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Medicare Advantage enrollment has increased steadily over the past two years after policy changes were made to encourage a stronger role for private plan options in Medicare. After a period of some instability in plan participation and enrollment, the Insurance Reform Act of 2003 created stronger financial incentives for plans to participate in the program nationwide and renamed private Medicare plans Health Benefit. By 2023, 30.8 million people will be enrolled in a Medicare Advantage plan, representing more than half, or 51 percent, of the Medicare-eligible population and $454 billion (or 54%) of total Medicare spending federal government (without profits). The average Medicare beneficiary in 2023 has access to 43 Medicare Advantage plans, the largest number of options ever.
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To better understand the program's growth trends, this brief provides updated information on Medicare Advantage enrollment by plan type and company, and shows how enrollment varies by state and locality. A second, peer-reviewed analysis describes Medicare Advantage premiums, out-of-pocket limits, cost sharing, additional benefits offered, prior authorization requirements and star ratings in 2023.
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By 2023, more than half (51%) of eligible Medicare beneficiaries—30.8 million people out of 60.0 million Medicare beneficiaries including both Medicare Parts A and B—are enrolled in Medicare Advantage plans. Insurance Benefit enrollment as a share of the Medicare population jumped from 19% in 2007 to 51% in 2023 (Figure 1).
Between 2022 and 2023, total Insurance Benefit enrollment increased by about 2.3 million beneficiaries, or 8 percent—a growth rate similar to the previous year (8%). The Congressional Budget Office (CBO) projects that the share of all Medicare beneficiaries enrolled in Medicare Advantage plans will increase to 62 percent by 2033 (Figure 2).
By 2023, nearly two-thirds of Medicare Advantage enrollees will be in individual plans that are open to public enrollment.
Nearly two-thirds (64%) of Medicare Advantage enrollees, or 19.6 million people, are in general plans that offer all benefits for individual enrollees (Figure 3). That's an increase of 0.9 million enrollments compared to 2022. Individual plans make up the same share of total Medicare Advantage enrollments as in 2018.
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One in five (about 5.4 million) Medicare Advantage enrollees are in a group plan offered to retirees by an employer or group.
While this is roughly the same percentage of total Medicare Enrollments since 2010 (18%), the actual number has increased from 1.8 million in 2010 to 5.4 million in 2023 (Figure 4). With a group plan, an employer or group contracts with an insurer, and Medicare pays the insurer a fixed amount for enrollment to provide Medicare-covered benefits. For example, some states, such as Illinois and Pennsylvania, provide health insurance benefits to Medicare-eligible retirees exclusively through Medicare Advantage plans.
As with other Medicare Advantage plans, employer and union plans may provide additional benefits and/or lower cost sharing than traditional Medicare and are eligible for bonus payments if they receive the required quality scores. The employer or union (and sometimes the retiree) may also pay additional premiums for these additional benefits. Group participants make up a third or more of Medicare Enrollment in five states: Alaska (99%), Michigan (40%), New Jersey (34%), Maryland (33%), and West Virginia (33 %).
More than 5.7 million Medicare beneficiaries are enrolled in special needs plans by 2023, double the number enrolled in 2018.
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More than 5.7 million health beneficiaries are registered in special needs programs (SNPs). SNPs limit enrollment to specific beneficiary types with special or specialized care needs or those who qualify because they are eligible for both Medicare and Medicaid. SNP enrollment increased 24% between 2022 and 2023 to account for 19% of total Medicare Advantage enrollment by 2023. In 2018, SNP enrollment doubled from 2.58 million to 5.74 million (Figure 5).
The majority of SNP enrollees (89%) are in dual beneficiary plans enrolled in Medicare and Medicaid (D-SNP). Another 9 percent of SNP enrollments are in plans for people with chronic or disabling conditions (C-SNP), and 2 percent are in plans for beneficiaries who need a nursing home or institutional care level (I -SNP).
While D-SNPs are designed specifically for dual-eligible individuals, 1.9 million Medicare beneficiaries with Medicaid are enrolled in Medicare Advantage plans in 2020 that are generally available to all beneficiaries (not designated important for this population), while 2.9 million are in the D- SNP.
