During the last decade, Medicare Benefit, the personal plan selection to conventional Medicare, has taken on a distinguished position within the Medicare program. In 2023, nearly 31 million Medicare beneficiaries are enrolled in a Medicare Benefit plan, greater than part, or 51%, of the eligible Medicare inhabitants. This transient supplies an outline of the Medicare Benefit plans which can be to be had for 2024 and key developments through the years. (A separate overview of the 2024 Medicare Part D marketplace is also available.)
Medicare Benefit Highlights for 2024
- The common Medicare beneficiary has get entry to to 43 Medicare Benefit plans in 2024, the similar as in 2023, however greater than double the collection of plans presented in 2018.
- HMOs account for greater than part of all Medicare Benefit plans national (56% in 2024) however are declining as a proportion of general, whilst native PPOs are emerging as a proportion of all plans (42% in 2024).
- The collection of D-SNPs (for dually-eligible beneficiaries) has higher considerably during the last 5 years, just about doubling from 465 twin SNPs in 2019 to 851 twin SNPs in 2024.
- One-third of Medicare beneficiaries are living in a county with greater than 50 Medicare Benefit plans to be had in 2024, up from 1 p.c in 2019. Not up to 1 p.c of beneficiaries are living in a county with fewer than 4 Medicare Benefit plans to be had.
- The common Medicare beneficiary can select amongst plans presented through 8 companies in 2024, one fewer than in 2023. 4 new insurers entered the Medicare Benefit marketplace in 2024, 3 of which provide SNPs, whilst fourteen companies exited the marketplace in 2024, basically because of low or no enrollment.
- Humana and UnitedHealthcare plans are to be had in maximum counties in 2024 (90% and 87%, respectively). Maximum main insurers also are increasing into new counties, with CVS Well being increasing within the biggest collection of counties in 2024.
- Two thirds of all MA-PDs (66%) will rate no top class (instead of the Phase B top class) in 2024, the similar as in 2023. As well as, 19% of Medicare Benefit plans will be offering some aid within the Phase B top class in 2024, very similar to 2023.
- Maximum Medicare Benefit plans are providing further advantages, similar to imaginative and prescient, dental and listening to as they have got in earlier years. Maximum Medicare Benefit plans aren’t providing Particular Supplemental Advantages for the Chronically Unwell, that are further advantages to be had to a subset of a plan’s enrollees, that aren’t basically well being comparable, and are in particular for chronically unwell beneficiaries. Alternatively, extra SNP plans than particular person plans in most cases be offering those advantages, specifically meals and convey (60.0% in SNPs in comparison to 13.9% in particular person plans).
Plan Choices in 2024
Choice of Plans
Choice of Plans To be had to Beneficiaries. For 2024, the typical Medicare beneficiary has get entry to to 43 Medicare Benefit plans, the similar as 2023, however greater than double the typical quantity to be had in 2018, and the most important collection of choices to be had over the duration we tested, which fits again to 2010 (Determine 1). Those numbers exclude employer or union-sponsored crew plans, Particular Wishes Plans (SNPs), PACE plans, value plans, and Medicare-Medicaid plans (MMPs) which can be best to be had to choose populations.
Of the 43 Medicare Benefit plans to be had for particular person enrollment, 36 of the plans come with prescription drug protection (MA-PDs), on reasonable.
Overall Choice of Plans. In general, 3,959 Medicare Benefit plans are to be had national for particular person enrollment in 2024 – a slight lower within the collection of plans (1% lower; 39 fewer plans) presented in 2023. Alternatively, it’s the second one biggest collection of plans to be had over the duration we tested, which fits again to 2010 (Determine 2; Appendix Desk 1).
HMOs account for greater than part (56%) of all Medicare Benefit plans presented in 2024 however have declined as a proportion of all Medicare Benefit plans since 2017 (71% of plans), whilst native PPOs are emerging as a proportion of all plans. All over this era, the supply of native PPOs has higher from 24% in 2017 to 42% in 2024. The proportion of regional PPOs has slowly declined from round 3% of plans presented in 2017 to at least one% in 2024.
