Medicare Advantage in 2023: Enrollment Update and Key Trends

Medicare Merit enrollment has been on a gradual climb for the previous twenty years following adjustments in coverage designed to inspire a powerful position for personal plan choices in Medicare. After a duration of a few instability relating to plan participation and enrollment, The Medicare Modernization Act of 2003 created more potent monetary incentives for plans to take part in this system all the way through the rustic and renamed personal Medicare plans Medicare Merit. In 2023, 30.8 million persons are enrolled in a Medicare Merit plan, accounting for greater than part, or 51 %, of the eligible Medicare inhabitants, and $454 billion (or 54%) of general federal Medicare spending (web of premiums). The typical Medicare beneficiary in 2023 has get right of entry to to 43 Medicare Advantage plans, the most important selection of choices ever.

To higher perceive traits within the enlargement of this system, this temporary supplies present details about Medicare Merit enrollment, by way of plan kind and agency, and displays how enrollment varies by way of state and county. A 2nd, companion analysis describes Medicare Merit premiums, out-of-pocket limits, value sharing, further advantages introduced, prior authorization necessities, and megastar scores in 2023.

Key highlights come with:

• Greater than part (51%) of eligible Medicare beneficiaries are enrolled in Medicare Merit in 2023.
• The proportion of Medicare beneficiaries enrolled in Medicare Merit varies broadly throughout counties. In 2023, just about one 3rd (31%) of Medicare beneficiaries are living in a county the place no less than 60 % of all Medicare beneficiaries are enrolled in Medicare Merit plans, whilst 10% are living in a county the place not up to one 3rd of all Medicare beneficiaries are enrolled in Medicare Merit plans. The large variation in county enrollment charges may mirror a number of components, equivalent to variations in agency technique, urbanicity of the county, Medicare cost charges, selection of Medicare beneficiaries, well being care use patterns, and historic Medicare Merit marketplace penetration.
• Medicare Merit enrollment is very concentrated amongst a small selection of companies. UnitedHealthcare and Humana account for almost part (47%) of all Medicare Merit enrollees national, and in just about a 3rd of counties (32%; or 1,013 counties), those two companies account for no less than 75% of Medicare Merit enrollment. 

Greater than part of eligible Medicare beneficiaries are enrolled in Medicare Merit in 2023

In 2023, greater than part (51%) of eligible Medicare beneficiaries – 30.8 million other folks out of 60.0 million Medicare beneficiaries with each Medicare Portions A and B – are enrolled in Medicare Merit plans. Medicare Merit enrollment as a percentage of the eligible Medicare inhabitants has jumped from 19% in 2007 to 51% in 2023 (Determine 1).

Between 2022 and 2023, general Medicare Merit enrollment grew by way of about 2.3 million beneficiaries, or 8 % – a identical enlargement charge to the prior yr (8%). The Congressional Funds Workplace (CBO) initiatives that the percentage of all Medicare beneficiaries enrolled in Medicare Merit plans will upward push to 62 % by way of 2033 (Determine 2).

In 2023, just about two-thirds of Medicare Merit enrollees are in person plans which might be open for normal enrollment.

Just about two-thirds (64%) of Medicare Merit enrollees, or 19.6 million other folks, are in plans usually to be had to all beneficiaries for person enrollment (Determine 3). That is a rise of 0.9 million enrollees in comparison to 2022. Particular person plans have accounted for roughly the similar percentage of general Medicare Merit enrollment since 2018.

One in 5 (about 5.4 million) Medicare Merit enrollees are in a gaggle plan introduced to retirees by way of an employer or union.

Whilst that is kind of the similar percentage of general Medicare Merit enrollment since 2010 (18%), the real quantity has greater from 1.8 million in 2010 to five.4 million in 2023 (Determine 4). With a gaggle plan, an employer or union contracts with an insurer and Medicare can pay the insurer a set quantity according to enrollee to supply advantages coated by way of Medicare. For instance, some states, equivalent to Illinois and Pennsylvania, supply medical insurance advantages to their Medicare-eligible retirees solely via Medicare Merit plans.

