Medicare Advantage Is Close to Becoming the Predominant Way That Medicare Beneficiaries Get Their Health Coverage and Care

As Medicare Benefit continues to develop, a gradual however important reshaping of the Medicare program is going down.

A brand new KFF evaluation finds that just about half of eligible Medicare beneficiaries – 28.4 million out of 58.6 million Medicare beneficiaries general – at the moment are enrolled in Medicare Benefit plans. That represents a greater than doubling of the share of the eligible Medicare inhabitants enrolled in such plans from 2007 to 2022 (19% to 48%). Enrollment is projected to cross the 50 % threshold as quickly as subsequent yr, making Medicare Benefit the predominant method that Medicare beneficiaries with Elements A and B get their protection and care.

The rise of Medicare Benefit indicators the transformation of Medicare to a program during which a majority of individuals obtain advantages by enrolling in plans provided by non-public medical health insurance firms.

The brand new evaluation is one among three launched in the present day by KFF during which researchers study numerous elements of Medicare Benefit. It offers the newest information on Medicare Benefit enrollment, together with the kinds of plans during which Medicare beneficiaries are enrolled, and the way enrollment varies throughout geographic areas. A companion evaluation describes Medicare Benefit premiums, out-of-pocket limits, value sharing, additional advantages provided, and prior authorization necessities. A 3rd examines traits in bonus funds to Medicare Benefit plans, enrollment in plans in bonus standing, and the way these measures differ throughout plan varieties and corporations.

Amongst different key findings:

  • Enrollment in non-public plans is very concentrated amongst a small variety of corporations, with UnitedHealthcare and Humana collectively accounting for 46 % of all Medicare Benefit enrollees nationwide. In practically a 3rd of counties throughout the U.S., these two corporations account for no less than 75 % of Medicare Benefit enrollment.
  • In 2022, practically 7 in 10 Medicare Benefit enrollees (69%) are in plans with prescription drug protection (MA-PDs) that require no premium apart from the Medicare Half B premium ($170.10 in 2022).
  • Practically all enrollees in particular person Medicare Benefit plans open for common enrollment have entry to some advantages not coated by conventional Medicare, together with eye exams and/or glasses (99%), listening to exams and/or aids (98%), and a health profit (98%).
  • Just about all Medicare Benefit enrollees (99%) are in plans that require prior authorization for some providers. Prior authorization is most frequently required for comparatively costly providers, comparable to pharmaceuticals administered by a doctor (Half B medication; 99%), expert nursing facility stays (98%), and inpatient hospital stays (acute: 98%; psychiatric: 94%), however it’s hardly ever required for preventive providers (6%).
  • Federal spending on Medicare Benefit bonus funds has elevated yearly since 2015 and can attain no less than $10 billion in 2022. Funds differ throughout corporations, with UnitedHealthcare receiving the most important complete funds ($2.8 billion) and Kaiser Permanente receiving the best cost per enrollee ($521). (KFF is an unbiased, nonprofit group that analyzes nationwide well being points and isn’t affiliated with Kaiser Permanente.) Just lately, the Medicare Cost Advisory Fee (MedPAC) and others have raised questions on whether or not the bonus program consists of too many measures, doesn’t adequately account for social threat elements, and is probably not a helpful indicator of high quality for beneficiaries.

The total analyses can be found on-line and embrace:

(KFF has adjusted its methodology from earlier years to calculate the share of eligible Medicare beneficiaries enrolled in Medicare Benefit, which means they will need to have each Half A and B protection. This aligns with how the Medicare Cost Advisory Fee (MedPAC) and others describe this inhabitants. The share enrolled in Medicare Benefit can be considerably smaller utilizing the previous methodology. See the strategies part of the evaluation.)

For extra information and analyses about Medicare Benefit, go to

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