MA will become the predominant form of coverage for Medicare beneficiaries, report finds - MedCity News

Almost half of Medicare beneficiaries, or 48%, are enrolled in Medicare Advantage plans. As early as next year, this number may cross the threshold of 50%, a report published on Thursday predicted.

The Kaiser Family Foundation analysis also found that in 2022, graduate enrollment would account for $427 billion, or 55%, of all federal Medicare spending. The report used data from the Centers for Medicare & Medicaid Services for its study.

MA enrollment has more than doubled since 2007, when it was just 19 percent of the Medicare population, the report said. Between 2021 and 2022, enrollment in master’s programs increased by 8%, or by 2.2 million beneficiaries. That’s down slightly from the previous year, when enrollment grew by 10%. The Congressional Budget Office projects that by 2032, MA enrollees will make up 61% of the Medicare population.

UnitedHealthcare and Humana account for nearly half of all MA enrollees this year. UnitedHealthcare has 28% of total master’s degree enrollment and Humana has 18%. In about one-third of all US counties, payers account for at least 75% of MA enrollees.

Meanwhile, Blue Cross Blue Shield has 14% of MA enrollees, CVS Health has 11%, Kaiser Permanente has 6%, Centene has 5%, Cigna has 2%, and the remaining 16% is made up of other insurers.

UnitedHealthcare and Humana have historically had the highest share of graduate enrollment. In 2010, UnitedHealthcare had 20% of MA beneficiaries and Humana had 16%. UnitedHealthcare also posted its biggest growth since 2010.

KFF also found:

  • About two-thirds of MA enrollees, or 66%, are in individual plans. Meanwhile, 18% are in employer/union sponsored group plans and 16% are in special needs plans.
  • The proportion of Medicare beneficiaries enrolled in MA plans varies by state. This year, Alaska has the lowest rate with 1% MA enrollment, while Hawaii has the highest with 59% MA enrollment.
  • In 2022, nearly seven in 10 MA enrollees are in plans with prescription drug coverage that do not require premiums other than the Medicare Part B premium. This was reported in a separate analysis by KFF, also published on Thursday.
  • Most enrollees in individual MA plans have access to benefits not covered by traditional Medicare. This includes eye exams, hearing exams and fitness.
  • Almost all MA enrollees, or 99%, are in plans that require prior authorization for some services. This refers to a process used by insurers to determine whether they will cover a particular procedure or drug. It’s mostly used for expensive services, such as prescription drugs dispensed by a doctor, skilled nursing facility stays and inpatient hospital stays, KFF found. However, it is rarely needed for preventive services.

Photo: designer491, Getty Images

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