Medicare Advantage in 2024: Enrollment Update and Key Trends

Medicare Benefit enrollment has been on a gentle climb for the previous 20 years following modifications in coverage designed to encourage a sturdy position for personal plan choices in Medicare. After a interval of some instability when it comes to plan participation and enrollment, The Medicare Modernization Act of 2003 created stronger monetary incentives for plans to take part in this system all through the nation and renamed personal Medicare plans Medicare Benefit. In 2024, 32.8 million persons are enrolled in a Medicare Benefit plan, accounting for greater than half, or 54 %, of the eligible Medicare inhabitants, and $462 billion (or 54%) of complete federal Medicare spending (internet of offsetting receipts, equivalent to premiums). Medicare Benefit enrolls a disproportionate share of individuals of coloration in Medicare in addition to an growing variety of twin eligible beneficiaries. The typical Medicare beneficiary in 2024 has entry to 43 Medicare Benefit plans, the identical as in 2023, however greater than double the variety of plans supplied in 2018.

The expansion in Medicare Benefit enrollment is because of quite a few elements, together with the supply of plans that cost no premium (aside from the Half B premium), and further advantages supplied by most Medicare Benefit plans. Practically all Medicare Benefit plans supply some advantages not included in conventional Medicare, equivalent to protection of dental, imaginative and prescient, or listening to companies, usually for no further premium. Medicare beneficiaries are additionally drawn to the monetary safety that comes with an out-of-pocket restrict, which Medicare Benefit plans are required to supply, whereas conventional Medicare has no out-of-pocket cap on spending. However, Medicare Benefit plans have restricted supplier networks and apply value administration instruments equivalent to prior authorization, which conventional Medicare doesn’t.

Typically, analysis reveals that Medicare pays extra to non-public Medicare Benefit plans for enrollees than their prices could be in conventional Medicare. The Medicare Fee Advisory Fee (MedPAC) stories that plans obtain funds from CMS which might be 122% of spending for related beneficiaries in conventional Medicare, on common, translating to an estimated $83 billion in larger spending in 2024. As Medicare Benefit takes on a extra dominant presence within the Medicare program, and with present funds to plans larger for Medicare Benefit than for conventional Medicare for related beneficiaries, policymakers have develop into more and more targeted on how nicely Medicare’s present cost methodology for Medicare Benefit is working to boost effectivity and maintain down beneficiary prices and Medicare spending.

To higher perceive traits within the progress of this system, this temporary gives present details about Medicare Benefit enrollment, by plan kind and agency, and reveals how enrollment varies by state and county. A second, companion evaluation describes Medicare Benefit premiums, out-of-pocket limits, supplemental advantages supplied, and prior authorization necessities in 2024. This evaluation doesn’t present detailed info by enrollee traits, equivalent to race/ethnicity, earnings, or twin standing, as a result of that info shouldn’t be obtainable.

Highlights for 2024:

Greater than half (54%) of eligible Medicare beneficiaries are enrolled in Medicare Benefit in 2024. The share of Medicare beneficiaries in Medicare Benefit plans varies throughout states, starting from 2% to 63%. In 7 states, AL, CT, MI, HI, ME, FL, RI (and Puerto Rico), 60% or extra of all Medicare beneficiaries are enrolled in Medicare Benefit plans, a rise from 3 states in 2023.
A couple of-third (37%) of Medicare beneficiaries dwell in a county the place at the least 60 % of all Medicare beneficiaries are enrolled in Medicare Benefit plans. Three counties (excluding these in Puerto Rico) enroll 80% or extra of Medicare beneficiaries in Medicare Benefit plans: Monroe County, NY (Rochester; 82%), Starr, Texas (81%), and Miami-Dade County, Florida (80%). On the similar time, 8 % of all Medicare beneficiaries nationwide dwell in a county with comparatively low enrollment, the place lower than one third of all Medicare beneficiaries are enrolled in Medicare Benefit plans. The vast variation in county enrollment charges mirror a number of elements, equivalent to variations in agency technique, urbanicity of the county, Medicare cost charges, variety of Medicare beneficiaries, well being care use patterns, and historic Medicare Benefit market penetration.
Medicare Benefit enrollment is very concentrated amongst a small variety of companies, with UnitedHealthcare and Humana accounting for practically half (47%) of all Medicare Benefit enrollees nationwide. In additional than 1 / 4 of all U.S. counties (29%; or 931 counties), these two companies account for at the least 75 % of Medicare Benefit enrollment. Since 2017, the market share for UnitedHealthcare and CVS Well being has elevated (25% to 29% and eight% to 12%, respectively), Humana (18%) and Cigna (2%) have held regular, whereas different companies’ share of complete enrollment has barely decreased (Blue Cross Blue Protect (BCBS) associates, Kaiser Permanente, and Centene). Small companies (which every account for lower than 2% of enrollment) have a smaller share of the market in 2024 than in 2017 (19% to 16%).