The decline in collection of plans varies throughout states and counties, with the preponderance of the decline happening in Alabama (20 fewer plans), Illinois (18 fewer plans), and Texas (16 fewer plans) (knowledge now not proven), although beneficiaries in Alabama nonetheless have a selection of 30 plans on reasonable (down from 32 in 2023), whilst beneficiaries in Illinois have a selection of 47 plans on reasonable and beneficiaries in Texas have a selection of 49 plans (each down 2 from 2023). In contrast to in 2022 and 2023 the place two plan choices have been presented in Alaska, in 2024, there aren’t any plans presented. Whilst there was an total decline within the collection of plans presented, Colorado has 18 extra plans to be had for 2024 than in 2023. In the rest states, the collection of plans both stayed the similar or the expansion or decline in plans was once 13 or fewer.
Whilst many employers and unions additionally be offering Medicare Benefit plans to their retirees, no details about those 2024 plan choices is made to be had through CMS to the general public all over the Medicare open enrollment duration as a result of those plans are administered one at a time and will have enrollment classes that don’t align with the Medicare open enrollment duration.
Particular Wishes Plans (SNPs). In 2024, 1,333 SNPs will likely be presented national, a 4 p.c building up between 2023 and 2024 (Determine 3).
D-SNPs. Just about two-thirds of SNPs (64%) are designed for other folks dually eligible for Medicare and Medicaid (D-SNPs). The collection of D-SNPs has higher considerably during the last 5 years, expanding from 465 twin SNPs in 2019 to 851 twin SNPs in 2024, suggesting insurers proceed to be attracted to this high-need inhabitants.
I-SNPs. The collection of SNPs for individuals who require an institutional-level of care (I-SNPs) just about doubled from 97 plans in 2018 to 189 plans in 2023, sooner than shedding modestly to 173 plans for 2024. I-SNPs is also horny to insurers as a result of they have a tendency to have a lot decrease advertising prices than different plan varieties since they’re steadily the one to be had possibility for individuals who require an institutional level-of-care, similar to those that had been in nursing properties for a longer time frame. In 2023, about 100,000 Medicare beneficiaries are enrolled in I-SNPs.
C-SNPs. The collection of SNPs presented for other folks with persistent prerequisites (C-SNPs) is similar to 2023 (309 plans in 2024 vs 306 in 2023), greater than doubling from 2019 (127 plans). Maximum C-SNPs focal point on other folks with diabetes, center illness, or lung prerequisites, as has been the case for the reason that inception of C-SNPs. For 2024, one company is providing a C-SNP for other folks with dementia (in comparison to two companies in 2023) in 4 states (California, Florida, Michigan, Virginia). No companies are providing C-SNPs for other folks with psychological well being prerequisites (in comparison to two companies in 2023), and just one company is providing a C-SNP for other folks with HIV/AIDS, the similar as 2023. 8 companies are providing C-SNPs for other folks with end-stage renal illness (up one from 2023).
Variation within the Choice of Medicare Benefit Plans, through Geographic Space. Medicare beneficiaries dwelling in metropolitan spaces – counties with a minimum of 50,000 other folks – can choose between 47 Medicare Benefit plans in 2024 on reasonable, considerably greater than beneficiaries dwelling in rural or micropolitan areas. Beneficiaries in rural spaces – counties with lower than 10,000 other folks – can choose between a median of 27 plans, whilst beneficiaries in micropolitan spaces (10,000 to 50,000 other folks) can choose between a median of 32 plans.
Greater than 2.4 million beneficiaries in 29 counties can choose between 75 or extra Medicare Benefit plans. Very similar to the final two years, the counties with essentially the most plan choices are predominantly in Ohio and Pennsylvania. In Ohio, for instance, beneficiaries can choose between 80 or extra Medicare Benefit plans in 10 counties, together with Hamilton County (Cincinnati) and Cuyahoga County (Cleveland). Beneficiaries in Summit County, Ohio (Akron) can choose between 87 Medicare Benefit plans – essentially the most choices of any county in the United States. Beneficiaries dwelling in 5 counties in Pennsylvania too can choose between 80 or extra plans. In California, beneficiaries in Orange County can choose between 78 plans (Determine 4).
