Medicare Benefit in 2022: Enrollment Replace and Key Tendencies

August 25, 2022

Since 2006, the position of Medicare Benefit, the non-public plan various to conventional Medicare, has steadily grown. In 2022, greater than 28 million persons are enrolled in a Medicare Benefit plan, accounting for practically half or 48 p.c of the eligible Medicare inhabitants, and $427 billion (or 55%) of complete federal Medicare spending (internet of premiums). The common Medicare beneficiary in 2022 has entry to 39 Medicare Benefit plans, the most important variety of choices obtainable in additional than a decade.

To raised perceive developments within the progress of this system, this transient offers present details about Medicare Benefit enrollment, together with the kinds of plans through which Medicare beneficiaries are enrolled, and the way enrollment varies throughout geographic areas. A second, companion evaluation describes Medicare Benefit premiums, out-of-pocket limits, value sharing, further advantages provided, prior authorization necessities, and star rankings in 2022.

The share of eligible Medicare beneficiaries enrolled in Medicare Benefit has greater than doubled since 2007

In 2022, practically half of (48%) eligible Medicare beneficiaries – 28.4 million individuals out of 58.6 million Medicare beneficiaries total – are enrolled in Medicare Benefit plans. Medicare Benefit enrollment as a share of the eligible Medicare inhabitants has greater than doubled from 2007 to 2022 (19% to 48%). KFF now calculates the share of eligible Medicare beneficiaries enrolled in Medicare Benefit, that means they will need to have each Half A and B protection. This impacts each 2022 information in addition to developments over time. The share could be considerably smaller if based mostly on the whole Medicare inhabitants that features 5.7 million beneficiaries with Half A solely or Half B solely who should not usually eligible to enroll in a Medicare Benefit plan. See strategies for extra particulars.

Between 2021 and 2022, complete Medicare Benefit enrollment grew by about 2.2 million beneficiaries, or 8 p.c – a barely slower progress charge than the prior yr (10%). The Congressional Finances Workplace (CBO) initiatives that the share of all Medicare beneficiaries enrolled in Medicare Benefit plans will rise to 61 p.c by 2032 (Determine 2).

In 2022, two-thirds of Medicare Benefit enrollees are in particular person plans which might be open for basic enrollment

Two-thirds (66%) of Medicare Benefit enrollees, or 18.7 million individuals, are in plans usually obtainable to all beneficiaries for particular person enrollment. That is a rise of 1.3 million enrollees in comparison with 2021. Particular person plans have accounted for about the identical share of complete Medicare Benefit enrollment since 2018.

Practically one in 5 Medicare Benefit enrollees (18%) are in group plans provided to retirees by employers and unions in 2022

Practically 5.1 million Medicare Benefit enrollees are in a gaggle plan provided to retirees by an employer or union. Whereas that is roughly the identical share of enrollment since 2010 (18%), the precise quantity has elevated from 1.8 million in 2010 to five.1 million in 2022 (Determine 4). With a gaggle plan, an employer or union contracts with an insurer and Medicare pays the insurer a hard and fast quantity per enrollee to offer advantages coated by Medicare. For instance, some states, reminiscent of Illinois and Pennsylvania, present medical health insurance advantages to their Medicare-eligible retirees completely by way of Medicare Benefit plans. As with different Medicare Benefit plans, employer and union group plans typically present further advantages and/or decrease value sharing than conventional Medicare and are eligible for bonus funds. The employer or union (and typically the retiree) may additionally pay a further premium for these supplemental advantages. Group enrollees comprise a disproportionately massive share of Medicare Benefit enrollees in six states: Alaska (99%), Michigan (42%), Maryland (36%), West Virginia (35%), New Jersey (35%), and Illinois (30%).

Greater than 4.6 million Medicare beneficiaries are enrolled in Particular Wants Plans in 2022

Greater than 4.6 million Medicare beneficiaries are enrolled in Particular Wants Plans (SNPs). SNPs prohibit enrollment to particular kinds of beneficiaries with important or comparatively specialised care wants, or who qualify as a result of they’re eligible for each Medicare and Medicaid. Nearly all of SNP enrollees (89%) are in plans for beneficiaries dually enrolled in each Medicare and Medicaid (D-SNPs). One other 9 p.c of SNP enrollees are in plans for individuals with extreme continual or disabling circumstances (C-SNPs) and a pair of p.c are in plans for beneficiaries requiring a nursing dwelling or institutional degree of care (I-SNPs).

