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Medicare Advantage Enrollment Growth Continued From January To February

In my January 22, 2024 Healthcare Labyrinth Blog ( ), I told you about the exciting news of Medicare Advantage’s (MA) continued strong growth (from January 2023 to January 2024) as well as a nice recovery from a bit of a sluggish increase from January 2022 to January 2023. As I always do, I publish short follow-up blogs in the first few months of each year given continuing growth outside of the main enrollment season of October 15 to December 7.

The key takeaways from the January 22, 2024 blog were:

  • MA has grown explosively this decade. Enrollment was up 9.54 million lives from January 2020 to January 2024, an almost 40% growth in four years. As of January 2024, enrollment in MA was 33.473 million.
  • MA hit the critical benchmark of enrolling over 50% of Medicare beneficiaries. This is earlier than both public and private estimates predicted. MA enrollment penetration grew almost one-third in four years.
  • Enrollment growth in both raw numbers and percentages slipped from January 2022 to January 2023. But the January 2023 to January 2024 numbers show a great rebound in both numbers and percentage growth.
  • Larger network Preferred Provider Organizations (PPOs) have taken over narrower network Health Maintenance Organizations (HMOs) as the growth engine. While HMO enrollment is still bigger, PPOs grew year over year by 1,860,908 or 14.84%. HMOs grew just 852,930 or 4.76%. PPOs are not only attractive in urban markets, but more importantly have helped MA penetrate into suburban and rural locales.
  • Special Needs Plans (SNPs) continued their phenomenal growth, increasing year over year by 1,154,422 or 20.07%.
  • Big Plan MA enrollment continues to dominate the program, but performance was mixed from January 2023 to January 2024. CVS’ Aetna had an amazing year and enrollment season. The biggest MA plans, United and Humana, had tough enrollment seasons, but still had good annual growth. Cigna and HCSC did reasonably well, while the others performed poorly.
  • Among prominent startups, Alignment Healthcare and Devoted Health did well.

So what happened with February enrollment?

A change over the past few years now allows all members enrolled in an MA plan to change to a different MA plan or go back to traditional Medicare (and also get a standalone Part D plan) between January 1 and March 31 of each year. Previously, an MA member could only return to original Medicare during this period. Because of this change, growth in the first three months of each year is greater than in the past. MA plans continue to advertise vigorously to attract additional members and there is net new enrollment because of people hitting age 65 each month. After March, enrollment will still grow (but at a lower rate) due to initial enrollments, special election periods, and for members who are allowed to enroll year-round (some dual eligibles and those who want to enter 5-Star plans).

What do the statistics show?

  • An additional 182,625 enrolled in MA from January to February. MA enrollment now stands at 33.655 million or about 50.7% of all Medicare beneficiaries.
  • PPOs again grew tremendously, picking up 149,674 new members in one month. HMOs grew by only 32,339 members. HMO and related is now just 55.8% of enrollment, while PPOs are now 43.2%. The remainder are in various pilots.
  • SNPs grew by another 22,790.
  • While Big MA Plans still have the biggest power, they continued to struggle from January to February. Discounting the purchase of the Bright Health lives by Molina that closed during the month of January, Big MA Plans grew by 109,906 of the total growth of 182,625. This is well below their normal share of growth.
  • CVS’ Aetna continued its phenomenal growth by adding 118,480 between January and February. Humana did reasonably well by growing 39,523. United Healthcare, Elevance Health, and Centene all lost some meaningful lives. Molina would have lost lives if not for the Bright Health lives acquisition. Others were relatively flat or slightly down.
  • If HCSC’s acquisition of the Cigna lives passes regulatory muster, that will catapult HCSC upward and make the Midwest Blue a much bigger player.

#medicareadvantage #enrollment

— Marc S. Ryan

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