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`
`Exhibit 2210
`Page 01 of 14
`
`

`

`12/31/21, 4:43 AM
`
`Medicare Advantage in 2021: Enrollment Update and Key Trends | KFF
`
`Figure 1
`Total Medicare Advantage Enrollment, 2000-2021
`
`Medicare Advantage Enrollment Medicare Advantage Penetration
`
`
`
`
`7M
`
`
`6M 6M 5M 5M 6M
`
`18M
`
`7M
`
`
`
`2000
`
`2002
`
`2004
`
`2006
`
`2008
`
`2010
`
`2012
`
`2014
`
`2016
`
`NOTE:Includescost plans as well as Medicare Advantage plans. About 62.7 million people are enrolled in
`Medicare in 2021
`SOURCE:KFFanalysis of MPR, "Tracking Medicare Health and Prescription Drug Plans: Monthly Report,” KFF
`2000-2005; Medicare Chronic Conditions (CCW) Data Warehousefrom 5 percentof beneficiaries, 2006-
`2017; CCW data from 20 percent of beneficiaries, 2018; and Medicare Enrollment Dashboard 2019-2021.
`
`In 2021, more than four in ten (42%) Medicare beneficiaries - 26.4 million people
`out of 62.7 million Medicare beneficiaries overall - are enrolled in Medicare
`Advantage plans; this share has steadily increased over time since the early 2000s.
`Between 2020 and 2021, total Medicare Advantage enrollment grew by about2.4
`million beneficiaries, or 10 percent - nearly the same growthrate as the prioryear.
`The CongressionalBudgetOffice(https://www,cbo,gow/system/files/2020-03/51302-2020-03-
`medicare.pdf) (CBO) projects that the share of all Medicare beneficiaries enrolled in
`Medicare Advantageplanswill rise to about 51 percent by 2030 (Figure 2)
`
`Exhibit 2210
`
`Page 02 of 14
`https://www. kff.org/medicare/issue-brief/medicare-advantage-in-2021-enrollment-update-and-key-trends/
`
`2/14
`
`Exhibit 2210
`Page 02 of 14
`
`

`

`12/31/21, 4:43 AM
`
`Medicare Advantage in 2021: Enrollment Update and Key Trends | KFF
`
`Figure 2
`Medicare Advantage and Traditional Medicare
`Enrollment, Past and Projected
`
`Medicare Advantage Enrollment
`100%
`
`80
`
`60
`
`40
`
`20
`
`0
`
`Traditional Medicare Enrollment
`
`
`
`2000
`
`2002
`
`2004
`
`2006
`
`2008
`
`2010
`
`2012
`
`2014
`
`2016
`
`2018
`
`2020
`
`2022
`
`20:
`
`SOURCE: KFFanalysis of MPR, "Tracking Medicare Health and Prescription Drug Plans: Monthly Report,"
`2000-2005; Medicare Chronic Conditions (CCW) Data Warehouse from 5 percentof beneficiaries, 2006-
`2017; CCW data from 20 percent of beneficiaries, 2018; and Medicare Enrollment Dashboard 2019-2021.
`Enrollment numbers from Marchof the respective year. Projections for 2022 to 2030 are from the March
`Congressional Budget Office (CBO) Medicare Baseline for 2020. * PNG
`
`In 2021, two-thirds of Medicare Advantage enrollees arein
`individual plans
`
`Exhibit 2210
`
`Page 03 of 14
`https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2021-enrollment-update-and-key-trends/
`
`3/14
`
`Exhibit 2210
`Page 03 of 14
`
`