Whereas D-SNPs are designed particularly for dually-eligible beneficiaries, 1.9 million Medicare beneficiaries with Medicaid had been enrolled in non-SNP Medicare Benefit plans in 2020 (the latest yr for which this information is on the market).

Enrollment in SNPs elevated from 3.8 million beneficiaries in 2021 to 4.6 million beneficiaries in 2022 (20% enhance), and accounts for about 16% of complete Medicare Benefit enrollment in 2022, up from 11% in 2011, with some variation throughout states. Within the District of Columbia and Puerto Rico, SNPs comprise about half of all Medicare Benefit enrollees (47% in DC and 48% in PR). In 11 states, SNP enrollment accounts for about one-fifth of Medicare Benefit enrollment (29% in MS, 27% in NY and in LA, 24% in AR and in FL, 23% in GA, 22% in SC, 21% in CT, and 20% in TN, in AZ, and in HI). Greater than 95% of C-SNP enrollees (about 380,000 individuals) are in plans for individuals with diabetes or cardiovascular circumstances in 2022. Enrollment in I-SNPs has been rising barely, however continues to be fewer than 100,000.

The share of Medicare beneficiaries in Medicare Benefit plans, by state, ranges from 1% to 59%

The share of Medicare beneficiaries in Medicare Benefit plans varies throughout the nation, however in 25 states, at the very least half of all Medicare beneficiaries are enrolled in Medicare Benefit plans. In distinction, Medicare Benefit enrollment is comparatively low (lower than 20 p.c) in 4 principally rural states (SD, ND, WY, and AK). General, Puerto Rico has the best Medicare Benefit penetration, with 93 p.c of Medicare beneficiaries enrolled in a Medicare Benefit plan. This can be due partially to the excessive share of beneficiaries in Puerto Rico with low incomes who’re dually enrolled in Medicare and Medicaid, as famous above.

The share of Medicare beneficiaries in Medicare Benefit plans varies extensively throughout counties

The share of Medicare beneficiaries enrolled in Medicare Benefit varies extensively throughout counties. For instance, in Florida, 56% of all Medicare beneficiaries within the state are enrolled in Medicare Benefit, starting from 19% in Monroe County (Key West) to 78% in Miami-Dade County. In Ohio, 52% of all Medicare beneficiaries are enrolled in Medicare Benefit, with the share starting from 30% in Mercer County (Celina) to 64% in Stark County (Canton).

In 2022, one in 5 (21%) Medicare beneficiaries dwell in a county the place at the very least 60 p.c of all Medicare beneficiaries in that county are enrolled in Medicare Benefit plans (321 counties). That’s considerably greater than in 2010 when simply 3 p.c of the Medicare inhabitants lived in a county the place 60 p.c or extra of Medicare beneficiaries had been enrolled in a Medicare Benefit plan (83 counties). Many counties with excessive Medicare Benefit penetration are centered round comparatively massive, city areas, reminiscent of Monroe County, NY (78%), which incorporates Rochester, and Allegheny County, PA (72%), which incorporates Pittsburgh. Nevertheless, some city areas, reminiscent of Baltimore Metropolis, MD (33%), Charleston, SC (33%), and Cook dinner County, IL (Chicago, 39%) have decrease Medicare Benefit enrollment.

UnitedHealthcare and Humana account for practically half of all Medicare Benefit enrollees nationwide in 2022

Medicare Benefit enrollment is very concentrated amongst a small variety of corporations. UnitedHealthcare and Humana collectively account for 46 p.c of all Medicare Benefit enrollees nationwide. In practically a 3rd of counties (29%; or 945 counties), these two corporations account for at the very least 75% of Medicare Benefit enrollment. (BCBS associates (together with Anthem BCBS plans) account for 14 p.c of enrollment, and 4 corporations (CVS Well being, Kaiser Permanente, Centene, and Cigna) account for an additional 24 p.c of enrollment in 2022.

UnitedHealthcare and Humana have constantly accounted for a comparatively massive share of Medicare Benefit enrollment

UnitedHealthcare has had the most important share of Medicare Benefit enrollment and largest progress in enrollment since 2010, rising from 20 p.c of all Medicare Benefit enrollment in 2010 to twenty-eight p.c in 2022. Humana has additionally had a excessive share of Medicare Benefit enrollment, although its share of enrollment has grown extra slowly, from 16 p.c in 2010 to 18 p.c in 2022. BCBS plans share of enrollment has been extra fixed over time, however has declined reasonably since 2014. CVS Well being, which bought Aetna in 2018, has seen its share of enrollment practically double from 6 p.c in 2010 to 11 p.c in 2022. Kaiser Permanente now accounts for six% of complete enrollment, a reasonable decline as a share of complete since 2010 (9%), primarily as a result of progress of enrollment in plans provided by different insurers and solely a modest enhance in enrollment progress for Kaiser Permanente over that point. Nevertheless, for these insurers which have seen declines of their total share of enrollment, the precise variety of enrollees for every insurer is bigger than it was in 2010.

