Nearly half of Medicare beneficiaries, or 48%, are enrolled in Medicare Advantage plans. This is highly concentrated across UnitedHealthcare and Humana, which account for almost half of all MA enrollees.

Nearly half of Medicare beneficiaries, or 48%, are enrolled in Medicare Advantage plans. As soon as next year, this number could cross the 50% threshold, a report published Thursday predicts.

The Kaiser Family Foundation analysis also found that in 2022, MA enrollment accounted for $427 billion, or 55%, of all federal Medicare spending. The report used data from the Centers for Medicare & Medicaid Services for its study.

 

MA enrollment has more than doubled since 2007, when it was just 19% of the Medicare population, the report said. Between 2021 and 2022, MA enrollment rose by 8%, or by 2.2 million beneficiaries. This is slightly lower than the prior year, when enrollment grew by 10%. The Congressional Budget Office predicts that by 2032, MA enrollees will make up 61% of the Medicare population.

UnitedHealthcare and Humana account for almost half of all MA enrollees this year. UnitedHealthcare has 28% of total MA enrollment and Humana has 18%. In about a third of all counties in the U.S., the payers account for at least 75% of MA enrollment. 

Meanwhile, Blue Cross Blue Shield has 14% of MA enrollment, CVS Health has 11%, Kaiser Permanente has 6%, Centene has 5%, Cigna has 2% and the remaining 16% is made up of other insurers.

UnitedHealthcare and Humana historically have had the highest share of MA enrollment. In 2010, UnitedHealthcare had 20% of MA beneficiaries and Humana had 16%. UnitedHealthcare has also seen the largest growth since 2010.

KFF also found:

• About two-thirds of MA enrollees, or 66%, are in individual plans. Meanwhile, 18% are in employer/union-sponsored group plans and 16% are in special needs plans.
• The share of Medicare beneficiaries enrolled in MA plans varies by state. This year, Alaska has the lowest with 1% enrolled in MA, while Hawaii has the highest with 59% enrolled in MA.
• In 2022, almost seven out of 10 MA enrollees are in plans with prescription drug coverage that don’t require premiums other than the Medicare Part B premium. This was reported in a separate analysis by KFF, also published Thursday.
• Most enrollees in individual MA plans have access to benefits that aren’t covered by traditional Medicare. This includes eye exams, hearing exams and fitness.
• Nearly all MA enrollees, or 99%, are in plans that require prior authorization for some services. This refers to a process utilized by insurers that determines if they will cover a certain procedure or medication. It is mostly used for expensive services, such as prescription drugs administered by a physician, skilled nursing facility stays and inpatient hospital stays, KFF found. However, it is rarely needed for preventive services.

Source: https://medcitynews.com/2022/08/ma-to-become-predominant-form-of-coverage-for-medicare-beneficiaries-report-finds/