Over the past decade, the position of Medicare Benefit, the personal plan different to conventional Medicare, has grown. In 2021, greater than 26 million individuals are enrolled in a Medicare Benefit plan, accounting for 42 % of the overall Medicare inhabitants, and $343 billion (or 46%) of whole federal Medicare spending (internet of premiums). The typical Medicare beneficiary in 2021 has entry to 33 Medicare Benefit plans, the most important variety of choices obtainable within the final decade.
To higher perceive developments within the progress of this system, this temporary gives present details about Medicare Benefit enrollment, together with the forms of plans wherein Medicare beneficiaries are enrolled, and the way enrollment varies throughout geographic areas. A second, companion evaluation describes Medicare Benefit premiums, out-of-pocket limits, price sharing, further advantages provided, and prior authorization necessities in 2021. A 3rd evaluation compares Medicare Benefit plans’ star scores and federal spending underneath the standard bonus program.
Enrollment in Medicare Benefit has greater than doubled over the previous decade
In 2021, greater than 4 in ten (42%) Medicare beneficiaries – 26.4 million folks out of 62.7 million Medicare beneficiaries total – are enrolled in Medicare Benefit plans; this share has steadily elevated over time for the reason that early 2000s. Between 2020 and 2021, whole Medicare Benefit enrollment grew by about 2.4 million beneficiaries, or 10 % – almost the identical progress charge because the prior yr. The Congressional Finances Workplace (CBO) initiatives that the share of all Medicare beneficiaries enrolled in Medicare Benefit plans will rise to about 51 % by 2030 (Determine 2)
In 2021, two-thirds of Medicare Benefit enrollees are in particular person plans
Two-thirds (67%) of Medicare Benefit enrollees, or 17.7 million folks, are plans usually obtainable for particular person enrollment. That is a rise of 1.6 million enrollees in comparison with 2020. Particular person plans have accounted for about the identical share of whole Medicare Benefit enrollment since 2014.
Almost one in 5 Medicare Benefit enrollees (19%) are in group plans provided to retirees by employers and unions in 2021
Almost 4.9 million Medicare Benefit enrollees are in a bunch plan provided to retirees by an employer or union. Whereas that is roughly the identical share of enrollment since 2014 (19%), the precise quantity has elevated from 1.9 million in 2010 to 4.9 million in 2021 (Determine 4). With a bunch plan, an employer or union contracts with an insurer and Medicare pays the insurer a hard and fast quantity per enrollee to supply advantages coated by Medicare. For instance, some states, equivalent to Illinois and Pennsylvania, present medical health insurance advantages to their Medicare-eligible retirees completely via Medicare Benefit plans. As with different Medicare Benefit plans, employer and union group plans typically present further advantages and/or decrease price sharing than conventional Medicare. The employer or union (and generally the retiree) might also pay an extra premium for these supplemental advantages. Group enrollees comprise a disproportionately giant share of Medicare Benefit enrollees in eight states: Alaska (100%), Michigan (45%), Maryland (39%), West Virginia (39%), New Jersey (37%), Wyoming (35%), Illinois (32%), and Kentucky (31%).
Nearly 4 million Medicare beneficiaries are enrolled in Particular Wants Plans in 2021
Almost 4 million Medicare beneficiaries are enrolled in Particular Wants Plans (SNPs). SNPs prohibit enrollment to particular forms of beneficiaries with important or comparatively specialised care wants, or who qualify as a result of they’re eligible for each Medicare and Medicaid. The vast majority of SNP enrollees (88%) are in plans for beneficiaries dually eligible for Medicare and Medicaid (D-SNPs). One other 10 % of SNP enrollees are in plans for folks with extreme power or disabling circumstances (C-SNPs) and a couple of % 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, 1.5 million Medicare beneficiaries with Medicaid had been enrolled in non-SNP Medicare Benefit plans in 2019 (the latest yr for which this knowledge is out there).
Enrollment in SNPs elevated from 3.3 million beneficiaries in 2020 to three.8 million beneficiaries in 2021 (15% improve), and accounts for about 15% of whole Medicare Benefit enrollment in 2021, up from 11% in 2010, with some variation throughout states. Within the District of Columbia and Puerto Rico, SNPs comprise about half of all Medicare Benefit enrollees (54% in DC and 47% in PR). In eight states, SNP enrollment accounts for about one-fifth of Medicare Benefit enrollment (25% in NY, 23% in LA and in MS, 22% in SC and in GA, 21% in AR and in FL, and 20% in TN). Almost 95% of C-SNP enrollees (about 362,000 folks) are in plans for folks with diabetes or cardiovascular circumstances in 2021. Enrollment in I-SNPs has been growing however barely declined in 2021 and continues to be fewer than 100,000.