In 2024, one-third of Medicare beneficiaries (33%) (in 8 p.c of counties), can choose between greater than 50 Medicare Benefit plans the place they are living (Determine 5).
The proportion of Medicare beneficiaries with a selection of a minimum of 50 Medicare Benefit plans has higher from 1% in 2019 to 33% in 2024.
In contrast to in 2022 and 2023, there aren’t any Medicare Benefit plans being presented in any county in Alaska in 2024, which contains about 94,000 beneficiaries. In 2024, lower than 1 p.c of beneficiaries are living in a county with fewer than 4 Medicare Benefit plans to be had. Moreover, no Medicare Benefit plans are to be had in territories instead of Puerto Rico.
Get entry to to Medicare Benefit Plans, through Plan Sort. As in recent times, nearly all Medicare beneficiaries (99.7%) have get entry to to a Medicare Benefit plan as a substitute for conventional Medicare, together with nearly all beneficiaries in metropolitan spaces (99.9%) and nearly all of beneficiaries in micropolitan (99.5%) and rural spaces (98.4%). In micropolitan and rural counties, a smaller proportion of beneficiaries have get entry to to HMOs (93% in micropolitan counties and 96% in rural counties as opposed to over 99% in metropolitan counties) or native PPOs (98% in micropolitan counties and 96% in rural counties as opposed to 99% in metropolitan counties), whilst a rather better proportion of beneficiaries in non-metropolitan counties have get entry to to regional PPOs (77% in each micropolitan and rural counties as opposed to 73% in metropolitan counties).
Choice of Corporations
The common Medicare beneficiary is ready to choose between plans presented through 8 companies in 2024, one fewer than in 2023 and 2022 (Determine 6). In spite of maximum beneficiaries getting access to plans operated through a number of other companies, enrollment is concentrated in plans operated through UnitedHealthcare and Humana, and in combination UnitedHealthcare and Humana account for nearly half (47%) of Medicare Advantage enrollment in 2023.
One-third of beneficiaries (33%), in 211 counties, are ready to choose between plans presented through 10 or extra companies or different sponsors. Fifteen companies are providing Medicare Benefit plans in Butler and Hamilton counties in Ohio, and 14 companies are providing Medicare Benefit plans in 12 counties: 6 in Ohio, 5 in California, and 1 in Arizona (Maricopa). By contrast, 4 p.c of beneficiaries are living in a county the place one to a few companies be offering Medicare Benefit plans (528 counties). Additional, in 130 counties, maximum of that are rural counties with somewhat few Medicare beneficiaries (lower than 1 p.c of general), just one company will be offering Medicare Benefit plans in 2024.
Availability of Plans through Company and County. UnitedHealthcare and Humana, the 2 companies with essentially the most Medicare Benefit enrollees in 2023, have massive footprints around the nation, providing plans in maximum counties. Humana is providing plans in 90 p.c of counties and UnitedHealthcare is providing plans in 87 p.c of counties in 2024, kind of the similar as in 2023 (Determine 7).
Maximum main insurers also are increasing into new counties, with CVS Well being increasing within the biggest collection of counties in 2024 – an building up of 249 counties from 2023 (2,227 counties total) (Determine 8).
Blue Go Blue Defend Associates are providing plans in 2,604 counties in 2024, an building up of 138 counties from 2023. UnitedHealthcare is providing plans in 2,804 counties in 2024, an building up of 95 counties from 2023, whilst Humana is providing plans in 2,906 counties in 2024, an building up of 46 counties from 2023. Cigna is providing plans in 603 counties, an building up of twenty-two counties, and Centene is providing plans in 1,748 counties, an building up of 9 counties; Kaiser Permanente is providing plans in 118 counties, an building up of two counties.