`

`12/31/21, 4:43 AM
`
`Medicare Advantage in 2021: Enrollment Update and Key Trends | KFF
`
`Figure 3
`Distribution of Medicare Advantage Enrollees by Plan
`Type, 2021
`
`Enrollment, 2021 = 26.4 million
`
`Total Medicare Advantage
`
`NOTE: Numbers may not sum due to rounding.
`
`Two-thirds (67%) of Medicare Advantageenrollees, or 17.7 million people, are
`plans generally available for individual enrollment. That is an increase of 1.6 million
`enrollees comparedto 2020.Individual plans have accounted for approximately
`the sameshare of total Medicare Advantage enrollment since 2014.
`
`Nearly onein five Medicare Advantageenrollees (19%)arein
`group plans offered to retirees by employers and unionsin 2021
`
`Exhibit 2210
`
`Page 04 of 14
`https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2021-enrollment-update-and-key-trends/
`
`4/14
`
`Exhibit 2210
`Page 04 of 14
`
`

`

`12/31/21, 4:43 AM
`
`Medicare Advantage in 2021: Enrollment Update and Key Trends | KFF
`
`Figure 4
`Numberof Beneficiaries in Employer or Union-
`Sponsored Health Plans, 2010-2021
`
`In millions
`
`
`
`2010
`
`2011
`
`2012
`
`2013
`
`2014
`
`2015
`
`2016
`
`2017
`
`2018
`
`201
`
`SOURCE: KFFanalysis of CMS Medicare Advantage EnrollmentFiles, 2010-2021. * PNG
`
`KFF
`
`Nearly 4.9 million Medicare Advantage enrollees are in a group plan offered to
`retirees by an employeror union. While this is roughly the same share of
`enrollment since 2014 (19%), the actual numberhas increased from 1.9 million in
`2010 to 4.9 million in 2021 (Figure 4). With a group plan, an employer or union
`contracts with an insurer and Medicare pays the insurera fixed amountper
`enrollee to provide benefits covered by Medicare. For example, somestates, such
`as Illinois and Pennsylvania, provide health insurance benefits to their Medicare-
`eligible retirees exclusively through Medicare Advantage plans. As with other
`Medicare Advantage plans, employer and union group plansoften provide
`additional benefits and/or lowercost sharing than traditional Medicare. The
`employeror union (and sometimesthe retiree) may also pay an additional
`premium for these supplemental benefits. Group enrollees comprise a
`disproportionately large share of Medicare Advantageenrolleesin eight states:
`Alaska (100%), Michigan (45%), Maryland (39%), WestVirginia (39%), New Jersey
`(37%), Wyoming (35%),Illinois (32%), and Kentucky (31%).
`
`Almost 4 million Medicare beneficiaries are enrolled in Special
`Needs Plans in 2021
`
`Exhibit 2210
`
`Page 05 of 14
`https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2021-enrollment-update-and-key-trends/
`
`6/14
`
`Exhibit 2210
`Page 05 of 14
`
`

`

`12/31/21, 4:43 AM
`
`Medicare Advantage in 2021: Enrollment Update and Key Trends | KFF
`
`Figure 5
`Numberof Beneficiaries in Special Needs Plans, 2010-
`2021
`
`In millions
`
`DualEligible Special Needs Plans (D-SNPs)
`Chronic or Disabling Conditions (C-SNPs)
`
`Institutional (I-SNPs)
`
`2010
`
`2011
`
`2012
`
`2013
`
`2014
`
`2015
`
`2016
`
`2017
`
`2018
`
`20'
`
`NOTE: Numbers maynot sum to the total due to rounding.
`
`KEE
`
`Nearly four million Medicare beneficiaries are enrolled in Special Needs Plans
`(SNPs). SNPsrestrict enrollmentto specific types of beneficiaries with significant or
`relatively specialized care needs, or who qualify becausetheyare eligible for both
`Medicare and Medicaid. The majority of SNP enrollees (88%) are in plans for
`beneficiaries dually eligible for Medicare and Medicaid (D-SNPs). Another 10
`percent of SNP enrollees are in plans for people with severe chronic or disabling
`conditions (C-SNPs) and 2 percentare in plans for beneficiaries requiring a nursing
`home or institutional level of care (I-SNPs).
`
`While D-SNPs are designed specifically for dually-eligible beneficiaries, 1.5 million
`Medicare beneficiaries with Medicaid were enrolled in non-SNP Medicare
`Advantage plans in 2019 (the most recent year for which this data is available).
`
`Enrollment in SNPs increased from 3.3 million beneficiaries in 2020 to 3.8 million
`beneficiaries in 2021 (15% increase), and accounts for about 15% of total Medicare
`Advantage enrollment in 2021, up from 11% in 2010, with somevariation across
`states. In the District of Columbia and Puerto Rico, SNPs comprise abouthalf ofall
`Medicare Advantage enrollees (54% in DC and 47% in PR). In eight states, SNP
`enrollment accounts for about one-fifth of Medicare Advantage enrollment (25% in
`NY, 23% in LA and in MS, 22% in SC and in GA, 21% in AR and in FL, and 20% in TN).
`Nearly 95% of C-SNP enrollees (about 362,000 people)are in plans for people with
`diabetes or cardiovascular conditions in 2021. Enrollmentin I-SNPs has been
`increasing butslightly declined in 2021 and isstill fewer than 100,000.
`
`Exhibit 2210
`
`Page 06 of 14
`https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2021-enrollment-update-and-key-trends/
`
`6/14
`
`Exhibit 2210
`Page 06 of 14
`
`