As with different Medicare Merit plans, employer and union workforce plans would possibly supply further advantages and/or cheaper price sharing than conventional Medicare and are eligible for bonus bills in the event that they download required high quality ratings. The employer or union (and occasionally the retiree) might also pay an extra top rate for those supplemental advantages. Workforce enrollees include a 3rd or extra of Medicare Merit enrollees in 5 states: Alaska (99%), Michigan (40%), New Jersey (34%), Maryland (33%), and West Virginia (33%).

Greater than 5.7 million Medicare beneficiaries are enrolled in particular wishes plans in 2023, double the enrollment in 2018.

Greater than 5.7 million Medicare beneficiaries are enrolled in particular wishes plans (SNPs). SNPs limit enrollment to express kinds of beneficiaries with vital or somewhat specialised care wishes, or who qualify as a result of they’re eligible for each Medicare and Medicaid. Enrollment in SNPs greater by way of 24% between 2022 and 2023, and accounts for 19% of general Medicare Merit enrollment in 2023.  Since 2018, SNP enrollment has doubled from 2.58 million to five.74 million (Determine 5).

Maximum SNP enrollees (89%) are in plans for beneficiaries dually enrolled in each Medicare and Medicaid (D-SNPs). Every other 9 % of SNP enrollees are in plans for other folks with critical continual or disabling stipulations (C-SNPs) and a pair of % are in plans for beneficiaries requiring a nursing house or institutional point of care (I-SNPs).

Whilst D-SNPs are designed in particular for dually-eligible folks, 1.9 million Medicare beneficiaries with Medicaid have been enrolled in Medicare Merit plans usually to be had to all beneficiaries (now not designed in particular for this inhabitants) in 2020, whilst 2.9 million have been in D-SNPs.

SNP enrollment varies throughout states. Within the District of Columbia and Puerto Rico, SNPs include about part of all Medicare Merit enrollees (48% in DC and 49% in PR). In 12 states, SNP enrollment accounts for no less than one-fifth of Medicare Merit enrollment (39% in MS, 31% in AR and LA, 30% in NY, 26% in FL and GA, 24% in CT, 22% in SC and AL, 21% in HI, and 20% in TX and AZ). Maximum (96%) C-SNP enrollees (about 446,000 other folks) are in plans for other folks with diabetes or cardiovascular stipulations in 2023. Enrollment in I-SNPs has been expanding rather, with roughly 103,000 enrollees in 2023, up from about 92,700 in 2022.

The proportion of Medicare beneficiaries in Medicare Merit plans varies by way of state and county

The proportion of Medicare beneficiaries in Medicare Merit plans varies throughout states, starting from 2% to 60%.

In 3 states (AL, HI, and MI) and Puerto Rico, 60 % or extra of all Medicare beneficiaries are enrolled in Medicare Merit plans, and in 26 states (and Puerto Rico), Medicare Merit enrollees account for no less than part of all Medicare beneficiaries (Determine 6). Against this, Medicare Merit enrollment is somewhat low (not up to 40%) in 16 states and the District of Columbia, together with 4 most commonly rural states (SD, ND, WY, and AK) with not up to 20 % of beneficiaries enrolled in a Medicare Merit plan. Total, Puerto Rico has the best possible Medicare Merit penetration, with 94 % of Medicare beneficiaries enrolled in a Medicare Merit plan. A decade in the past, the percentage of Medicare beneficiaries in Medicare Merit plans didn’t exceed 50% in any state (as opposed to Puerto Rico).

The proportion of Medicare beneficiaries enrolled in Medicare Merit varies broadly throughout counties.

For instance, in Florida, 58% of all Medicare beneficiaries within the state are enrolled in Medicare Merit, starting from 20% in Monroe County (Key West) to 79% in Miami-Dade County (Determine 7). In Ohio, 54% of all Medicare beneficiaries are enrolled in Medicare Merit, with the percentage starting from 31% in Mercer County (Celina) to 67% in Stark County (Canton).

In 2023, 3 in 10 (31%) Medicare beneficiaries are living in a county the place no less than 60 % of all Medicare beneficiaries in that county are enrolled in Medicare Merit plans (473 counties). This is considerably greater than in 2010 when simply 3 % of the Medicare inhabitants lived in a county the place 60 % or extra of Medicare beneficiaries have been enrolled in a Medicare Merit plan (83 counties). Many counties with top Medicare Merit penetration are focused round somewhat huge, city spaces, equivalent to Monroe County, NY (80%), which incorporates Rochester, and Allegheny County, PA (73%), which incorporates Pittsburgh. Against this, 1 in 10 (10%) Medicare beneficiaries are living in a county the place not up to a 3rd of all Medicare beneficiaries in that county are enrolled in Medicare Merit plans (967 counties). Counties with somewhat low enrollment have a tendency to be much less populated rural spaces. On the other hand, others, such Bernard Law Montgomery County, MD (25%) and Suffolk, NY (29%), which incorporates maximum of Lengthy Island, are in additional populous spaces.