More than one Plan Choices through Corporations within the Identical County. Many Medicare Benefit companies also are providing a couple of plan possibility in each and every county. In 1,276 counties (accounting for 59% of beneficiaries), a minimum of one company is providing 10 or extra plans for particular person enrollment. As an example, in Dollars and Delaware counties in Pennsylvania, 4 companies are providing 10 or extra plans (Humana, UnitedHealthcare, Blue Go Blue Defend Associates, and CVS Well being). In 92 counties, two companies are providing 10 or extra plans, and in 28 counties, 3 companies are providing 10 or extra plans.
Blue Go Blue Defend Associates and Humana are providing essentially the most plan choices in particular person counties. BCBS Associates are providing 19 other plan choices in seven counties, 17 plan choices in 9 counties, and 16 plans in 5 counties. Humana is providing 18 Medicare Benefit plans in 3 counties, 17 plan choices in 1 county, and 16 plan choices in 35 counties.
New Marketplace Entrants and Exits
In 2024, 4 companies (CalOptima Well being OneCare, Champion Well being Plan, Top Well being, and Verda Well being Plan of Texas) entered the marketplace for the primary time, whilst fourteen companies exited the marketplace. One new entrant has two new plans to be had for basic enrollment in West Virginia. 3 companies are providing SNP plans, jointly accounting for approximately 12 p.c of the expansion in SNPs (Appendix Desk 2). One of the crucial new entrants is providing a D-SNP for other folks dually eligible for Medicare and Medicaid in California, and two companies are providing a C-SNP for other folks with make a selection persistent prerequisites in California, Nevada, and Texas.
In the previous few years, extra companies have presented plans which can be both co-branded or are in partnership with every other corporate. As an example, in 2024, Alignment Well being is providing 4 plans co-branded with Instacart in 13 counties in California and Nevada. Those plans will be offering groceries to qualifying beneficiaries with persistent prerequisites. UnitedHealthcare has partnered with Walgreens over the previous few years to supply plans, whilst Alignment Well being has a brand new partnership with Walgreens for 2024. UnitedHealthcare’s plans with Walgreens in 2024 are to be had in California, Georgia, Illinois, Missouri, Nevada, Texas, Utah, and Wisconsin, whilst Alignment Well being’s plans with Walgreens in 2024 are presented in Arizona, California, Florida and Texas. Different corporations with a partnership which can be providing plans in 2024 come with Make a selection Well being and Kroger and Alignment Well being and Ceremony Help, although this isn’t an exhaustive checklist.
Fourteen companies that participated within the Medicare Benefit marketplace in 2023 aren’t providing plans in 2024. 5 of the fourteen companies had low enrollment in 2023 (lower than 3,500 enrollees) whilst 5 companies both had no enrollment or enrollment of lower than 11 other folks in 2023, one in all which was once a Medicare Scientific Financial savings Account (MSA) running in lots of states. One company was once sanctioned and terminated. Two of the corporations with rather upper enrollment had contracts taken over through different insurers, whilst every other company with rather upper enrollment (17,000 enrollees) is leaving the marketplace.
The majority of Medicare Benefit plans for particular person enrollment (89%) will come with prescription drug protection (MA-PDs), and the percentage of MA-PDs that rate no top class (instead of the Phase B top class) is 66% in 2024, the similar as in 2023. As well as, 19% of Medicare Benefit plans will be offering some aid within the Phase B top class in 2024, very similar to the percentage in 2023. Just about all beneficiaries (99%) have get entry to to a MA-PD without a further per 30 days top class in 2024, the similar as in 2023 (99%).
In 2023, 73% of enrollees in MA-PD plans pay no premium instead of the Medicare Phase B top class of $164.90 per thirty days. In accordance with enrollment in March 2023, 10% of enrollees pay a minimum of $50 a month, together with 3% who pay $100 or extra. CMS announced that the typical per 30 days plan top class amongst all Medicare Benefit enrollees in 2024, together with those that pay no top class for his or her Medicare Benefit plan, is predicted to be $18.50 a month. In 2023, 10 percent of Medicare Benefit enrollees are in a plan that presented some aid in Medicare Phase B premiums.