Greater than half of eligible Medicare beneficiaries are enrolled in Medicare Benefit in 2024

In 2024, greater than half (54%) of eligible Medicare beneficiaries – 32.8 million folks out of 61.2 million Medicare beneficiaries with each Medicare Elements A and B – are enrolled in Medicare Benefit plans. Medicare Benefit enrollment as a share of the eligible Medicare inhabitants has jumped from 19% in 2007 to 54% in 2024 (Determine 1).

Between 2023 and 2024, complete Medicare Benefit enrollment grew by about 2.1 million beneficiaries, or 7 % – the same progress fee because the prior 12 months (8%). The Congressional Funds Workplace (CBO) initiatives that the share of all Medicare beneficiaries enrolled in Medicare Benefit plans will rise to 64% by 2034 (Determine 2).

In 2024, practically two-thirds of Medicare Benefit enrollees are in particular person plans which might be open for normal enrollment.

Greater than 6 in 10 Medicare Benefit enrollees (62%), or 20.5 million folks, are in plans usually obtainable to all beneficiaries for particular person enrollment (Determine 3). That is a rise of 0.9 million enrollees in comparison with 2023. Particular person plans have declined as a share of complete Medicare Benefit enrollment since 2010 (71%).

Greater than 6.6 million Medicare beneficiaries are enrolled in particular wants plans in 2024, greater than double the enrollment in 2019.

Greater than 6.6 million Medicare beneficiaries are enrolled in particular wants plans (SNPs). SNPs limit enrollment to particular forms of beneficiaries with important or comparatively specialised care wants, or who qualify as a result of they’re eligible for each Medicare and Medicaid. Enrollment in SNPs elevated by 16 % between 2023 and 2024, and accounts for 20 % of complete Medicare Benefit enrollment in 2024, a rise from 12 % in 2010. Since 2019, SNP enrollment has greater than doubled from 2.92 million to six.64 million (Determine 4). This improve is due partly to the growing variety of SNP plans  obtainable on common and extra twin eligible people accessing these plans.

Most SNP enrollees (88%) are in plans for beneficiaries dually enrolled in each Medicare and Medicaid (D-SNPs). One other 10 % of SNP enrollees are in plans for folks with extreme continual or disabling circumstances (C-SNPs) and a pair of % are in plans for beneficiaries requiring a nursing residence or institutional stage of care (I-SNPs).

Whereas D-SNPs are designed particularly for dually-eligible people, 1.2 million Medicare beneficiaries with full Medicaid advantages had been enrolled in Medicare Benefit plans usually obtainable to all beneficiaries (not designed particularly for this inhabitants) in 2021, whereas 2.3 million full twin eligible people had been in D-SNPs. D-SNPs have more and more develop into the principle supply of Medicare Benefit protection for twin eligible people.

SNP enrollment varies throughout states. Within the District of Columbia and Puerto Rico, SNP enrollees comprise about half of all Medicare Benefit enrollees (49% in DC and 51% in PR). In 9 states, SNP enrollment accounts for at the least 1 / 4 of Medicare Benefit enrollment: 46% in MS, 34% in AR, 33% in LA and NY, 28% in FL and GA, and 25% in CT, SC and AL.

C-SNP enrollment in 2024 (about 675,000 folks) is 45% larger than it was in 2023 – a rise of about 210,000 enrollees. Practically all (97%) C-SNP enrollees are in plans for folks with diabetes or cardiovascular circumstances in 2024. Enrollment in I-SNPs has been growing barely, with roughly 115,000 enrollees in 2024, up from about 103,000 in 2023.

Barely lower than one in 5 (17% or about 5.7 million) Medicare Benefit enrollees are in a bunch plan supplied to retirees by an employer or union.

Group enrollment as a share of complete Medicare Benefit enrollment has fluctuated between 17% to twenty% since 2010, however the precise quantity has elevated from 1.8 million in 2010 to five.7 million in 2024 (Determine 5). With a bunch plan, an employer or union contracts with an insurer and Medicare pays the insurer a set quantity per enrollee to supply advantages lined by Medicare. For instance, 13 states present medical insurance advantages to their Medicare-eligible retirees completely via Medicare Benefit plans.

As with different Medicare Benefit plans, employer and union group plans might present further advantages and/or decrease value sharing than conventional Medicare and are eligible for bonus funds in the event that they get hold of required high quality scores. The employer or union (and generally the retiree) may pay an extra premium for these supplemental advantages. Group enrollees comprise 1 / 4 or extra of Medicare Benefit enrollees in 9 states: Alaska (100%), Michigan (38%), New Jersey (33%), West Virginia (31%), Maryland (30%), Illinois (29%), Vermont (27%), Kentucky (26%), and Connecticut (25%).