Variation within the percentage of eligible Medicare beneficiaries who’re enrolled in a Medicare Merit plan is most likely defined by way of a mixture of things, together with firm-level methods to focus on specific geographic spaces, the urbanicity of the county and state, variation in Medicare cost charges, the quantity and traits of other folks eligible for Medicare, well being care use patterns, and the historic Medicare Merit marketplace penetration.

Medicare Merit enrollment is very concentrated amongst a small selection of companies

The typical Medicare beneficiary is in a position to choose between Medicare Merit plans introduced by way of 9 firms in 2023, and 4 in ten (40%) beneficiaries can select amongst Medicare Merit plans introduced by way of 10 or extra companies.

UnitedHealthcare and Humana account for almost part of all Medicare Merit enrollees national in 2023

In spite of maximum beneficiaries gaining access to plans operated by way of a number of other companies, Medicare Merit enrollment is very concentrated amongst a small selection of companies. UnitedHealthcare, by myself, accounts for 29% of all Medicare Merit enrollment in 2023, or 8.9 million enrollees. In combination, UnitedHealthcare and Humana account for almost part (47%) of all Medicare Merit enrollees national. In just about a 3rd of counties (32%; or 1,013 counties), those two companies account for no less than 75% of Medicare Merit enrollment. Those counties come with East Baton Rouge (Baton Rouge), LA (81%), Clark County (Las Vegas), NV (79%), Travis County (Austin), FL (78%), and El Paso County (Colorado Springs), CO (77%).

BCBS associates (together with Anthem BCBS plans) account for 14 % of enrollment, and 4 companies (CVS Well being, Kaiser Permanente, Centene, and Cigna) account for some other 23 % of enrollment in 2022.

UnitedHealthcare and Humana have constantly accounted for a somewhat huge percentage of Medicare Merit enrollment.

UnitedHealthcare has had the most important percentage of Medicare Merit enrollment and biggest enlargement in enrollment since 2010, expanding from 20 % of all Medicare Merit enrollment in 2010 to 29 % in 2023. Humana has additionally had a top percentage of Medicare Merit enrollment, even though its percentage of enrollment has grown extra slowly, from 16 % in 2010 to 18 % in 2023. BCBS plans percentage of enrollment has been extra consistent through the years, however has declined reasonably since 2014.

CVS Well being, which bought Aetna in 2018, has noticed its percentage of enrollment just about double from 6 % in 2010 to 11 % in 2023. Kaiser Permanente now accounts for six % of general enrollment, a reasonable decline as a percentage of general Medicare Merit enrollment since 2010 (9%), basically because of the expansion of enrollment in plans introduced by way of different insurers and just a modest building up in enrollment enlargement for Kaiser Permanente over that point. On the other hand, for the ones insurers that experience noticed declines of their total percentage of enrollment, the real selection of enrollees for each and every insurer is greater than it used to be in 2010.

For the 7th yr in a row, enrollment in UnitedHealthcare’s plans grew greater than another agency, expanding by way of greater than 1 million beneficiaries between March 2022 and March 2023. Humana had the second one biggest enlargement in plan yr enrollment, with an building up of about 512,000 beneficiaries between March 2022 and March 2023. BCBS plans had the 3rd best possible enlargement in plan yr enrollment of 296,000 beneficiaries between March 2022 and March 2023. CVS Well being had the fourth biggest enlargement in plan enrollment with an building up of about 217,000, adopted by way of Kaiser Permanente, expanding by way of about 51,000 beneficiaries between March 2022 and March 2023. On the other hand, Centene in fact misplaced enrollees, declining by way of about 91,000 between March 2022 and March 2023.

