Two new KFF issue briefs examine trends in the Medicare Advantage (MA) market in 2024.
The first analysis looks at current information about MA enrollment, by plan type and organization, and shows how enrollment varies by state and county. The second brief looks at MA premiums, out-of-pocket limits, supplemental benefits offered, and prior authorization requirements in 2024.
Here are the highlights:
- Fifty-four percent of eligible Medicare beneficiaries are enrolled in MA in 2024. The share of Medicare beneficiaries in MA plans varies across states, ranging from two percent to 63 percent. In seven states, Alabama, Connecticut, Mississippi, Hawaii, Maine, Florida, and Rhode Island (and Puerto Rico), 60 percent or more of all Medicare beneficiaries are enrolled in MA plans, an increase from three states in 2023.
- More than one-third (37 percent) of Medicare beneficiaries live in a county where at least 60 percent of all Medicare beneficiaries are enrolled in MA plans. Three counties (excluding those in Puerto Rico) enroll 80 percent or more of Medicare beneficiaries in MA plans: Monroe County, N.Y. (Rochester; 82 percent), Starr, Texas (81 percent), and Miami-Dade County, Fla. (80 percent). At the same time, eight percent of all Medicare beneficiaries nationwide live in a county with relatively low enrollment, where less than one third of all Medicare beneficiaries are enrolled in MA plans. The wide variation in county enrollment rates reflect several factors, such as differences in firm strategy, urbanicity of the county, Medicare payment rates, number of Medicare beneficiaries, health care use patterns, and historical MA market penetration.
- MA enrollment is highly concentrated among a small number of insurers, with UnitedHealthcare and Humana accounting for nearly half (47 percent) of all MA enrollees nationwide. In more than a quarter of all U.S. counties (29 percent or 931 counties), these two organizations account for at least 75 percent of MA enrollment. Since 2017, the market share for UnitedHealthcare and CVS Health has increased (25 percent to 29 percent and eight percent to 12 percent, respectively), Humana (18 percent) and Cigna (two percent) have held steady, while other firms’ share of total enrollment has slightly decreased (Blue Cross Blue Shield (BCBS) affiliates, Kaiser Permanente, and Centene). Small carriers (which each account for less than two percent of enrollment) have a smaller share of the market in 2024 than in 2017 (19 percent to 16 percent).
- Seventy-five percent of enrollees in individual MA plans with prescription drug coverage pay no premium other than the Medicare Part B premium.
- Most MA enrollees are in plans that offer supplemental benefits not covered by traditional Medicare, such as vision, hearing, and dental.
- Nearly all MA enrollees (99 percent) are in plans that require prior authorization for some services.