Statistical Area. National data represent national per capita spending on enrollees in CCP; figures are for the month December for 1996–2000 and January for 2002.
High- and moderate-penetration markets have enrollment; above the national average limited and minimal below average.
Medicare HMO penetration includes cost and demonstration plans with at least 1,000 beneficiaries. In Indianapolis, one cost plan has most of the enrollment.
Source: Based on data from the Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration) and the Interstudy Competitive Edge 7.1, 9.1, 11.1.