Registration in the SNP varies from state to state. In the District of Columbia and Puerto Rico, SNPs make up half of all Medicare Advantage enrollees (48% in DC and 49% in PR). In 12 states, SNP enrollment accounts for less than one-fifth of Medicare Advantage enrollment (39% in MS, 31% in AR and LA, 30% in NY, 26% in FL and GA, 24% in CT, 22% in SC and AL, 21% in HI and 20% in TX and AZ). Most (96%) C-SNP enrollees (about 446,000 people) are in programs for people with diabetes or cardiovascular disease in 2023. I-SNP enrollment is increasing slightly, with about 103,000 in 2023. about 92,700 in 2022.
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Share of Medicare Benefits in Medicare Benefit Plans Varies by State and Territory The share of Medicare benefits in Medicare Benefit plans varies by state, ranging from 2% to 60%.
In three states (AL, HI, and MI) and Puerto Rico, 60 percent or more of all Medicare beneficiaries are enrolled in Medicare Advantage plans, and in 26 states (and Puerto Rico) the The Medicare Advantage benefit is at least half of the total. Health Care Benefits (Figure 6). In contrast, Medicare Advantage enrollment is low (less than 40%) in 16 states and the District of Columbia, with mostly rural states (SD, ND, WY, and AK) with less than 20 percent of beneficiaries enrolled. you are enrolled in Medicare. Benefits Plan. Overall, Puerto Rico has the highest Medicare Advantage penetration, with 94 percent of Medicare beneficiaries enrolled in the Medicare Advantage program. In the past decade, the share of health benefits in Medicare Advantage plans did not exceed 50% in any state (except Puerto Rico).
For example, in Florida, 58% of all Medicare beneficiaries in the state are enrolled in Medicare Benefit, ranging from 20% in Monroe County (Key West) to 79% in Miami-Dade County (Figure 7). In Ohio, 54% of all Medicare beneficiaries are enrolled in Medicare, ranging from 31% in Mercer County (Celina) to 67% in Stark County (Canton).
By 2023, 3 in 10 (31%) Medicare beneficiaries live in a county where at least 60 percent of all Medicare beneficiaries in that county are enrolled in Medicare Advantage plans (473 counties). That's up from 2010, when just 3 percent of the Medicare population lived in a county where 60 percent or more of Medicare beneficiaries were enrolled in the Medicare Advantage Plan (83 counties). Many areas with high Medicare Advantage penetration are concentrated around large metropolitan areas, such as Monroe County, NY (80%), which includes Rochester, and Allegheny County, PA (73%). which includes Pittsburgh. In contrast, 1 in 10 (10%) Medicare beneficiaries live in a county where less than one-third of all Medicare beneficiaries in that county are enrolled in Medicare Advantage plans (967 counties). Districts with a small number of students tend to be smaller rural districts. However, others, such as Montgomery County, MD (25%) and Suffolk, NY (29%), which includes most of Long Island, are located in more areas.
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The difference in the percentage of eligible Medicare beneficiaries enrolled in the Medicare Advantage program is explained by a combination of factors, including firm-level strategies that target specific geographic, regional and urban areas, differences in Medicare payment rates, and number and characteristics. of people eligible for Medicare, health care utilization patterns, and Advantage's historical market penetration.
The average Medicare beneficiary can choose from Medicare Advantage plans offered by 9 companies by 2023, and four in ten (40%) beneficiaries can choose from among Medicare Advantage plans offered by 10 or more companies .
Despite the fact that many beneficiaries have access to plans operated by many different companies, Medicare Advantage registration is highly concentrated among a small number of companies. UnitedHealthcare alone accounts for 29% of all Medicare Advantage enrollments in 2023, or 8.9 million enrollments. Combined, UnitedHealthcare and Humana account for nearly half (47%) of all Medicare Advantage enrollments nationwide. In nearly a third of counties (32%; or 1,013 counties), these two agencies account for at least 75% of Medicare Advantage enrollment. These counties include 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 (77%).
BCBS affiliates (including Anthem BCBS plans) account for 14 percent of enrollment, and four companies (CVS Health, Kaiser Permanente, Centene and Cigna) account for another 23 percent of enrollment in 2022.
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UnitedHealthcare had the largest share of Medicare Advantage enrollment and the largest enrollment growth since 2010, growing from 20 percent
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