Page 4 - ACO Report Revised

Impact of Medicare Moderate to High Medicare Population Density By County

Advantage on ACO Medicare Advantage Plan Penetration
Geographic Market

Opportunity

ACOs target Original
Medicare recipients so the
higher the penetration of
Medicare Advantage the
lower the market oppor-
tunity for ACOs.
Medicare Advantage
plan coverage varies signif-
icantly by County. To il- Areas with low Medicare eligi-
ble populations are omitted.
lustrate, 37% of Medicare Source: Analysis by 2CY, Inc.
eligibles are covered by
Medicare Advantage on av-
erage; Miami-Dade County,
FL has 482,658 Medicare
eligible of which 355,369 are in Medicare Advantage Plans; this is a penetration of 74%.
CMS data shows 42% of all U.S. counties with 40% or more of Medicare eligibles en-
rolled into a Medicare Advantage Plan. This leaves ACOs fighting for a smaller piece of the pie
every year.

Original Medicare vs. Medicare Advantage Plan Coverage, 2014 to 2019
Medicare Advantage
growth is a barrier
to ACO expansion.
Growth drivers in-
cludes: lower over-
all cost; simplicity of
coverage; and more
benefits such as se-
lect dental, vision,
and hearing services
at no additional cost.

Source: CMS & 2CY, Inc. data analytics

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