Medicare Advantage is poised to become the predominant way for Medicare beneficiaries to get their health care coverage and care

As Medicare Advantage continues to grow, a gradual but significant overhaul of the Medicare program is underway.

A new KFF analysis finds that nearly half of eligible Medicare beneficiaries — 28.4 million out of 58.6 million total Medicare beneficiaries — are now enrolled in Medicare Advantage plans. This is more than double the share of the Medicare-eligible population enrolled in these plans from 2007 to 2022 (19% to 48%). Enrollment is expected to cross the 50% threshold as early as next year, making Medicare Advantage the predominant way for Medicare beneficiaries with Parts A and B to obtain their coverage and care.

The rise of Medicare Advantage signals the transformation of Medicare into a program in which a majority of people receive benefits by enrolling in plans offered by private health insurance companies.

The new analysis is one of three released today by KFF in which researchers examine various aspects of Medicare Advantage. It provides the latest Medicare Advantage enrollment data, including the types of plans Medicare beneficiaries are enrolled in and how enrollment varies by geography. Additional analysis outlines Medicare Advantage premiums, spending limits, cost sharing, additional benefits offered, and pre-authorization requirements. A third examines trends in bonus payments to Medicare Advantage plans, plan enrollment in bonus status, and how these metrics vary across plan types and companies.

Among other key findings:

  • Enrollment in private plans is heavily concentrated in a small number of companies, with UnitedHealthcare and Humana together accounting for 46% of all Medicare Advantage enrollees nationwide. In nearly a third of US counties, these two companies account for at least 75% of Medicare Advantage enrollments.
  • In 2022, nearly 7 in 10 Medicare Advantage enrollees (69%) are in plans with prescription drug coverage (MA-PD) that require no premium other than the Medicare Part B premium ($170.10 in 2022 ).
  • Almost all enrollees in individual Medicare Advantage plans open to general enrollment have access to some benefits not covered by traditional health insurance, including eye exams and/or glasses (99%), exams and/or or hearing aids (98%) and a fitness benefit. (98%).
  • Virtually all Medicare Advantage enrollees (99%) are in plans that require pre-authorization for certain services. Prior authorization is most often required for relatively expensive services, such as prescription drugs administered by a physician (Part B drugs; 99%), stays in a skilled nursing facility (98%) and stays hospital (acute: 98%; psychiatric: 94%). %), but it is rarely required for preventive services (6%).
  • Federal spending on Medicare Advantage bonus payments has increased every year since 2015 and will reach at least $10 billion in 2022. Payments vary by company, with UnitedHealthcare receiving the largest total payments (2, $8 billion) and Kaiser Permanente receiving the highest payout per enrollee ($521). ). (KFF is an independent, nonprofit organization that analyzes national health issues and is not affiliated with Kaiser Permanente.) Recently, the Medicare Payment Advisory Commission (MedPAC) and others have raised questions about whether the bonus program includes too many measures, does not take into account social risk factors and may not be a useful quality indicator for the beneficiaries.

Full scans are available online and include:

(KFF has adjusted its methodology from previous years to calculate the share of eligible Medicare beneficiaries enrolled in Medicare Advantage, which means they must have both Part A and Part B coverage. This aligns with how the Medicare Payment Advisory Commission (MedPAC) and others describe this population. The share of Medicare Advantage enrollees would be somewhat smaller with the old method. See methods section of analysis.)

For more data and analysis on Medicare Advantage, visit kff.org

About Bradley J. Bridges

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