`

`12/31/21, 4:43 AM
`
`Medicare Advantage in 2021: Enrollment Update and Key Trends | KFF
`
`The share of Medicare beneficiaries in Medicare Advantageplans,
`by state, ranges from 1% to over 50%, and varies substantially
`within states
`
`Medicare Advantage Penetration
`Hl 1% to less than 10%
`[Ij 30% to less than 40%
`Hi 10% toless than 20%=J 40% to less than 50%
`Bi 20% toless than 30%§[§§ 50% or more
`
`eA AIT IVIVMUUIVUIYS TF WwvuUui rmleyy “Tri «#
`shboard, 2021.
`
`20%
`
`20% to less than
`30%
`
`30% to less than
`40%
`
`50% or more
`
`40% to less than
`50%
`
`Exhibit 2210
`
`Page 07 of 14
`https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2021-enrollment-update-and-key-trends/
`
`7/14
`
`Exhibit 2210
`Page 07 of 14
`
`

`

`12/31/21, 4:43 AM
`
`   ÿ ÿ
`
`Medicare Advantage in 2021: Enrollment Update and Key Trends | KFF
`
`
`

`ÿ 
`ÿ
ÿ  ÿ
`ÿ 
`ÿ ÿ
`ÿ
` ÿÿ
`
`The share of Medicare beneficiaries in Medicare Advantageplans varies across the
`country. At least 50 percent of Medicare beneficiaries are enrolled in Medicare
`Advantage plans in twostates (MN, FL) and Puerto Rico. Puerto Rico has the
`highest Medicare Advantage penetration, with 80 percent of Medicare
`beneficiaries enrolled in a Medicare Advantageplan. Additionally, in 24 states, at
`least 40 percent of Medicare beneficiaries are enrolled in Medicare Advantage
`plans (AL, MI, HI, OR, WI, CT, GA, PA, ME, LA, CO, NY, CA, OH, TX, AZ, TN, RI, NC, NV,
`MO,UT, KY, NM). Medicare Advantage enrollmentis relatively low (less than 20
`percent) in four states, Vermont, Maryland, and two mostly rural states whereit is
`virtually non-existent (AK and WY).
`
`Within states, the share of Medicare beneficiaries enrolled in Medicare Advantage
`varies substantially across counties. For example, in Florida, 51% of all Medicare
`beneficiaries in the state are enrolled in Medicare Advantage, and the share by
`county ranges from 16% in Monroe County(Key West) to 73% in Miami-Dade
`County. In Ohio, 45% of all Medicare beneficiaries are enrolled in Medicare
`Advantage, with the share by county ranging from 27% in Mercer County(Celina)
`to 58% in Stark County (Canton). To explore this variation, click on a state on the
`map in Figure 6.
`
`Historically, the majority of Medicare private health plan enrollment in Minnesota
`has been in cost plans, which are not Medicare Advantage plans, but are a type of
`Medicare health coverage that has some of the same rules as Medicare Advantage
`plans, and are offeredin limited areas of the country. However, as of 2019, most
`cost plans in Minnesota are no longer offered and have been replacedwith risk-
`based HMOsand PPOs.In 2021, cost plans represent about 11% of Medicare
`Advantage enrollment in Minnesota.
`
`Nearly three in ten Medicare beneficiaries live in a county where
`morethan half of Medicare beneficiaries in that county are
`enrolled in a Medicare Advantageplan
`
`Exhibit 2210
`
`Page 08 of 14
`https://www.kff.org/medicare/issue-brief/medicare-advantage-in-202 1-enrollment-update-and-key-trends/
`
`!"""#$%%#
`

