Descriptive Statistics

Blue Cross Blue Shield of North Carolina (BCBSNC) Claims Data

Average Member Months

 Year
1: Insured & Multiple Employer Welfare Arrangements (INS)
2: Administrative Services Only (ASO) 3: Individual Market and  Affordable Care Act Plans (after 1/1/14) (IND)
2006 623,486 512,170 325,732
2007 657,484 585,934 344,201
2008 673,342 693,674 354,169
2009 639,661 737,749 350,110
2010 618,601 768,984 353,124
2011 573,002 728,962 367,039
2012 581,048 703,800 386,823
2013 632,816 701,256 397,809
2014 614,624 682,465 536,193
2015 572,176 704,291 571,320
2016 529,627 712,257 437,181

 

GENDER – 2014 (number of members)
GENDER 1:  INS 2:  ASO 3:IND
Female 397,498 (48.05) 414,862 (50.60) 367,198 (52.46)
Male 425,101 (51.38) 400,362 (48.83) 329,903 (47.13)
Unknown 4,709 (0.57) 4,724 (0.58) 2,813 (0.40)
Total 827,308 819,948 699,914

 

 Age Group 2014 (number of members)
AGE 1: INS
2:  ASO
3: IND
<2 13,339 (1.61) 17,870 (2.18) 12,300 (1.76)
2-17 126,258 (15.26) 167,719 (20.45) 109,296 (15.62)
18-44 425,465 (51.43) 357,205 (43.56) 278,164 (39.74)
45-64 245,469 (29.67) 257,555 (31.41) 279,700 (39.96)
65-84 16,644 (2.01) 19,166 (2.34) 19,933 (2.85)
85+ 133 (0.02) 433 (0.05) 521 (0.07)
Total 827,308 819,948 699,914

 

Distribution by CPT Category in Professional Claims BCBSNC, 2014 (Number of Procedure codes per Unique Member ID, Service Date and Rendering Provider).
CPT Procedure Categories
Frequency Percent Cumulative
Frequency
Cumulative
Percent
missing 725 0.00 725 0.00
other 356 0.00 1,081 0.00
Anesthesia/Surgery 4,105,516 7.01 4,106,597 7.01
Radiology 4,034,085 6.88 8,140,682 13.89
Pathology/Laboratory 17,531,559 29.92 25,672,241 43.81
Medicine 15,169,496 25.89 40,841,737 69.70
Evaluation/Management 13,898,629 23.72 54,740,366 93.42
HCPCS 3,852,971 6.58 58,593,337 100.00

 

 

 

NC Medicaid Data

Medicaid Eligibility Category Average member months, 2016
Aged, Blind, and Disabled 447,666
Children and Families 1,375,017
Medicare Savings Program 78,529
Other Medicaid 145,838
NC Health Choice 96,567

 

Aged, blind, and disabled. This category includes Medicaid recipients who are older adults (age 65 or older), blind, or those considered disabled (under the Social Security disability standards).  This category includes some dual eligibles (those who receive both Medicare and Medicaid), as well as individuals who are aged, blind or disabled who only receive Medicaid.  These individuals are entitled to full Medicaid benefits.

Children and Families. This category includes Medicaid recipients who are children under age 19, young adults ages 20-21, and the parents or other caretaker relatives of children who are taking care of the children under age 19. It also includes pregnant women who qualify on the basis of their pregnancy.

Medicare Savings Programs (sometimes referred to as Medicaid for Medicare Qualified Beneficiaries (MQB)). This category includes aged (65 or older), blind, or disabled adults who receive Medicare. There are different types of Medicare Savings programs. Individuals enrolled in the different Medicare Savings programs have incomes too high to qualify for full Medicaid services. These individuals get help paying some of the Medicare cost sharing (such as the Part B premium, or deductible, depending on the type of Medicare Savings program). They do not get full Medicaid coverage.  Thus, unlike the regular aged, blind, and disabled category, the Medicare Savings individuals are not eligible for coverage of Medicaid-covered services that Medicare does not cover (such as dental services or hearing aids).

Other Medicaid. This includes other groups, not included in the other categories. For example, this includes people enrolled in Medicaid through the Family Planning program, Breast and Cervical Cancer program, or emergency Medicaid.

NC Health Choice. This program covers children who are enrolled in North Carolina’s Child Health Insurance Program (CHIP). This includes children ages 6-18 whose income is too high to qualify for Medicaid, but no more than 210% of the federal poverty guidelines.