The share of Medicare beneficiaries in Medicare Benefit plans, by state, ranges from 1% to over 50%, and varies considerably inside states
The share of Medicare beneficiaries in Medicare Benefit plans varies throughout the nation. No less than 50 % of Medicare beneficiaries are enrolled in Medicare Benefit plans in two states (MN, FL) and Puerto Rico. Puerto Rico has the very best Medicare Benefit penetration, with 80 % of Medicare beneficiaries enrolled in a Medicare Benefit plan. Moreover, in 24 states, no less than 40 % of Medicare beneficiaries are enrolled in Medicare Benefit plans (AL, MI, HI, OR, WI, CT, GA, PA, ME, LA, CO, NY, CA, OH, TX, AZ, TN, RI, NC, NV, MO, UT, KY, NM). Medicare Benefit enrollment is comparatively low (lower than 20 %) in 4 states, Vermont, Maryland, and two largely rural states the place it’s just about non-existent (AK and WY).
Inside states, the share of Medicare beneficiaries enrolled in Medicare Benefit varies considerably throughout counties. For instance, in Florida, 51% of all Medicare beneficiaries within the state are enrolled in Medicare Benefit, and the share by county ranges from 16% in Monroe County (Key West) to 73% in Miami-Dade County. In Ohio, 45% of all Medicare beneficiaries are enrolled in Medicare Benefit, with the share by county starting from 27% in Mercer County (Celina) to 58% in Stark County (Canton). To discover this variation, click on on a state on the map in Determine 6.
Traditionally, the vast majority of Medicare personal well being plan enrollment in Minnesota has been in price plans, which aren’t Medicare Benefit plans, however are a kind of Medicare well being protection that has a few of the similar guidelines as Medicare Benefit plans, and are provided in restricted areas of the nation. Nevertheless, as of 2019, most price plans in Minnesota are now not provided and have been changed with risk-based HMOs and PPOs. In 2021, price plans signify about 11% of Medicare Benefit enrollment in Minnesota.
Almost three in ten Medicare beneficiaries dwell in a county the place greater than half of Medicare beneficiaries in that county are enrolled in a Medicare Benefit plan
In 2021, 29 % of all Medicare beneficiaries dwell in a county the place greater than half of Medicare beneficiaries in that county are enrolled in Medicare Benefit plans (446 counties). That’s considerably greater than in 2010 when simply 4 % of the Medicare inhabitants lived in a county the place greater than 50 % of Medicare beneficiaries had been enrolled in a Medicare Benefit plan (109 counties). Many counties with excessive Medicare Benefit penetration are centered round comparatively giant, city areas, equivalent to Monroe County, NY (71%), which incorporates Rochester, and Allegheny County, PA (64%), which incorporates Pittsburgh.
In distinction, in 383 counties, accounting for two % of Medicare beneficiaries, not more than 10 % of beneficiaries are enrolled in personal Medicare plans; many of those low penetration counties are in rural elements of the nation. Nevertheless, some city areas, equivalent to Baltimore Metropolis, MD (27%), Charleston, SC (27%), and Prepare dinner County, IL (Chicago, 31%) have low Medicare Benefit enrollment, in comparison with the nationwide common (42%).
To see how Medicare Benefit penetration has modified over time and to spotlight counties with no less than a minimal share of beneficiaries enrolled in Medicare Benefit, choose a Medicare Benefit penetration degree and regulate the yr utilizing the slider in Determine 7.
UnitedHealthcare and Humana account for almost half of all Medicare Benefit enrollees nationwide in 2021
Medicare Benefit enrollment is very concentrated amongst a small variety of corporations. UnitedHealthcare and Humana collectively account for 45 % of all Medicare Benefit enrollees nationwide, and the BCBS associates (together with Anthem BCBS plans) account for one more 14 % of enrollment in 2021. 4 corporations (CVS Well being, Kaiser Permanente, Centene, and Cigna) account for one more 23 % of enrollment in 2021.