`
&
`'(

`%
`

`' 
`'
'  '
`
`'& 
`' '$
`'
` 
`
`8/14
`
`)
`
`Exhibit 2210
`Page 08 of 14
`
`

`

`12/31/21, 4:43 AM
`
`Medicare Advantage in 2021: Enrollment Update and Key Trends | KFF
`
`SOURCE: KFFanalysis of Medicare Chronic Conditions (CCW) Data Warehouse from 5 percentof beneficiaries, 20°
`PRPRRRAREoPieReRsares&paddledinneEnekaeatfagehboard 2019-2021. Enrollment numbers from March oft
`Select
`year
`
`SPBirtk to Show All Values |VSearch|
`
`VAIl Values in Database|/Show QuickFilter Context Menu
`
`In 2021, 29 percent of all Medicare beneficiaries live in a county where more than
`half of Medicare beneficiaries in that county are enrolled in Medicare Advantage
`plans (446 counties). That is substantially more than in 2010 whenjust 4 percent of
`the Medicare population lived in a county where more than 50 percent of Medicare
`beneficiaries were enrolled in a Medicare Advantageplan (109 counties). Many
`counties with high Medicare Advantage penetration are centered around relatively
`large, urban areas, such as Monroe County, NY (71%), which includes Rochester,
`and Allegheny County, PA (64%), which includes Pittsburgh.
`
`In contrast, in 383 counties, accounting for 2 percent of Medicare beneficiaries, no
`more than 10 percent of beneficiaries are enrolled in private Medicare plans; many
`of these low penetration counties are in rural parts of the country. However, some
`urban areas, such as Baltimore City, MD (27%), Charleston, SC (27%), and Cook
`County, IL (Chicago, 31%) have low Medicare Advantageenrollment, compared to
`the national average (42%).
`
`Exhibit 2210
`
`Page 09 of 14
`https://www. kff.org/medicare/issue-brief/medicare-advantage-in-2021-enrollment-update-and-key-trends/
`
`9/14
`
`Exhibit 2210
`Page 09 of 14
`
`

