Considerations for plan segmentation in Medicare Advantage bids

In recent years, Medicare Advantage organizations (MAOs) have been adding benefit plans with segments to their portfolios. With these plans, also known as Plan Benefit Packages (PBPs), MAOs aim to take advantage of the ability to segment. For this paper, we reviewed the available information published by the Centers for Medicare and Medicaid Services (CMS), presenting data on the growth of segmented plans, and percentages of MAOs and health maintenance organizations (HMOs) plans that are segmented. In this paper, we discuss: 

• A market summary
• Why an MAO would consider implementing segmentation
• Mechanics of plan segmentation
• Requirements for the bid process