Slower Growth From June to July In Medicare Advantage

As noted, I decided to continue my Medicare Advantage (MA) monthly enrollment blogs because of continuing strong month-over-month increases. Admittedly, the continuing growth is tied to remaining strong benefit packages for 2024 and appears to be isolated to a few big plans. Month-over-month growth appears to be slowing a bit, but we are so close to the Fall open enrollment season that I will keep doing these monthly snapshots for those who like to track the data.

One new feature in the chart below: you may notice the percentage of MA enrollment against the total Medicare beneficiary population has changed slightly. That is because I stumbled upon a great Centers for Medicare and Medicaid Services (CMS) monthly Medicare enrollment site. It has both annual average enrollment as well as monthly enrollment. This goes all the way to the county level in each state. The site is here: https://data.cms.gov/summary-statistics-on-beneficiary-enrollment/medicare-and-medicaid-reports/medicare-monthly-enrollment . The good news is the website only lags a few months compared with others that lag as much as six months to a year.

For the purposes of the summary chart, I was using the CY 2023 average total Medicare enrollment to compute each monthly MA enrollment percentage. Because of the more granular data, I now am using the actual monthly Medicare enrollment total for each month to compute the MA enrollment percentage. The latest data for actual monthly Medicare enrollment is to Match 2024, so for April through June I am using the March 2024 figures. Of course, I am using the official MA monthly enrollment figures found here: https://www.cms.gov/data-research/statistics-trends-and-reports/medicare-advantagepart-d-contract-and-enrollment-data/monthly-enrollment-plan

As I said last month, many plans will rein in benefits and geographies for contract year 2025 due to significantly deteriorating bottom lines. This is being caused by the return of robust utilization, inflation picking up in the healthcare sector (especially at hospitals), poor Star scores, negative rate increases for 2024 and 2025, and new regulatory burdens (such as the new prior authorization restrictions).

But remember, CMS did recalculate 2024 Star scores for many contracts. There were several analyses. Those receiving higher scores ranged from 61 to 76 contracts, impacting 40 to 44 plans. The recent 2024 Star recalculation was precipitated by losses in court by CMS. CMS gave plans who obtained Star increases (and had 3 Stars or greater before the recalculation) a chance to refile bids and benefits for 2025. Some plans were reluctant to refile due to the quick deadlines, the negative financial position they are in, and uncertainty over what will occur for 2025 Star and rates in subsequent years. We will see if expected deterioration in benefits was mitigated sometime in October.

At any rate, let’s look at growth from June to July and growth so far this year. While we are outside of the two regular annual enrollment windows, increases in MA enrollment still occur given the aging of America and the ability of some populations, such as dual eligibles, to continue to make changes throughout the year. New enrollees see huge value in enrolling in MA over the traditional fee-for-service (FFS) program. Whatever the stinginess of benefits in 2025, this value difference will continue to drive growth in 2025, perhaps at lower growth trends.

As I have reported, growth from January 2023 to January 2024 was a robust 8.7% increase or 2.674 million. Enrollment in MA reached 30.799 million in January. Since that time, enrollment has continued to climb:

  • By about 183,000 from January 1 to February 1
  • By about 144,000 from February 1 to March 1
  • By about 86,000 from March 1 to April 1
  • By about 100,000 from April 1 to May 1.
  • By about 98,000 from May 1 to June 1.
  • By about 72,000 from June to July, about a 0.2% increase.

Enrollment in MA has now hit 34.155 million. The growth from January 1 to July 1 represents an additional approximate 2.0% increase or about 683,000 lives. MA enrollment has now increased to 50.84% of all Medicare beneficiaries. This is slightly below last month’s number due to the more recent total Medicare enrollment figures.

As we saw with January 2023 to January 2024, PPO growth now significantly outstrips HMO growth. From January 1 to July 1, HMOs grew by about 236,000, with PPOs growing about 442,000. HMOs grew about 23,000 from June to July, with PPOs growing about 49,000 in that timeframe.

Special Needs Plans (SNPs) continued to do very well too. After growing about 1.154 million from January 2023 to January 2024, SNPs grew by another approximate 240,000 from January to July. Enrollment grew by about 29,000 from June to July.

As was the case year-over-year, many of the Big MA plans continued to struggle. From June to July, again only CVS Health/Aetna and Humana scored major monthly gains.

From January to July, CVS Health/Aetna continued its powerhouse growth, with gains of about 383,000 members. This comes off a January 2023 to January 2024 growth of about 772,000. From January to July, CVS Health/Aetna has registered about 56% of all growth in the MA program. From June to July, CVS Health/Aetna added about 30,000 lives.

Humana has rebounded well from a poor open enrollment season. It has added about 126,000 lives from January to July, with almost 20,000 from June to July.

(Note: Molina’s growth is entirely from its acquisition of Bright Health MA lives in mid-January. Its enrollment would have contracted significantly otherwise.)

Both CVS Health/Aetna and Humana are expected to rein in benefits in 2025 due to financial pressures. CVS Health/Aetna says its overall enrollment could contract by about 10%.

One last point: the financial woes of the Big MA plans are not impacting their percentage of MA enrollment. In January 2023, Big MA plan enrollment was about 76.2%. As of July 2024, that number is 76.5%. CVS Health’s major enrollment in 2024, however, impacted these figures markedly. Let’s see what 2025 holds.

#medicareadvantage #enrollment #humana #cvshealth #aetna #snps

— Marc S. Ryan

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