Medicare Benefit plans would possibly supply extra benefits that aren’t to be had in conventional Medicare, are regarded as “basically well being comparable,” and will use rebate greenbacks (together with bonus bills) to lend a hand quilt the price of those further advantages. Starting in 2019, CMS expanded the definition of “basically well being comparable” to permit Medicare Benefit plans to supply further supplemental advantages. Medicare Benefit plans might also prohibit the supply of those further advantages to positive subgroups of beneficiaries, similar to the ones with diabetes or congestive center failure, making other advantages to be had to other enrollees.
Availability of Additional Advantages in Plans for Normal Enrollment. In 2024, 97% or extra particular person plans be offering some imaginative and prescient, health, listening to or dental advantages (Determine 9). Despite the fact that those advantages are extensively to be had, the scope of protection for those products and services varies. As an example, a dental benefit would possibly come with cleanings and preventive care or extra complete protection, and steadily is topic to an annual buck cap at the quantity coated through the plan. Plans aren’t required to record knowledge about usage of those advantages or related prices, so it isn’t transparent the level to which supplemental advantages are utilized by enrollees.
As of 2020, Medicare Benefit plans had been allowed to incorporate telehealth advantages as a part of the elemental receive advantages bundle – beyond what was allowed under traditional Medicare prior to the COVID-19 public health emergency. Those advantages are proven within the determine above, although their prices are constructed into the bid, and aren’t coated through both rebates or supplemental premiums. Moreover, Medicare Benefit plans would possibly be offering supplemental telehealth advantages by means of far off get entry to applied sciences and/or telemonitoring products and services, which can be utilized for the ones products and services that don’t meet the necessities for protection beneath conventional Medicare or the necessities for the telehealth advantages as a part of the elemental receive advantages bundle (such because the requirement of being coated through Medicare Phase B when equipped in-person). The bulk (83%) of Medicare Benefit plans are providing telehealth in 2024, however a decline from 2023, when 97% of plans presented those advantages.
Different further advantages which can be regularly presented for 2024, very similar to the percentage of plans providing those advantages in 2023, come with over-the-counter pieces, similar to adhesive or elastic bandages (85%), far off get entry to applied sciences (74%), meal advantages, similar to meal supply (72%), acupuncture (34%), fortify for caregivers of enrollees (5%), and telemonitoring products and services (3%). A bit greater than a 3rd of plans be offering transportation advantages for clinical wishes (36%), down from 43% in 2023, about two in ten plans (22%) be offering get entry to to rest room protection units, up from 10% in 2023, and 9 p.c be offering in-home fortify products and services, down from 14% in 2023. This isn’t an exhaustive checklist of additional advantages that plans be offering, and plans would possibly supply different products and services similar to home-based palliative care, healing therapeutic massage, and grownup day well being products and services, amongst others.
Get entry to to Medicare Benefit Plans with Additional Advantages. Nearly all Medicare beneficiaries are living in a county the place a minimum of one Medicare Benefit plan to be had for basic enrollment (aside from SNPs) has some further advantages now not coated through conventional Medicare, with over 99% getting access to a minimum of a number of plans with dental, health, imaginative and prescient, and listening to advantages for 2024. The majority of beneficiaries even have get entry to to a number of plans that supply telehealth advantages (over 99%), over-the-counter pieces (over 99%), a meal receive advantages (over 99%), far off get entry to applied sciences (99%), acupuncture (99%), rest room protection units (97%), transportation help (96%) however fewer have get entry to to a number of plans that supply in-home fortify products and services (72%), caregiver fortify (44%), or telemonitoring products and services (20%) .