`

`12/31/21, 4:43 AM
`
`Medicare Advantage in 2021: Enrollment Update and Key Trends | KFF
`
`To see how Medicare Advantage penetration has changed over time and to
`highlight counties with at least a minimum share of beneficiaries enrolled in
`Medicare Advantage, select a Medicare Advantage penetration level and adjust the
`year using theslider in Figure 7.
`
`UnitedHealthcare and Humana accountfor nearly half of all
`Medicare Advantage enrollees nationwidein 2021
`
`Figure 8
`Medicare Advantage Enrollment by
`Firm or Affiliate, 2021
`
`All other insurers (4.5 million;
`17%
`
`
`
`Ci
`
`
`(.6 million; 2%)
`
`
`Ce
`
`ion; 4%)
`
`Total Medicare
`Advantage
`Kaiser Permanbnteolmgent.2021=26.4
`lion; 7%)
`
`million
`
`BCBSplans(3.8million;14%)_
`
`NOTE:All otherinsurers includesfirms with less than 2% of total
`enrollment. BCBS are BlueCross and BlueShield affiliates and includes
`
`Medicare Advantage enrollmentis highly concentrated among a small numberof
`firms. UnitedHealthcare and Humanatogether accountfor 45 percentofall
`Medicare Advantage enrollees nationwide, and the BCBSaffiliates (including
`Anthem BCBSplans) account for another 14 percent of enrollment in 2021. Four
`firms (CVS Health, Kaiser Permanente, Centene, and Cigna) account for another 23
`percent of enrollment in 2021.
`
`UnitedHealthcare and Humana haveconsistently accounted for a
`large share of Medicare Advantage enrollment
`
`Exhibit 2210
`
`Page 10 of 14
`https://www. kff.org/medicare/issue-brief/medicare-advantage-in-2021-enrollment-update-and-key-trends/
`
`10/14
`
`Exhibit 2210
`Page 10 of 14
`
`

`

`12/31/21, 4:43 AM
`
`Medicare Advantage in 2021: Enrollment Update and Key Trends | KFF
`
`Figure 9
`Medicare Advantage Enrollment by
`Firm or Affiliate, 2010-2021
`
`All-other insurers
`
`Cigna
`
`2288
`seer ees.le
`
`pl
`
`a H
`
`2010
`
`2012
`
`2014
`
`2016
`
`2018
`
`NOTE:All other insurers includesfirms with less than 2% of total
`enrollment. BCBS are BlueCross and BlueShield affiliates and includes
`Anthem BCBSplans. Anthem non-BCBSplansare less than 2% oftotal ee
`
`UnitedHealthcare has had the largest share of Medicare Advantage enrollment
`since 2010.Its share of Medicare Advantage enrollment has grown from 19
`percent in 2010 to 27 percent in 2021. Humana hasalso had a high share of
`Medicare Advantage enrollment, thoughits share of enrollment has grown more
`slowly, from 16 percent in 2010 to 18 percent in 2021. BCBS plans share of
`enrollment has moderately declined overthe years,initially rising from 15 percent
`in 2010 to 17 percent in 2011, but then declining to 14 percent in 2021. CVS Health,
`which purchasedAetnain 2018, has seen its share of enrollment nearly double
`from 6 percent in 2010 to 11 percent in 2021. Kaiser Permanente hasseenits
`share of enrollment moderately decline, from 9% in 2010 to 7% in 2021. The
`largest decline has beenfor all other insurers (insurers that have less than 2
`percent of enrollment), which has dropped from 26 percent in 2010 to 17 percent
`in 2021.
`
`For thefifth year in a row, enrollment in UnitedHealthcare’s plans grew more than
`any otherfirm, increasing by more than 854,000 beneficiaries between March 2020
`and March 2021. Humana’s increase in plan year enrollment was abouthalf of
`UnitedHealthcare’s, with an increase of about 395,000 beneficiaries between
`March 2020 and March 2021. BCBSaffiliates had the third largest growth in plan
`enrollment with an increase of about 305,000 between March 2020 and March
`2021. CVS Health, which purchased Aetnain 2018, had the fourth largest growthin
`Medicare Advantage enrollmentin 2021, increasing by about 242,000 beneficiaries
`between March 2020 and March 2021.
`
`Discussion
`
`Exhibit 2210
`
`Page 11 of 14
`https://www. kff.org/medicare/issue-brief/medicare-advantage-in-2021-enrollment-update-and-key-trends/
`
`11/14
`
`Exhibit 2210
`Page 11 of 14
`
`