UnitedHealthcare and Humana have constantly accounted for a big share of Medicare Benefit enrollment
UnitedHealthcare has had the most important share of Medicare Benefit enrollment since 2010. Its share of Medicare Benefit enrollment has grown from 19 % in 2010 to 27 % in 2021. Humana has additionally had a excessive share of Medicare Benefit enrollment, although its share of enrollment has grown extra slowly, from 16 % in 2010 to 18 % in 2021. BCBS plans share of enrollment has reasonably declined over time, initially rising from 15 % in 2010 to 17 % in 2011, however then declining to 14 % in 2021. CVS Well being, which bought Aetna in 2018, has seen its share of enrollment almost double from 6 % in 2010 to 11 % in 2021. Kaiser Permanente has seen its share of enrollment reasonably decline, from 9% in 2010 to 7% in 2021. The biggest decline has been for all different insurers (insurers which have lower than 2 % of enrollment), which has dropped from 26 % in 2010 to 17 % in 2021.
For the fifth yr in a row, enrollment in UnitedHealthcare’s plans grew greater than some other agency, growing by greater than 854,000 beneficiaries between March 2020 and March 2021. Humana’s improve in plan yr enrollment was about half of UnitedHealthcare’s, with a rise of about 395,000 beneficiaries between March 2020 and March 2021. BCBS associates had the third largest progress in plan enrollment with a rise of about 305,000 between March 2020 and March 2021. CVS Well being, which bought Aetna in 2018, had the fourth largest progress in Medicare Benefit enrollment in 2021, growing by about 242,000 beneficiaries between March 2020 and March 2021.
Medicare Benefit enrollment has steadily elevated each nationally and inside most states since 2005, with greater than 40 % of Medicare beneficiaries enrolled in Medicare Benefit plans in 2021. The share of Medicare Benefit enrollees varies throughout the nation: in 26 states and Puerto Rico, no less than 40 % of Medicare beneficiaries are enrolled in Medicare Benefit plans in 2021, and no less than 50 % in Florida, Minnesota and Puerto Rico. In a rising variety of counties, greater than half 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 45 % of enrollment in 2021.
As Medicare Benefit takes on an excellent bigger presence within the Medicare program, and because the Medicare Hospital Insurance coverage Belief Fund is at the moment projected to be bancrupt by 2026, will probably be more and more essential to evaluate how nicely Medicare’s present fee methodology for Medicare Benefit is working to reinforce effectivity and maintain down beneficiary prices and Medicare spending. It should even be essential to observe how nicely beneficiaries are being served in each Medicare Benefit and conventional Medicare, when it comes to prices, advantages, high quality of care, affected person outcomes, and entry to suppliers, with specific consideration to these with the best wants.
Meredith Freed, Jeannie Fuglesten Biniek, Tricia Neuman are with KFF.
Anthony Damico is an impartial guide.
|This evaluation makes use of knowledge from the Facilities for Medicare & Medicaid Companies (CMS) Medicare Benefit Enrollment, Profit and Panorama information for the respective yr. KFF is now utilizing the Medicare Enrollment Dashboard for enrollment knowledge, from March of every yr.
In earlier years, KFF has used the Medicare Benefit Penetration Recordsdata to calculate the variety of Medicare beneficiaries eligible for Medicare. The Medicare Benefit Penetration Recordsdata contains individuals who had been beforehand, however now not coated by Medicare (e.g., individuals who obtained employer-sponsored medical health insurance protection after initially enrolling in Medicare). It additionally contains folks inside 5 months of their sixty fifth birthday, however not but age 65. As well as, CMS recognized a difficulty the place beneficiaries with a number of addresses had been double counted within the Penetration File. KFF refined its strategy final yr and is utilizing the Medicare Enrollment Dashboard to calculate the variety of Medicare beneficiaries as a result of it solely contains Medicare beneficiaries with both Half A or Half B protection, which is a extra correct estimate of the Medicare inhabitants.
This evaluation makes use of the time period Medicare Benefit to seek advice from Medicare Benefit plans and different forms of personal plans, together with price and PACE plans. Nevertheless, MMPs are excluded from this evaluation. Enrollment counts in publications by corporations working within the Medicare Benefit market, equivalent to firm monetary statements, may differ from KFF estimates because of inclusion or exclusion of sure plan sorts, equivalent to SNPs or employer plans.