Availability of Additional Advantages in Particular Wishes Plans. SNPs are designed to serve a disproportionately high-need inhabitants, and a slightly better proportion of SNPs than plans for different Medicare beneficiaries supply their enrollees over-the-counter advantages (94%; up from 86% in 2023), transportation advantages for clinical wishes (88%; the similar as 2023), rest room protection units (34%; up from 14% in 2023), and in-home fortify products and services (25%; down from 34% in 2023). Very similar to plans to be had for basic enrollment, a somewhat small proportion of SNPs be offering fortify for caregivers (6%) or telemonitoring products and services (2%).
Availability of Particular Supplemental Advantages for the Chronically Unwell (SSBCI). Starting in 2020, Medicare Benefit plans have additionally been ready to supply further advantages to a subset of a plan’s enrollees, that aren’t basically well being comparable and are in particular for chronically unwell beneficiaries, referred to as Particular Supplemental Advantages for the Chronically Unwell (SSBCI). Maximum particular person and SNP Medicare Benefit plans nonetheless don’t be offering those advantages, although extra SNP plans in most cases be offering those advantages, specifically meals and convey. SSBCI advantages presented in 2024 come with meals and convey (13.9% for particular person plans and 60.0% for SNPs), basic helps for dwelling (e.g., housing, utilities) (7.8% in particular person plans and 48.0% for SNPs), transportation for non-medical wishes (6.1% for particular person plans and 29.8% for SNPs), and pest keep watch over (3.8% for particular person plans and 13.6% for SNPs) (Determine 10).
The common Medicare beneficiary has a selection of 43 plans in 2024, the similar as in 2023, presented through a median of 8 insurers, one lower than in 2023. Medicare Benefit plans will also be horny to beneficiaries as a result of they usually be offering further advantages, similar to dental, imaginative and prescient and listening to, steadily for no further top class, with the trade-off of extra restrictive supplier networks and larger use of value control equipment, similar to prior authorization. The sheer collection of plans items each alternatives (to buy higher protection) and demanding situations (to decipher doubtlessly necessary variations throughout plans) although a minority of Medicare Advantage enrollees compare plans during the open enrollment period. Insurers had been attracted to the Medicare Benefit marketplace because it is profitable relative to other health insurance markets, and this comes at a price to Medicare, in that Medicare lately can pay Medicare Benefit 106% of conventional Medicare prices, on reasonable, according to MedPAC. As enrollment continues to climb, it’ll be increasingly more necessary to evaluate how smartly Medicare Benefit is serving beneficiaries when it comes to prices, high quality, advantages and affected person results, in addition to how smartly Medicare’s present fee technique for Medicare Benefit is operating to carry down beneficiary prices and Medicare spending.
Meredith Freed, Jeannie Fuglesten Biniek, and Tricia Neuman are with KFF. Anthony Damico is an impartial advisor.
|This research specializes in the Medicare Benefit market in 2024 and developments through the years. The research contains just about 31 million enrollees in Medicare Benefit plans in 2023.
Knowledge on Medicare Benefit plan availability, enrollment, and premiums have been accrued from a collection of knowledge information launched through the Facilities for Medicare & Medicaid Products and services (CMS):
In earlier years, KFF had calculated the percentage of Medicare beneficiaries enrolled in Medicare Benefit through together with Medicare beneficiaries with both Phase A and/or B protection. We changed our method in 2022 to estimate the percentage enrolled amongst beneficiaries eligible for Medicare Benefit who’ve each Medicare Phase A and Medicare B. Those adjustments are mirrored in all knowledge displayed trending again to 2010.
Moreover, in earlier years, KFF had used the time period Medicare Benefit to check with Medicare Benefit plans in addition to different varieties of non-public plans, together with value plans, PACE plans, and HCPPs. Alternatively, value plans, PACE plans, HCPPs are excluded from this research along with MMPs. Those exclusions are mirrored in all knowledge displayed trending again to 2010.
KFF’s plan counts is also less than the ones reported through CMS and others as a result of KFF makes use of total plan counts and now not plan segments. Segments in most cases allow a Medicare Benefit group to supply the “identical” native plan, however would possibly range supplemental advantages, top class and value sharing in several carrier spaces (in most cases non-overlapping counties).