For the sixth yr in a row, enrollment in UnitedHealthcare’s plans grew greater than every other agency, rising by greater than 749,000 beneficiaries between March 2021 and March 2022. Centene had the second largest progress in plan yr enrollment, which was rather less than half of UnitedHealthcare’s with a rise of about 306,000 beneficiaries between March 2021 and March 2022. BCBS plans had the third highest progress in plan yr enrollment of 293,000 beneficiaries between March 2021 and March 2022. CVS Well being had the fourth largest progress in plan enrollment with a rise of about 282,000, adopted by Humana, rising by about 250,000 beneficiaries between March 2021 and March 2022. Nevertheless, Cigna truly misplaced enrollees, declining by about 12,000 between March 2021 and March 2022.

Dialogue

Medicare Benefit enrollment has elevated steadily since 2006, with practically half (48%) of all eligible Medicare beneficiaries enrolled in Medicare Benefit plans in 2022. The share of Medicare Benefit enrollees varies throughout the nation: in 25 states and Puerto Rico, at the very least 50 p.c of Medicare beneficiaries are enrolled in Medicare Benefit plans in 2022. In a rising variety of counties, 60 p.c or extra of all Medicare beneficiaries are in a Medicare Benefit plan, in lieu of conventional Medicare. Enrollment continues to be extremely concentrated amongst a handful of corporations, each nationally and in native markets, with UnitedHealthcare and Humana collectively accounting for 46 p.c of enrollment in 2022.

As Medicare Benefit takes on an excellent bigger presence within the Medicare program, and with present funds to plans increased for Medicare Benefit than for conventional Medicare for comparable beneficiaries, it is going to be more and more vital to evaluate how effectively Medicare’s present fee methodology for Medicare Benefit is working to boost effectivity and maintain down beneficiary prices and Medicare spending. It’ll even be vital to watch how effectively beneficiaries are being served in each Medicare Benefit and conventional Medicare, by way of prices, advantages, high quality of care, affected person outcomes, and entry to suppliers, with explicit consideration to these with the best wants.

Meredith Freed, Jeannie Fuglesten Biniek, Tricia Neuman are with KFF.

Anthony Damico is an impartial advisor.

This evaluation makes use of information from the Facilities for Medicare & Medicaid Providers (CMS) Medicare Benefit Enrollment, Profit and Panorama recordsdata for the respective yr. KFF makes use of the Medicare Enrollment Dashboard for enrollment information, from March of every yr.

In earlier years, KFF had calculated the share of Medicare beneficiaries enrolled in Medicare Benefit by together with Medicare beneficiaries with both Half A and/or B protection. We now have modified our method this yr to estimate the share enrolled amongst beneficiaries eligible for Medicare Benefit who’ve each Medicare Half A and Medicare B. Up to now, the variety of beneficiaries enrolled in Medicare Benefit was smaller and subsequently the distinction between the share enrolled with Half A and/or B vs Half A and B was additionally smaller. For instance, in 2010, 24% of all Medicare enrollees had been in enrolled in Medicare Benefit versus 25% with simply Components A and B. Nevertheless, these shares have diverged over time: in 2022, 44% of all Medicare enrollees had been in enrolled in Medicare Benefit versus 48% with simply Components A and B. These modifications are mirrored in each the 2022 information and in information displayed trending again to 2010.

Moreover, in earlier years, KFF had used the time period Medicare Benefit to check with Medicare Benefit plans in addition to different kinds of non-public plans, together with value plans, PACE plans, and HCPPs. Nevertheless, value plans, PACE plans, HCPPs at the moment are excluded from this evaluation along with MMPs. On this evaluation, KFF excludes these different plans as some might have totally different enrollment necessities than Medicare Benefit plans (e.g., could also be obtainable to beneficiaries with solely Half B protection) and in some instances, could also be paid otherwise than Medicare Benefit plans. These exclusions are mirrored in each the 2022 information and in information displayed trending again to 2010.

Enrollment counts in publications by corporations working within the Medicare Benefit market, reminiscent of firm monetary statements, would possibly differ from KFF estimates as a result of inclusion or exclusion of sure plan varieties, reminiscent of SNPs or employer group well being plans.

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