The share of Medicare beneficiaries in Medicare Benefit plans varies by state and county

The share of Medicare beneficiaries in Medicare Benefit plans varies throughout states, starting from 2% to 63%.

In 30 states, Medicare Benefit enrollees account for greater than half of all Medicare beneficiaries, together with in 7 states, AL, CT, MI, HI, ME, FL, RI (and Puerto Rico) the place 60% or extra of all Medicare beneficiaries are enrolled in Medicare Benefit plans (Determine 6). In distinction, Medicare Benefit enrollment is comparatively low (lower than 40%) in 13 states, together with 5 states with lower than 30% of beneficiaries enrolled in a Medicare Benefit plan – AK, MD, ND, SD, and WY – all of which (beside MD) are largely rural. Total, Puerto Rico has the best Medicare Benefit penetration, with 95 % of Medicare beneficiaries enrolled in a Medicare Benefit plan. A decade in the past, the share of Medicare beneficiaries in Medicare Benefit plans didn’t exceed 50 % in any state (aside from Puerto Rico).

The share of Medicare beneficiaries enrolled in Medicare Benefit varies extensively throughout counties.

For instance, in Florida, 60% of all Medicare beneficiaries within the state are enrolled in Medicare Benefit, starting from 21% in Monroe County (Key West) to 80% in Miami-Dade County (Determine 7). In Ohio, 57% of all Medicare beneficiaries are enrolled in Medicare Benefit, with the share starting from 32% in Mercer County (Celina) to 69% in Stark County (Canton).

In 2024, greater than a 3rd (37%) of Medicare beneficiaries dwell in a county the place at the least 60 % of all Medicare beneficiaries in that county are enrolled in Medicare Benefit plans (618 counties). That’s considerably greater than in 2010 when simply 3 % of the Medicare inhabitants lived in a county the place 60 % or extra of Medicare beneficiaries had been enrolled in a Medicare Benefit plan (83 counties). Many counties with excessive Medicare Benefit penetration are centered round comparatively massive, city areas, equivalent to Monroe County, NY (82%), which incorporates Rochester, and Allegheny County, PA (74%), which incorporates Pittsburgh. In distinction, 8 % of Medicare beneficiaries dwell in a county the place lower than one third of all Medicare beneficiaries in that county are enrolled in Medicare Benefit plans (849 counties). Counties with comparatively low enrollment are usually much less populated rural areas. Nevertheless, others, such Montgomery County, MD (27%) and Suffolk, NY (31%), which incorporates a lot of Lengthy Island, are in additional populous areas. (This county-level evaluation excludes Medicare Benefit enrollment in Connecticut. See strategies for extra particulars.)

Variation within the share of eligible Medicare beneficiaries who’re enrolled in a Medicare Benefit plan is defined by a mix of things, together with firm-level methods to focus on specific geographic areas, the urbanicity of the county and state, variation in Medicare cost charges, the quantity and traits of individuals eligible for Medicare, well being care use patterns, and the historic Medicare Benefit market penetration.

Medicare Benefit enrollment is very concentrated amongst a small variety of companies

The typical Medicare beneficiary is ready to select from Medicare Benefit plans supplied by 8 companies in 2024, one fewer than in 2023 and 2022, and one-third of beneficiaries (33%) can select amongst Medicare Benefit plans supplied by 10 or extra companies.

UnitedHealthcare and Humana account for practically half of all Medicare Benefit enrollees nationwide in 2024.

Regardless of most beneficiaries accessing plans operated by a number of completely different companies, Medicare Benefit enrollment is very concentrated amongst a small variety of companies. UnitedHealthcare, alone, accounts for 29% of all Medicare Benefit enrollment in 2024, or 9.4 million enrollees. Collectively, UnitedHealthcare and Humana (18%) account for practically half (47%) of all Medicare Benefit enrollees nationwide, the identical as in 2023. In additional than 1 / 4 of counties (29%; or 931 counties), these two companies account for at the least 75% of Medicare Benefit enrollment. These counties embody 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 (76%). (Once more, this county-level evaluation doesn’t embody Connecticut.)

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 an additional 23% of enrollment in 2024.

UnitedHealthcare and Humana have constantly accounted for a comparatively massive share of Medicare Benefit enrollment.

UnitedHealthcare has had the most important share of Medicare Benefit enrollment and largest progress in enrollment since 2010, growing from 20 % of all Medicare Benefit enrollment in 2010 to 29 % in 2024. Humana has additionally had a excessive share of Medicare Benefit enrollment, although its share of enrollment has grown extra slowly, from 16 % in 2010 to 18 % in 2024. BCBS plans share of enrollment has been extra fixed over time however has declined reasonably since 2014.

