Monthly

The Monthly Reports, 1985-2005

There are three reports published on this page.

• The monthly report
• The monthly summary report
• The 13-Month report

All three reports present aggregate enrollment for Medicare Advantage Organizations. At the bottom of this page you will find information for CMS files that aggregate 2006 Rx enrollment by Medicare Advantage Organization.

The Monthly Report

The Monthly report is a text file report containing Medicare Advantage enrollment, aggregated by Organization. The Monthly report is available by year for 1991-2000 and by month for 2001-2005. The monthly report was not published in Feb 2005. The number of plan types available has varied during the tenure of the monthly report. The current plan types include

• RISK plans (Also called Coordinate Care Plans, CCP, Health Maintenance Organizations, HMO, or Managed Care plans, M+C)
• COST plans
• HCPP plans
• PACE plans (Program for the All Inclusive Care of the Elderly)
• PFFS plans (Private Fee for Service Plans)
• PPO (Preferred Provider organizations---these are paid like Risk plans)
• PSO (Provider Sponsored Organization--there are also paid like Risk plans)
• DEMO (Demonstration projects)
• DEMP (PPO Demos, that is demonstration projects using the PPO model)
• DEMC (Cost Demos, that is demonstration projects using a cost payment scheme)

An explanation of the characteristics of the various plan types may be found in chapter 1 of the Managed Care Manual. The Managed Care Manual may be found in the Regulations and Guidance bucket of the main CMS web page. Under this bucket one should click manuals and then click internet only manuals. The Medicare Advantage manual is publication 100-16.

Excel Format for the Monthly Report

The Flat_Xls.xls macro located in the Flat_xls.zip file may be used to transform the Monthly report from a text file into an excel file. The user then has the full capability of sorting and subtotaling in any manner. The instructions for running the Flat_xls file may be found on the main page. The Flat_Xls macro captures most, but not all fields on the Monthly report (For example it does not capture the Billing section of the report).  

Currently the Flat_Xls macro only works on 2005 and 2004 files. We plan to update this macro so that it works on all files shortly.

Fields of the Monthly Report

Besides reporting on enrollment the Monthly report has numerous fields presenting important attributes of each organization. For example the the monthly report indicates for MA Organizations profit status, the model type, and for Demonstration projects it reports what type of demonstration is involved. The monthly Summary report also aggregates by some of these fields.

Monthly Summary report

The monthly summary report, also known as the MMCC or the Monthly Managed Care Contract report is a text document that presents aggregate data from the monthly report. The MMCC contains aggregate enrollment by plan type and state. It also has some payment information. The monthly report is archived by year from 1985 to 2000 and by month since 2001.

The 13-Month Report

The 13 month report only lists plan enrollment and only for the current year. It contains two trend indicators indicating monthly growth. Bear in mind that while the data in the 13-month report is accurate it only presents 13 months of data for those plans active in the latest month of the report. For example, the 2005-13-month report presents enrollment data from Dec 2004 through Dec 2005 for those plans active during Dec 2005. Consequently the aggregate enrollment for say Dec 2004 would not be accurate as it would omit those plans that were active in 2004 but not in 2005. I have had some requests to publish 13-month reports from prior years and we are currently looking into the availability of such reports.

Enrollment accuracy

Recall that Risk plans are payed prospectively at the beginning of the month for what they expect to pay during that month. In practice, plan enrollment is fixed prior to the beginning of the month. For example the number of enrollees in an Organization for the Period March 2005 is more or less fixed the 3rd or 4th week in February 2005. However, under limited circumstances, beneficiaries in later months may be retroactively enrolled to March 2005. Furthermore, if two reports are "cut" on say Feb 24 and Feb 27 there may be some March enrollees which "just made it."

Because of the above, enrollments from various reports may occasionally differ by a minute amount. Usually this difference is under a 1%. We emphasize however, that all reports do report true enrollment relative to a snapshot at that point of time. Typically however, the trends inferred from the consistent use of any one source tend to be identical. CMS staff have always made diligent efforts to ensure minimal differences in published numbers and this will continue in the future.

During 2005, in the transition to the MMA (Medicare Modernization Act), we published two sheets in the 13 month report; the two sheets represented enrollment snapshots at two points in time. The trends per organization on both sheets tend to be the same but the enrollment may, for any particular plan differ by a small amount, say 1%.

Users of these reports should therefore be aware (a) that the numbers they deal with are true but because of the timing of snapshots may differ minutely from other true snapshots and (b) trends inferred from enrollment numbers represent a true consistent picture independent of the source.

Comparison of Reports

Different reports have different uses. It is important for a user to understand the different reports and what they are good for. A general overview is contained on the main Health Plans, Files and Data page in the Research, Statistics, Data and Systems bucket. Here is a very rough overview

• For enrollment by state and county use the SC, State County Market penetration report
• To study trends in Organization enrollment use the 13-month report
• To get an overview of the distribution of enrollment use the monthly summary report
• To study the attributes of a particular plan use the Monthly summary report
• To study enrollment by state, county,& organization use the Geographic Service Area report.

The above should be construed as advice and a rule of thumb. It is always good to review several reports and create opinions based on a consensus.

2006 Rx Enrollment

CMS publishes files aggregating Rx enrollment by Medicare Advantage Organization. You can find links to downloadable files with 2006 Rx enrollment in the Related Links Inside CMS section below. The format of these 2006 Rx enrollment files is similar, but not identical, to the pre-2006 format. For example:

• (a) Rx enrollment is presented, not MA-only enrollment;
• (b) enrollment is by parent organization, not by H####;
• (c) enrollment is rounded to the nearest 100;
• (d) Organizations with less than 1% of total enrollment are not presented; the
• (e) enrollment of employer only plans is excluded;
• (f) enrollment for MA-PD and PDP Organizations is presented separately(Not in one file).

These links have footnotes (sometimes at the bottom of the spreadsheet) carefully explaining all the characteristics of the data.

For convenience I have named these links using similar naming formats of pre-2006 files. For example MR-0406(PDP) is a file with enrollment aggregated by Organization for PDP organizations for the period Apr 2006. Users should be aware that these files may not be archived...that is CMS may elect to use the same download URL to refer to the current month. Therefore, users who wish to maintain archives should do so themselves by storing each file. I regularly review the various CMS websites and update my own pages with new links within a day or two.