Dialogue

Medicare Merit enrollment has greater continuously lately, with part (51%) of all eligible Medicare beneficiaries enrolled in Medicare Merit plans in 2023. The proportion of Medicare beneficiaries enrolled in Medicare Merit varies broadly throughout counties. 3 in ten Medicare beneficiaries are living in a county the place no less than 60 % of all Medicare beneficiaries are enrolled in Medicare Merit plans. Against this, 1 in 10 are living in a county the place not up to a 3rd of all Medicare beneficiaries are enrolled in Medicare Merit plans. Enrollment remains to be extremely concentrated amongst a handful of companies, each nationally and in native markets, with UnitedHealthcare and Humana in combination accounting for 47 % of enrollment in 2023 national.

As Medicare Merit takes on a extra dominant presence within the Medicare program, and with current payments to plans higher for Medicare Merit than for standard Medicare for identical beneficiaries, it is going to change into increasingly more related to evaluate how smartly Medicare’s present cost technique for Medicare Merit is operating to toughen potency and dangle down beneficiary prices and Medicare spending. Further concerns come with tracking how smartly beneficiaries are being served in each Medicare Merit and conventional Medicare, relating to prices, advantages, high quality of care, affected person results, and get right of entry to to suppliers, with specific consideration to these with the best wishes. Whilst there’s a rising body of research evaluating Medicare Merit and conventional Medicare, gaps in Medicare Merit knowledge prohibit the facility to guage whether or not upper spending is main to raised worth for enrollees and taxpayers, higher results or diminished disparities.

This research makes use of knowledge from the Facilities for Medicare & Medicaid Services and products (CMS) Medicare Merit Enrollment, Receive advantages and Panorama recordsdata for the respective yr. KFF makes use of the Medicare Enrollment Dashboard for enrollment knowledge, from March of each and every yr. Development research starts at 2007 as a result of that used to be the earliest yr of knowledge that used to be in keeping with March enrollment. KFF calculates the percentage of eligible Medicare beneficiaries enrolled in Medicare Merit, that means they should have each Section A and B protection. The proportion of enrollees in Medicare Merit can be reasonably smaller if in keeping with the entire Medicare inhabitants that comes with 5.7 million beneficiaries with Section A best or Section B best (in 2023) who aren’t usually eligible to sign up for a Medicare Merit plan. In earlier years, KFF calculated the percentage of Medicare beneficiaries enrolled in Medicare Merit by way of together with Medicare beneficiaries with both Section A and/or B protection. We changed our means in 2022 to estimate the percentage enrolled amongst beneficiaries eligible for Medicare Merit who’ve each Medicare Section A and Medicare B. Up to now, the selection of beneficiaries enrolled in Medicare Merit used to be smaller and subsequently the variation between the percentage enrolled with Section A and/or B vs Section A and B used to be additionally smaller. For instance, in 2010, 24% of all Medicare enrollees have been in enrolled in Medicare Merit as opposed to 25% with simply Portions A and B. On the other hand, those stocks have diverged through the years: in 2023, 48% of all Medicare enrollees have been in enrolled in Medicare Merit as opposed to 51% with simply Portions A and B. Those adjustments are mirrored in all knowledge displayed trending again to 2010. Moreover, in earlier years, KFF had used the time period Medicare Merit to discuss with Medicare Merit plans in addition to different kinds of personal plans, together with value plans, PACE plans, and HCPPs. On the other hand, value plans, PACE plans, and HCPPs are actually excluded from this research along with MMPs. On this research, KFF excludes those different plans as some will have other enrollment necessities than Medicare Merit plans (e.g., is also to be had to beneficiaries with best Section B protection) and in some instances, is also paid in a different way than Medicare Merit plans. Those exclusions are mirrored in all knowledge displayed trending again to 2010. Medicare projections for 2023-2023 are from the Might Congressional Funds Workplace (CBO) Medicare Baseline for 2023. In step with the CBO baseline, Medicare enrollment is in keeping with people who are enrolled in Section B, which is designed to incorporate best people who are eligible for Medicare Merit and exclude those that best have Section A best (~5 million other folks in 2023) and can not sign up in Medicare Merit. On the other hand, it’s going to come with some people who have Section B best and likewise aren’t eligible for Medicare Merit. Enrollment counts in publications by way of companies running within the Medicare Merit marketplace, equivalent to corporate monetary statements, would possibly vary from KFF estimates because of inclusion or exclusion of positive plan varieties, equivalent to SNPs or employer workforce well being plans.