CVS Well being, which bought Aetna in 2018, has seen its share of enrollment double from 6 % in 2010 to 12 % in 2024. Kaiser Permanente now accounts for six % of complete enrollment, a reasonable decline as a share of complete Medicare Benefit enrollment since 2010 (9%), primarily as a result of progress of enrollment in plans supplied by different insurers and solely a modest improve in enrollment progress for Kaiser Permanente over that point. Nevertheless, for these insurers which have seen declines of their total share of enrollment, the precise variety of enrollees for every insurer is bigger than it was in 2010.

By absolute numbers, CVS Well being had the most important progress in plan 12 months enrollment, growing by 758,000 beneficiaries between March 2023 and March 2024. Humana had the second largest progress in plan 12 months enrollment, with a rise of about 472,000 beneficiaries between March 2023 and March 2024. UnitedHealthcare plans had the third highest progress in plan 12 months enrollment, growing by 456,000 beneficiaries – the primary time in 8 years it didn’t have the most important plan progress amongst all companies. BCBS plans had the fourth largest progress in plan enrollment with a rise of about 283,000, adopted by Kaiser Permanente, growing by about 45,000 beneficiaries between March 2023 and March 2024. Nevertheless, Centene had fewer enrollees, with enrollment declining by about 202,000 between March 2023 and March 2024.

Strategies

This evaluation makes use of information from the Facilities for Medicare & Medicaid Providers (CMS) Medicare Benefit Enrollment, Profit and Panorama information for the respective 12 months. KFF makes use of the Medicare Enrollment Dashboard for enrollment information for March 2023 and 2024, and the CMS Continual Circumstances Information Warehouse Grasp Beneficiary Abstract File (MBSF) for March for earlier years. Development evaluation begins in 2007 as a result of that was the earliest 12 months of information that was based mostly on March enrollment. Enrollment information is simply supplied for plan-county mixtures which have at the least 11 beneficiaries; thus, this evaluation excludes roughly 400,000 people who reside in a county the place county-wide plan enrollment doesn’t meet this threshold. Connecticut is excluded from the evaluation of Medicare Benefit penetration on the county stage as a result of a change in FIPS codes which might be within the Medicare Enrollment Dashboard information however aren’t but mirrored within the Medicare Benefit enrollment information.

KFF calculates the share of eligible Medicare beneficiaries enrolled in Medicare Benefit, that means they will need to have each Half A and B protection. The share of enrollees in Medicare Benefit could be considerably smaller if based mostly on the whole Medicare inhabitants that features 5.9 million beneficiaries with Half A solely or Half B solely (in 2024) who aren’t usually eligible to enroll in a Medicare Benefit plan.

In earlier years, KFF calculated the share of Medicare beneficiaries enrolled in Medicare Benefit by together with Medicare beneficiaries with both Half A and/or B protection. We modified our strategy in 2022 to estimate the share enrolled amongst beneficiaries eligible for Medicare Benefit who’ve each Medicare Half A and Medicare B. Up to now, the variety of beneficiaries enrolled in Medicare Benefit was smaller and due to this fact the distinction between the share enrolled with Half A and/or B vs Half A and B was additionally smaller. For instance, in 2010, 24% of all Medicare enrollees had been enrolled in Medicare Benefit versus 25% with simply Elements A and B. Nevertheless, these shares have diverged over time: in 2024, 49% of all Medicare beneficiaries had been enrolled in Medicare Benefit versus 54% with simply Elements A and B. These modifications are mirrored in all information displayed trending again to 2007.

Moreover, in earlier years, KFF had used the time period Medicare Benefit to consult with Medicare Benefit plans in addition to different forms of personal plans, together with value plans, PACE plans, and HCPPs. Nevertheless, value plans, PACE plans, and HCPPs at the moment are excluded from this evaluation along with MMPs. On this evaluation, KFF excludes these different plans as some might have completely different enrollment necessities than Medicare Benefit plans (e.g., could also be obtainable to beneficiaries with solely Half B protection) and in some instances, could also be paid otherwise than Medicare Benefit plans. These exclusions are mirrored in all information displayed trending again to 2007.

Medicare projections for 2025-2033 are from the June Congressional Funds Workplace (CBO) Medicare Baseline for 2024. Utilizing the CBO baseline, Medicare enrollment is predicated on people who’re enrolled in Half B, which is designed to incorporate solely people who’re eligible for Medicare Benefit and exclude those that solely have Half A solely (~5 million folks in 2025) and can’t enroll in Medicare Benefit. Nevertheless, it might embody some people who’ve Half B solely and in addition aren’t eligible for Medicare Benefit.

Enrollment counts in publications by companies working within the Medicare Benefit market, equivalent to firm monetary statements, would possibly differ from KFF estimates as a result of inclusion or exclusion of sure plan varieties, equivalent to SNPs or employer group well being plans.