`

`12/31/21, 4:43 AM
`
`Medicare Advantage in 2021: Enrollment Update and Key Trends | KFF
`
`Medicare Advantage enrollment has steadily increased both nationally and within
`most states since 2005, with more than 40 percent of Medicare beneficiaries
`enrolled in Medicare Advantage plans in 2021. The share of Medicare Advantage
`enrollees varies across the country: in 26 states and Puerto Rico, at least 40
`percent of Medicare beneficiaries are enrolled in Medicare Advantage plans in
`2021, and at least 50 percentin Florida, Minnesota and Puerto Rico. In a growing
`number of counties, more than half of all Medicare beneficiaries are in a Medicare
`Advantageplan, in lieu of traditional Medicare. Enrollment continuesto be highly
`concentrated amonga handfuloffirms, both nationally and in local markets, with
`UnitedHealthcare and Humanatogether accounting for 45 percent of enrollment
`in 2021.
`
`As Medicare Advantagetakes on an even larger presence in the Medicare program,
`and as the Medicare Hospital Insurance Trust Fundiscurrentlyprojectedtobe
`insolventby2026(https://www,cbo,gov/system/files/2021-02/51136-2021-02-11-
`trustfundprojections.xlsx), it will be increasingly important to assess how well
`Medicare's current payment methodology for Medicare Advantage is working to
`enhanceefficiency and hold down beneficiary costs and Medicare spending.It will
`also be important to monitor how well beneficiaries are being served in both
`Medicare Advantage andtraditional Medicare, in terms of costs, benefits, quality of
`care, patient outcomes, and accessto providers, with particular attention to those
`with the greatest needs.
`
`Meredith Freed, Jeannie Fuglesten Biniek,Tricia
`Neuman are with KFF.
`Anthony Damicois an independent consultant.
`
`Exhibit 2210
`
`Page 12 of 14
`https://www. kff.org/medicare/issue-brief/medicare-advantage-in-2021-enrollment-update-and-key-trends/
`
`12/14
`
`Exhibit 2210
`Page 12 of 14
`
`

`

`12/31/21, 4:43 AM
`
`Medicare Advantage in 2021: Enrollment Update and Key Trends| KFF
`
`This analysis uses data from the Centers for Medicare & Medicaid Services (CMS)
`Medicare AdvantageEnrollment, Benefit and Landscape files for the respective
`year. KFF is now using the Medicare Enrollment Dashboard for enrollment data,
`from March ofeach year.
`
`In previous years, KFF has used the Medicare Advantage Penetration Files to
`calculate the number of Medicare beneficiaries eligible for Medicare. The
`Medicare AdvantagePenetration Files includes people who werepreviously,
`but no longer covered by Medicare (e.g., people who obtained employer-
`sponsored health insurance coverageafter initially enrolling in Medicare).It
`also includes people within 5 months of their 65th birthday, but not yet age
`65. In addition, CMS identified an issue where beneficiaries with multiple
`addresses were double counted in the Penetration File. KFF refined its
`approach last year and is using the Medicare Enrollment Dashboard to
`calculate the number of Medicare beneficiaries becauseit only includes
`Medicare beneficiaries with either Part A or Part B coverage, which is a more
`accurate estimate of the Medicare population.
`
`This analysis uses the term Medicare Advantage to refer to Medicare
`Advantage plans and othertypesofprivate plans, including cost and PACE
`plans. However, MMPsare excluded from this analysis. Enrollment countsin
`publications by firms operating in the Medicare Advantage market, such as
`companyfinancial statements, might differ from KFF estimates due to
`inclusion or exclusion of certain plan types, such as SNPs or employer plans.
`
`C1 ee) ae)
`
`Sign Up For Email Alerts
`
`Exhibit 2210
`
`Page 13 of 14
`https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2021-enrollment-update-and-key-trends/
`
`13/14
`
`Exhibit 2210
`Page 13 of 14
`
`

`

`12/31/21, 4:43 AM
`
`Medicare Advantage in 2021: Enrollment Update and Key Trends | KFF
`
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`
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`
`Exhibit 2210
`
`Page 14 of 14
`https://www. kff.org/medicare/issue-brief/medicare-advantage-in-2021-enrollment-update-and-key-trends/
`
`14/14
`
`Exhibit 2210
`Page 14 of 14
`
`

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