48% of Medicare Beneficiaries are Enrolled in Medicare Advantage Plans
Most beneficiaries were enrolled in individual Medicare Advantage plans, but 18 percent of members were in employer-sponsored group plans and 16 percent were in special needs plans.
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- Medicare Advantage enrollment has continued to grow in 2022, with almost half of eligible Medicare beneficiaries enrolled in a Medicare Advantage plan, according to an analysis from the Kaiser Family Foundation (KFF).
Researchers used data from CMS Medicare Advantage enrollment, benefit, and landscape files and the Medicare Enrollment Dashboard to determine trends in Medicare Advantage growth.
KFF newly started basing its Medicare Advantage data on Medicare beneficiaries with both Part A and B coverage instead of the total Medicare population that includes individuals with only Part A or only Part B who are not eligible for Medicare Advantage.
Of the 58.6 million eligible Medicare beneficiaries, 28.4 million are enrolled in Medicare Advantage plans in 2022. Between 2007 and 2022, the share of eligible beneficiaries enrolled in Medicare Advantage more than doubled, going from 19 percent to 48 percent.
Total Medicare Advantage enrollment grew by 2.2 million beneficiaries (8 percent) between 2021 and 2022. The Congressional Budget Office predicted that 61 percent of all Medicare beneficiaries will be enrolled in Medicare Advantage plans by 2032.
The types of Medicare Advantage plans beneficiaries were enrolled in varied.
For example, 66 percent of Medicare Advantage beneficiaries (18.7 million people) were enrolled in plans that are generally open to all for individual enrollment. Compared to 2021, an additional 1.3 million people were enrolled in individual plans.
Eighteen percent of beneficiaries were in an employer-sponsored or union-sponsored group health plan and 16 percent were enrolled in a special needs plan (SNP).
The number of individuals enrolled in a group plan increased from 1.8 million in 2010 to 5.1 million in 2022, the report noted. Six states had particularly high shares of Medicare Advantage members enrolled in group plans, including Alaska (99 percent), Michigan (42 percent), Maryland (36 percent), West Virginia (35 percent), New Jersey (35 percent), and Illinois (30 percent).
In a group plan, an employer or union contracts with an insurer. Medicare then pays the insurer a fixed amount per beneficiary to provide benefits covered by Medicare. These plans typically offer more benefits and lower cost-sharing than traditional Medicare.
SNPs are available for beneficiaries with specialized care needs or individuals who are dually eligible for Medicare and Medicaid.
Most SNP members (89 percent) were enrolled in plans specifically for dual eligibles (D-SNPs). Nine percent of SNP members were in plans for people with severe chronic or disabling conditions (C-SNPs), while 2 percent were in plans for people requiring a nursing home or institutional level of care (I-SNPs).
SNP enrollment grew from 3.8 million beneficiaries in 2021 to 4.6 million in 2022, signifying a 20 percent increase. In addition, SNP enrollment accounted for around 16 percent of total Medicare Advantage enrollment in 2022, compared to 11 percent in 2011.
In Washington DC and Puerto Rico, SNP enrollment accounted for nearly half of all Medicare Advantage enrollment, the report noted.
Total Medicare Advantage enrollment varied across the country as well. For example, in 25 states, at least half of all Medicare beneficiaries were enrolled in Medicare Advantage plans. However, in four states, South Dakota, North Dakota, Wyoming, and Alaska, less than 20 percent of beneficiaries were enrolled in Medicare Advantage plans.
Around 20 percent of Medicare beneficiaries live in a county where at least 60 percent of all Medicare beneficiaries are enrolled in a Medicare Advantage plan, compared to 3 percent in 2010.
Certain payers dominate the Medicare Advantage market, researchers found. UnitedHealthcare (28 percent) and Humana (18 percent) accounted for almost half of all Medicare Advantage enrollment in 2022. In 945 counties, the two payers accounted for at least 75 percent of Medicare Advantage enrollment.
Blue Cross Blue Shield affiliates accounted for 14 percent of enrollment, while CVS Health Kaiser Permanente, Centene, and Cigna together accounted for 24 percent of enrollment.
As Medicare Advantage enrollment continues to grow, the program has received high member satisfaction rates. In addition, healthcare spending for Medicare Advantage members is typically lower than it is for beneficiaries in traditional Medicare.
