Special Needs Plan enrollment booming
A quick blog to tell you about enrollment growth in Medicare Advantage (MA) from March 2025 to April 2025. As I told you in previous blogs this year, the Centers for Medicare and Medicaid Services (CMS) enrollment statistics were delayed, but we appear to be receiving the monthly uploads on time now. But I am writing later in the month because of all the activities going on in healthcare.
I told you that MA growth from 2024 to 2025 slowed down because of the financial woes of the MA industry. But the rolls are still growing due to aging and the popularity and value of MA compared with the archaic traditional Medicare (fee-for-service) program.
What do the latest statistics show?
As I have reported, growth from January 2024 to February 2025 was 4.39% or 1.468 million. (I used February 2025 because of issues with the January 2025 statistics). Enrollment in MA reached 34.941M in February 2025. In April 2025, it has reached 35.163M. MA enrollment grew about 95K from March to April and about 221K from February to April.
How did Big MA do?
From January 2024 to February 2025, Big Plan MA enrollment performed very poorly because of retrenchment among some of these plans. Big MA grew by about 780K or 3.1%. Big MA enrollment hit 26.348M. This compares with about 688K growth for all other MA plans, or 8.7% and 8.953M in February 2025. Big MA’s penetration dropped from 76.4% in January 2024 to 75.4% in February 2025. Big MA plans rebounded a bit from February to March, taking about 82% of overall enrollment gains. But from March to April, they fell off again, to about 67% of new enrollment. Still, from February to April, Big MA’s new enrollment is about 75.8% — its rough overall penetration.
United Healthcare grew by about 43K from March to April 2025 and about 138K since February. Humana continued its contraction, dropping by about 2K in April and about 29K since February. CVS grew by about 12K in April and about 22K since February. Centene dropped by about 2K in April and about 10K since February. Elevance Health was about flat in April but has shed about 30K since February.
In March, Cigna closed its sale of all of its Medicare assets, including its over 700K MA lives, to Health Care Service Corporation (HCSC). Even though CMS continued to show Cigna separately in the April file, I merged that enrollment into HCSC. As such, HCSC jumped from about 239K in March to 957K in April. It is now the 7th largest MA player.
Special Needs Plans chugging along
Special Needs Plans (SNPs) (including MMPs) continued to see a healthy increase in enrollment. From January 2024 to February 2025, SNPs grew to 7.553 million, a gain of about 646K or 9.35%. SNP enrollment grew about 264K in the enrollment season. But this growth is still down from the January 2023 to January 2024 period. In that period, SNPs added 1.154 million or 20.07%.
From February to March, SNPs added 33K more lives, or 0.4%. But SNPs added a phenomenal amount of enrollment in April – about 56K. In fact, about 59% of all enrollment from March to April went to SNPs.
PPOs vs. HMOs
Over the years, PPOs began growing and competing well with HMOs in terms of raw numbers as well as percentage growth. While PPOs’ sheer numbers and percentage growth were beating HMOs over the past several years, that trend changed from January 2024 to February 2025. From January 2023 to January 2024, HMOs grew about 853K (4.8%) and PPOs 1.861 million (14.8%). But from January 2024 to February 2025, HMOs grew more than PPOs in terms of numbers and percentage: HMOs up about 882K (4.7%) vs. PPOs up about 580K (4%). HMOs grew by about 480K during the enrollment season, while PPOs contracted by about 58K.
From February to March, PPOs had a bit of a rebound. PPOs grew 64K compared with 61K for HMOs. From March to April, the greater HMO trend returned – HMOs grew by about 64K compared with 31K for PPOs.
#medicareadvantage #enrollment #cms #healthplans #coverage
— Marc S. Ryan
