Medicare Advantage enrollment increased by 1.7 million beneficiaries

March 11, 2024 - Medicare Advantage enrollment has increased by 1.7 million beneficiaries since 2023, with for-profit health plans dominating the market, a Chartis report revealed.

Among 65.9 million Medicare-eligible individuals, 33 million are enrolled in Medicare Advantage in 2024. The private program saw a 5.4 percent enrollment growth from last year—a slower increase than previous years. Meanwhile, traditional Medicare enrollment declined by 515,000 beneficiaries, marking a smaller loss than the last two years.

In 26 states, over half of Medicare beneficiaries are enrolled in a Medicare Advantage plan. States with low penetration saw the highest growth rates, while states with high enrollment rates going into the year had slower growth rates.

Special needs plan (SNP) enrollment rose by 21.5 percent, adding 1.2 million beneficiaries from 2023 to 2024. SNP enrollment has grown an average of 18 percent per year for the past five years, with dual-eligible SNPs contributing significantly to that growth. Almost one in five Medicare Advantage beneficiaries have coverage through a SNP.

The top five health plans—UnitedHealthcare, Humana, Elevance, Centene Corporation, and CVS Health Corporation—represent 77 percent of the SNP market. CVS/Aetna accounts for 6 percent of all SNP enrollment, up from less than 1 percent in 2019.

The number of Medicare Advantage plan options has hit a plateau. In 2024, 5,349 plans were available, up slightly from 5,333 in 2023. The number of SNPs available increased from 1,270 to 1,329, while the number of non-SNP Medicare Advantage plans fell from 4,063 to 4,020.

At the local level, the average number of plan options by county increased by one. Plan options have increased by 80 percent by county and 49 percent by state since 2019.

The Medicare Advantage market is primarily made up of for-profit health plans. These plans account for 73.5 percent of all Medicare Advantage enrollment, up from 73 percent in 2023 and 68.7 percent in 2019. Non-profit plans’ market share fell from 16.8 percent in 2023 to 16.4 percent in 2024, while the market share of Blues plans dropped slightly from 10.2 percent to 10.1 percent.

Similarly, 83 percent of the 1.7 million new beneficiaries are enrolled in for-profit plans, 9 percent are in non-profit Blues plans, and 9 percent are in non-Blue non-profit plans.

Blues plans added 147,000 beneficiaries, with Health Care Service Corporation adding 40,000 and Blue Cross Blue Shield of Michigan adding 30,000. Non-profit plans saw 155,000 new members, led by Kaiser Permanente (39,000) and Healthfirst (30,000).

UnitedHealthcare (478,000), Humana (412,000), and Aetna (544,000) together enrolled 1.4 million beneficiaries, accounting for 86 percent of all new enrollment. Meanwhile, Centene lost 212,000 beneficiaries and Elevance lost 25,000.

Star ratings declined in 2024, with Medicare Advantage plans collectively falling by 0.1 star when weighted by membership. Kaiser went from five to four stars, and United, Cigna, and Elevance saw declining star rankings. Centene, whose star ratings fell in 2023, saw some recovery and stabilization in 2024.

Around three-quarters of beneficiaries are in a four- or five-star plan, but five-star plan enrollment alone decreased from 22 percent of all members in 2023 to 7 percent in 2024. Additionally, 24 percent of beneficiaries are in a plan with fewer than four stars.

As the aging population grows and seniors tend to favor Medicare Advantage over traditional Medicare, enrollment in the private program will likely keep increasing, the report noted. Although plans have faced new marketing restrictions, prior authorization guidelines, rising costs, and quality rating declines, Medicare Advantage executives are hopeful for the future.

Nearly 80 percent of plan leaders think the Medicare Advantage outlook for the next five years is neutral or positive. Many leaders expect enrollment growth to continue, but some expect benefit packages to shrink.