A new analysis shows that nearly half of all Medicare beneficiaries will enroll in Medicare Advantage plans by 2022, and more than 28 million people will use the program. The Kaiser Family Foundation published a new analysis recently that revealed nearly half of federal Medicare spending had been spent on Medicare Advantage, including quality bonuses.
According to these findings, the Massachusetts insurance market has become increasingly profitable. The KFF’s senior policy analyst is Meredith Freed. He stated that one of the main factors driving enrollment was the increased number of insurance companies offering extra benefits such as dental, vision, and over-the-counter drug benefits, transportation, and meals.
“We don’t know much about how people use them, how they work for people, and if they lower healthcare costs for plans that used taxpayer money to provide these benefits.”
The foundation reviewed data from the Centers for Medicare & Medicaid Service (CMS) regarding enrollment and benefits in MA. Kaiser discovered that the percentage of Medicare beneficiaries who choose an MA plan doubled between 2007 and 2018, from 19% in 2007 to 48% by 2022.
The Congressional Budget Office had previously projected that Medicare beneficiaries in MA would rise to 61% by 2032. Most MA beneficiaries (66%) are in an individual plan selected by general enrollment, 18% are in an employee or union-sponsored program, and 16% are in special needs plans. The number of special-needs plans has increased slightly, from 3.8 million in 2021 to 4.62 million this year.
Kaiser’s analysis revealed some well-established players in the MA market, even though it has been more attractive to insurance companies. For example, UnitedHealthcare and Humana make up 46% of MA enrollment, and UnitedHealthcare holds the largest market share, with 7.9 million MA enrollments this year.
This makes up 28% of the total market share. Humana has 5,000,000 enrollees, which is an 18% share. According to the study, 75% of MA enrollees are from Humana and UHC. Blue Cross and Blue Shield affiliates account for 14%. Another 24% comprises four companies, Cigna Centene Kaiser Permanente, CVS Health, Cigna, and Centene. In the sixth year of UnitedHealthcare’s MA, enrollment grew by almost 750,000 people between March 2021 and March 2022. Centene was the beneficiary with the second largest growth, adding 306,000 beneficiaries.
Market power is concentrated on a handful of Medicare plans, so smaller entrants might have to take extreme measures to gain entry. Freed stated, “we have seen some plans try better benefits, lower cost-sharing, and other incentives to get people signed up.” She wondered if such initiatives would be sufficient to sustain a startup or if smaller startups would have difficulty in profitability.
Kaiser also found that almost all MA Medicare enrollees have a plan that requires prior authorization to receive certain services. This finding comes as a federal watchdog raises questions about the extent of prior authorization denials that might fit within Medicare’s coverage requirements. High star ratings increase. Kaiser discovered that 86% of MA enrollees this year are in plans with four or more stars, an increase of 73% in 2021. This is the highest number of people enrolled in a plan with four stars or more since 2015.
Kaiser stated that plans with at least four stars or plans without ratings could be eligible for bonus payments for enrollees in the next year. According to the analysis, there are several possible reasons for this significant increase. Star ratings are calculated using data from the prior year, and CMS has changed its calculations due to the COVID-19 pandemic. Kaiser wrote that ratings would be reverted to the 2021 value for some measures to keep plans harmless.
Kaiser stated these changes might be responsible for rising enrollees in high-star rating plans. The Medicare Payment Advisory Commission and other experts have examined risk adjustment practices in MA plans. They question whether plans have used chart reviews to increase risk scores or get a higher rating or quality bonus payment. The analysis stated that MA would continue to receive higher payments. This will require information about service utilization and out-of-pocket spending to ensure MA “meets its goals in terms of value and quality.”
For eligible Medicare beneficiaries interested in enrolling in a high-quality Medicare Advantage plan or original Medicare, you should consider looking into MedicareConsumer.com today. You can compare several free rate quotes from top Medicare insurance providers within minutes.